Assessing Quality of Life after Traumatic Brain Injury: Examination of the Short Form 36 Health Survey

Abstract

Measuring health-related quality of life (HRQoL) has an important role in the comprehensive assessment of patient recovery following traumatic brain injury (TBI). We examined the validity of domain and summary scores derived from the Medical Outcomes Survey 36-Item Short Form Health Questionnaire (SF-36) as outcome measures for TBI in a prospective study of 514 patients with a range of functional impairment (Glasgow Outcome Scale-Extended [GOSE] scores 3-8). Item scaling criteria for the eight domain scores were tested and principal component analysis was used to examine if physical and mental component summary scores were valid. External validity was assessed by comparison with GOSE. Mean response, variance, and distribution of the items were largely equivalent, and item-own scale correlations corrected for overlap all exceeded the threshold for equivalent contribution to domain scores and convergent validity. All corrected item-own scale correlations were greater than the respective item-other correlations indicating no scaling failures, and reliability coefficients for the domain scores were high and substantially more than the inter-domain correlations. Overall, criteria for summing items into domain scores were satisfied, and there was a significant relationship of increasing score with more favorable GOSE class across all domains. However, there were floor and/or ceiling effects in four of the eight domains, and principal component analysis of the domain scores demonstrated only a unidimensional structure to the data. We conclude that individual SF-36 domain scores are valid measures of HRQoL in TBI patients, but that the physical and mental component summaries should be interpreted with caution.

Health-related quality of life after mild, moderate and severe traumatic brain injury: Patterns and predictors of suboptimal functioning during the first year after injury

“…The significant relationship of increasing scores with more favourable GOSE category across all SF-36 domains confirms results of earlier studies [8,36]. This study was the first to examine the relationship between GOSE and PQoL, which also showed a significant increase with higher GOSE categories.…”

“…The SF-36 is the most frequently used HRQL instrument in TBI and showed positive results for internal consistency and validity in a TBI population [36,37]. It is a 36-item questionnaire that covers eight domains of health status: physical functioning (PF), role limitations related to physical health problems (RP), bodily pain (BP), general health perception (GH), vitality (VT), social functioning (SF), role limitations related to emotional problems (RE), and mental health (MH) [38].…”

Relating Quality of Life to Glasgow Outcome Scale Health States

“…The annual direct and indirect monetary burden of TBI on the United States was estimated at $60 billion in 2000 (Finkelstein et al, 2006). Survivors of TBI have a reduced QOL, as assessed by multiple scales, including the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the Sickness Impact Profile and the General Health Questionnaire, the Life Satisfaction Inventory, and the newlydeveloped Quality of Life in TBI or QOLIBRI scale (Colantonio et al, 1998;Corrigan et al, 1998;Findler et al, 2001;Guilfoyle et al, 2010;Kinsella et al, 1989;Kreuter et al, 1998;O'Carroll et al, 1991;Paniak et al, 1999;Resch et al, 2009;Temkin et al 1988;Truelle et al, 2010). There has been a call for increased utilization of CER to improve these statistics, though such studies in the TBI field have heretofore been limited due to the lack of QOL values for comparing intermediate outcomes as described by the GOSE.…”

Amnésia pós-traumática e qualidade de vida pós-trauma

“…Therefore, knowing the duration of the PTA and its implications after the CTBI is of considerable clinical importance, as this helps in the planning and evaluation of rehabilitation programs and allows additional information to be provided to the family and patient regarding the post-trauma recovery. Another perspective suggests that the TBI affects the individual in the physical, cognitive and behavioral sphere, indicating the relevance of the evaluation of the QoL in the clinical monitoring of patients with this type of injury (4,6) .…”

“…Researchers have highlighted that the relationship between disability and social disadvantage is complex and the result of the use of objective measures of physical and mental functions which often correlate poorly with the individual perception of harm from the trauma, therefore they consider the measure of quality of life to be potentially better to express the post-trauma consequences (6) . In seeking to encompass the different consequences of the CTBI and to portray the result of their interaction, this study used the quality of life evaluation to characterize the consequences of the CTBI, since the physical, behavioral and cognitive impairments that occur as brain injury sequelae are capable of causing significant alterations in the life of the patient (4) .…”