Activating the ICF: integrating participatory and navigational agency into bio-psycho-social rehabilitation

The International Classification of Functioning, Disability and Health (ICF) offers a bio-psycho-social framework for understanding disability, yet its application in rehabilitation remains vulnerable to medical reductionism. This article argues that this tension reflects insufficient social-theoretical grounding of the Activity and Participation components, particularly concerning disabled persons’ agency. Through conceptual analysis, it integrates Rutger Claassen’s agency-based capability approach into the ICF. Within the proposed framework, Activity is linked to participatory agency: autonomous goal-setting and action within specific social practices. Participation is linked to navigational agency: the capacity to move between practices, negotiate competing demands, exit oppressive arrangements, and pursue structural reform. Distinguishing autonomy from freedom across internal capabilities and external opportunities provides an analytical basis for identifying constraints on agency. These distinctions inform a three-tier capability pathway comprising basic capabilities, participatory agency, and navigational agency. Illustrative analyses of acute and chronic rehabilitation show how the framework directs attention to patient-defined goals, meaningful choices, and structural barriers alongside functional restoration. It also clarifies the complementary roles of rehabilitation professionals, social workers, and peer support in expanding agency. The analysis emphasises that individual agency depends on enabling social conditions and collective action, rather than individual responsibility alone. By giving Activity and Participation explicit social-theoretical content, the framework offers a basis for connecting disability rights with rehabilitation practice and orienting rehabilitation towards disabled persons’ opportunities to pursue lives they value.