Spectrum of outcomes following traumatic brain injury—relationship between functional impairment and health-related quality of life

Abstract

BackgroundThe outcome following traumatic brain injury (TBI) is heterogeneous and poorly defined and physical disability scales like the extended Glasgow Outcome Score (GOSE) while providing valuation information in terms of broad categorisation of outcome are unlikely to capture the full spectrum of deficits. Quality of life questionnaires such as SF-36 are emerging as potential tools to help characterise factors important to patients’ recovery. This study assessed the association between physical disability and subjective health rating. The relationship is of value as it may help evaluate the impact of TBI on patients’ lives and facilitate the delivery of appropriate neuro-rehabilitation services.MethodsA single-centre retrospective study was undertaken to assess the relationship between physical outcome as measured by GOSE and quality of life captured by the SF-36 questionnaire. Cronbach’s alpha was calculated for each of the eight SF-36 domains to measure internal consistency of the test. Multivariate analysis of variance was conducted to look at the association between GOSE and the physical (PCS) and mental (MCS) component scores on the SF-36. Finally, we performed a generalised linear mixed model (GLMM) to assess the relative contribution of GOSE score, age at the time of trauma, sex and TBI duration towards MCS and PCS rating.ResultsThere is a statistically significant difference in the MCS and PCS scores based on patients’ GOSE scores. The mean scores of the eight SF-36 domains showed significant association with GOSE. GLMM demonstrated that GOSE was the strongest predictor of PCS and MCS. Age was an important variable in the PCS score while time following trauma was a significant predictor of MCS rating.ConclusionsThis study highlights that patients’ physical outcome following TBI is a strong predictor of the subjective mental and physical health. Nevertheless, there remains tremendous variability in individual SF-36 scores for each GOSE category, highlighting that additional factors play a role in determining quality of life.

Quality of life up to 10 years after traumatic brain injury: a cross-sectional analysis

“…Based on a close examination of the relative proportions of patients who underwent decompressive craniectomy and/or received ICP monitoring and/or a shunt device, 58 to 70% were either primarily or secondarily severe brain injured, thus our cohort is comparable to the QOLIBRI validation cohort [38]. Other factors regarding our cohort, including TBI etiology and sex distribution, were consistent with the literature [23,28,39].…”

Illustration of patient-reported outcome challenges and solutions in rare diseases: a systematic review in Cushing’s syndrome

“…Results indicate that neurocognitive functioning is impacted by CS and may affect HRQL. In other diseases, such as traumatic brain injury and multiples sclerosis, there is evidence of a moderate correlation between physical function and HRQoL, as the two dimensions are linked but not redundant [48, 49]. A PRO measure to assess neurocognitive functioning can be confounded by the degree of neurocognitive impairment the patient has experienced.…”

Mental Health and Family Functioning in Patients and Their Family Members after Traumatic Brain Injury: A Cross-Sectional Study

“…To form a more comprehensive picture of the challenges that families face after TBI, it is important to include the perspectives of both the patients and their family members [ 20 ]. Previous research has demonstrated that personal, familial, and social characteristics and injury severity affect HRQL, disease burden, and family adjustment after TBI [ 21 , 22 , 23 ]. However, there is a paucity of knowledge on mental health and family functioning related to the consequences of TBI, which include the impact on these outcomes for members within the same family system.…”