Associations Among Decisional Autonomy, Fatigue, Pain, and Well-Being in Long-Term Physical Disability

• Published in: Rehabilitation psychology 2019-08, Vol.64 (3), p.288-297
• Main Authors: Teshale, Salom M., Molton, Ivan R., Jensen, Mark P.
• Format: Article
• Language: English
• Subjects: Aging; Autonomy; Decision Making; Disabled Persons - psychology; Disabled Persons - rehabilitation; Disabled Persons - statistics & numerical data; Fatigue; Fatigue - complications; Fatigue - psychology; Female; Human; Humans; Longitudinal Studies; Male; Middle Aged; Pain; Pain - complications; Pain - psychology; Personal Autonomy; Physical Disorders; Quality of Life; Quality of Life - psychology; Social Support; Well Being
• ISSN: 0090-5550; 1939-1544
• DOI: 10.1037/rep0000279

Objective: Decisional autonomy-or sense of one's ability to make independent choices about one's life-is especially relevant to individuals who may feel their autonomy is limited due to physical challenges. Past work has found associations between measures of autonomy and quality of life (QoL) in individuals with disability and in older adults. However, it is less clear how decisional autonomy influences the impact of pain and fatigue severity on QoL, especially in adults aging with physical disability. This study examined the relationship of decisional autonomy to QoL and the extent to which autonomy moderates the association between symptom severity and QoL. Method: We used hierarchical linear regression models to examine the associations between autonomy, pain and fatigue, and quality of life in a sample of individuals with long-term disability. In 2 sets of models, we examined individuals reporting some level of fatigue (n = 1,060, Mage = 62.66, SD = 11.88) and some level of pain (n = 964, Mage = 62.79, SD = 11.69). Results: We found that decisional autonomy significantly predicted QoL over and above other measures related to social participation. Decisional autonomy also weakly moderated the associations between fatigue and QoL and the associations between pain and QoL. Conclusions: The findings indicate that levels of decisional autonomy may be important to QoL in individuals aging with physical limitations. Impact and Implications The findings add to the literature by indicating the possibility that increasing decisional autonomy may help individuals with long-term disability increase well-being, potentially through improved management of symptoms such as pain and fatigue. This work provides a basis for further research that examines the role of choice and decisional autonomy in maintaining quality of life for individuals aging with long-term physical disability. The findings also suggest that in working with adults aging with long-term disability, a focus on choice and decisional autonomy may be another method to improve well-being.