Self-perceived health care needs and delivery of health care services 5 years after moderate-to-severe traumatic brain injury

Nada Andelic; Helene L Soberg; Svein Berntsen; Solrun Sigurdardottir; Cecilie Roe

doi:10.1016/j.pmrj.2014.05.005

Self-perceived health care needs and delivery of health care services 5 years after moderate-to-severe traumatic brain injury

PM R. 2014 Nov;6(11):1013-21; quiz 1021. doi: 10.1016/j.pmrj.2014.05.005. Epub 2014 May 15.

Authors

Nada Andelic¹, Helene L Soberg², Svein Berntsen³, Solrun Sigurdardottir⁴, Cecilie Roe⁵

Affiliations

¹ Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway.∗; Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway†. Electronic address: nandelic@online.no.
² Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway.∗; Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway†
³ Department of Physical Medicine and Rehabilitation, Sørlandet Hospital, Kristiansand, Norway‡
⁴ Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway†; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway§
⁵ Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway.∗; Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway||

PMID: 24844444
DOI: 10.1016/j.pmrj.2014.05.005

Abstract

Objective: To describe the self-perceived health care needs of patients with moderate-to-severe traumatic brain injury (TBI) and to assess the impact of the functional level at 1 year after injury on patients' unmet needs at the 5-year follow-up.

Design: A prospective follow-up study.

Setting: Clinical research.

Participants: A total of 93 patients participated in the 5-year follow-up.

Methods: We registered demographic and injury-related data at the time of admission and the scores for the Disability Rating Scale, Glasgow Outcome Scale-Extended, and Short Form 36 subscales for physical functioning and mental health at 1 and 5 years. The patients' self-perceived health care needs and use of health care services at 5 years were the main outcome measurements.

Results: At the 5-year follow-up, 70% of patients reported at least 1 perceived need. The self-perceived health care needs were met for 39% of the patients. The patients with unmet needs (n = 29 [31%]) reported frequent needs in emotional (65%), vocational (62%), and cognitive (58%) domains. These patients were significantly more likely to present a less severe disability on the Disability Rating Scale at the 1-year follow-up (odds ratio [OR] 0.11 [95% confidence interval {CI}, 0.02-0.7]; P = .02). Worse mental health at the 1-year follow-up and a younger age (16-29 years) largely predicted unmet needs at the 5-year follow-up (OR 3.28 [95% CI, 1.1-10.04], P = .04; and OR 4.93 [95% CI, 0.16-15.2], P = .005, respectively).

Conclusion: Gaps between self-perceived health care needs and health care services received at the 5-year follow-up were found. An important message to clinicians who provide health care services in the late TBI phase is that they should be aware of patients' long-term needs regarding cognitive and emotional difficulties. Of equal importance is an emphasis on long-term vocational rehabilitation services. To ensure the appropriateness of health care service delivery, health care services after TBI should be better targeted at less-severe TBI population as well.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Brain Injuries / diagnosis
Brain Injuries / rehabilitation*
Disabled Persons / rehabilitation*
Female
Follow-Up Studies
Glasgow Outcome Scale
Health Services Needs and Demand / statistics & numerical data*
Humans
Male
Mental Health*
Prospective Studies
Quality of Life*
Self Concept*
Time Factors
Trauma Severity Indices
Young Adult