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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.
Injury. 2015 Apr; 46(4):616-24.I

Abstract

BACKGROUND

The Glasgow Outcome Scale Extended (GOSE) is the established functional outcome scale to assess disability following traumatic brain injury (TBI), however does not capture the patient's subjective perspective. Health-related quality of life (HRQL) does capture the individual's perception of disability after TBI, and has therefore been recognized as an important outcome in TBI. In contrast to GOSE, HRQL enables comparison of health outcome across various disease states and with healthy individuals. We aimed to assess functional outcome, HRQL, recovery, and predictors of 6 and 12-month outcome in a comprehensive sample of patients with mild, moderate or severe TBI, and to examine the relationship between functional impairment (GOSE) and HRQL.

METHODS

A prospective cohort study was conducted among a sample of 2066 adult TBI patients who attended the emergency department (ED). GOSE was determined through questionnaires or structured interviews. Questionnaires 6 and 12 months after ED treatment included socio-demographic information and HRQL measured with Short-Form Health Survey (SF-36; reflecting physical, mental and social functioning) and Perceived Quality of Life Scale (PQoL; measuring degree of satisfaction with functioning).

RESULTS

996 TBI survivors with mild, moderate or severe TBI completed the 6-month questionnaire. Functional outcome and HRQL after moderate or severe TBI was significantly lower than after mild TBI. Patients with moderate TBI showed greatest improvement. After one year, the mild TBI group reached outcomes comparable to population norms. TBI of all severities highly affected SF-36 domains physical and social functioning, and physical and emotional role functioning. GOSE scores were highly related to all SF-36 domains and PQoL scores. Female gender, older age, co-morbidity and high ISS were strongest independent predictors of decreased HRQL at 6 and 12 months after TBI.

CONCLUSIONS

HRQL and recovery patterns differ for mild, moderate and severe TBI. This study indicates that GOSE, although clinically relevant, fails to capture the subjective perspective of TBI patients, which endorses the use of HRQL as valuable addition to established instruments in assessing disability following TBI. Influence of TBI severity on recovery, together with female gender, older age, co-morbidity and high ISS should be considered in long-term follow-up and intervention programs.

Authors+Show Affiliations

Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: a.scholten@erasmusmc.nl.Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.Department of Neurology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.Department of Neurology, Slingeland Hospital, PO Box 169, 7000 AD Doetinchem, The Netherlands.Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25476014

Citation

Scholten, A C., et al. "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." Injury, vol. 46, no. 4, 2015, pp. 616-24.
Scholten AC, Haagsma JA, Andriessen TM, et al. 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. Injury. 2015;46(4):616-24.
Scholten, A. C., Haagsma, J. A., Andriessen, T. M., Vos, P. E., Steyerberg, E. W., van Beeck, E. F., & Polinder, S. (2015). 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. Injury, 46(4), 616-24. https://doi.org/10.1016/j.injury.2014.10.064
Scholten AC, et al. 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. Injury. 2015;46(4):616-24. PubMed PMID: 25476014.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Scholten,A C, AU - Haagsma,J A, AU - Andriessen,T M J C, AU - Vos,P E, AU - Steyerberg,E W, AU - van Beeck,E F, AU - Polinder,S, Y1 - 2014/11/04/ PY - 2014/06/10/received PY - 2014/10/15/revised PY - 2014/10/26/accepted PY - 2014/12/6/entrez PY - 2014/12/6/pubmed PY - 2016/1/1/medline KW - Follow-up studies KW - Glasgow outcome scale-extended KW - Health-related quality of life KW - SF-36 KW - Traumatic brain injury SP - 616 EP - 24 JF - Injury JO - Injury VL - 46 IS - 4 N2 - BACKGROUND: The Glasgow Outcome Scale Extended (GOSE) is the established functional outcome scale to assess disability following traumatic brain injury (TBI), however does not capture the patient's subjective perspective. Health-related quality of life (HRQL) does capture the individual's perception of disability after TBI, and has therefore been recognized as an important outcome in TBI. In contrast to GOSE, HRQL enables comparison of health outcome across various disease states and with healthy individuals. We aimed to assess functional outcome, HRQL, recovery, and predictors of 6 and 12-month outcome in a comprehensive sample of patients with mild, moderate or severe TBI, and to examine the relationship between functional impairment (GOSE) and HRQL. METHODS: A prospective cohort study was conducted among a sample of 2066 adult TBI patients who attended the emergency department (ED). GOSE was determined through questionnaires or structured interviews. Questionnaires 6 and 12 months after ED treatment included socio-demographic information and HRQL measured with Short-Form Health Survey (SF-36; reflecting physical, mental and social functioning) and Perceived Quality of Life Scale (PQoL; measuring degree of satisfaction with functioning). RESULTS: 996 TBI survivors with mild, moderate or severe TBI completed the 6-month questionnaire. Functional outcome and HRQL after moderate or severe TBI was significantly lower than after mild TBI. Patients with moderate TBI showed greatest improvement. After one year, the mild TBI group reached outcomes comparable to population norms. TBI of all severities highly affected SF-36 domains physical and social functioning, and physical and emotional role functioning. GOSE scores were highly related to all SF-36 domains and PQoL scores. Female gender, older age, co-morbidity and high ISS were strongest independent predictors of decreased HRQL at 6 and 12 months after TBI. CONCLUSIONS: HRQL and recovery patterns differ for mild, moderate and severe TBI. This study indicates that GOSE, although clinically relevant, fails to capture the subjective perspective of TBI patients, which endorses the use of HRQL as valuable addition to established instruments in assessing disability following TBI. Influence of TBI severity on recovery, together with female gender, older age, co-morbidity and high ISS should be considered in long-term follow-up and intervention programs. SN - 1879-0267 UR - https://www.unboundmedicine.com/medline/citation/25476014/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-1383(14)00549-X DB - PRIME DP - Unbound Medicine ER -