Is independence enough? Rehabilitation should include autonomy and social engagement to achieve quality of life

Abstract

Purpose: This discussion paper argues that holding independence as the central goal for rehabilitation has limitations that hinder successful outcomes. It shows why autonomy and social engagement should also serve as goals of rehabilitation, in order to achieve quality of life and effective functioning. Methods: The paper reviews problems arising from the over-emphasis on independence in rehabilitation. Although independence is a valuable goal on some tasks, it is sometimes not possible or desirable and is best complimented by autonomy and social engagement. Autonomy recognises that enacting some goals requires the support of other people. Autonomy is thus linked to social engagement (connectivity) in the workplace and personal relationships. The paper applies this framework to motor and cognitive disabilities. Results: The inclusion of autonomy and social engagement as goals for rehabilitation addresses the limitations of independence and can serve the unifying aim of enhancing the person’s quality of life. These goals apply equally to motor disabilities and the cognitive and behavioural effects of injuries which affect personal and work relationships. Conclusions: Rehabilitation is likely to be more effective if it aims at a combination of independence, autonomy and social engagement, in service of the goal of a good quality of life.

Measures of self-regulation used in adult rehabilitation populations: A systematic review and content screening

“…Medical rehabilitation treatment contributes to this adaptation and helps preventing, reducing and eliminating limitations caused by this health condition. 1,2 Research has shown that effective rehabilitation consists of two types of intervention: (1) exercise, and (2) self-management and education. 1 Interventions in self-management and education include gaining knowledge about the condition, about consequences of this condition, and learning skills in order to deal with them.…”

“…1,2 Research has shown that effective rehabilitation consists of two types of intervention: (1) exercise, and (2) self-management and education. 1 Interventions in self-management and education include gaining knowledge about the condition, about consequences of this condition, and learning skills in order to deal with them. 1 The overall aim of rehabilitation is to improve a person's self-regulation, societal participation, and health-related quality of life (HRQoL).…”

“…1 Interventions in self-management and education include gaining knowledge about the condition, about consequences of this condition, and learning skills in order to deal with them. 1 The overall aim of rehabilitation is to improve a person's selfregulation, societal participation, and health-related quality of life (HRQoL). 3 Self-regulation is a complex concept with diverging definitions and meanings for different target populations.…”

Perceived Support Needs of School-Aged Young People on the Autism Spectrum and Their Caregivers

“…Globally, there has been a societal shift towards focusing health, disability and education supports to go beyond decreasing symptoms and dependence and towards optimizing participation and engagement in important life situations [ 6 , 7 , 8 ]. Arguably, the most influential conceptual framework introduced to assist interprofessional stakeholders across sectors to make this transition is the International Classification of Functioning, Disability and Health (ICF [ 7 ]).…”

The Lived Experience of Interdependence: Support Worker Relationships and Implications for Wider Rehabilitation

“…Indeed, for many people following impairment, whether due to compromised cognitive, social or physical function, exercising autonomy is not through 'doing' the act unassisted, but through participating in interactive relationships with support workers, challenging the traditional view in rehabilitation of pursuing independent, unassisted, autonomy (Gibson, 2014;McClure & Leah, 2020). Such relationships extend beyond a transactional nature and are characterised by a number of subtle and complex characteristics.…”