Disability and quality of life 20 years after traumatic brain injury

Nada Andelic; Emilie I Howe; Torgeir Hellstrøm; Maria Fernandez Sanchez; Juan Lu; Marianne Løvstad; Cecilie Røe

doi:10.1002/brb3.1018

Disability and quality of life 20 years after traumatic brain injury

Brain Behav. 2018 Jul;8(7):e01018. doi: 10.1002/brb3.1018. Epub 2018 Jun 11.

Authors

Nada Andelic^{1

2}, Emilie I Howe^{1

3}, Torgeir Hellstrøm¹, Maria Fernandez Sanchez⁴, Juan Lu^{2

5}, Marianne Løvstad^{6

7}, Cecilie Røe^{1

3}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway.
² Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁴ Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Salamanca, Spain.
⁵ Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
⁶ Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
⁷ Department of Psychology, University of Oslo, Oslo, Norway.

Abstract

Objectives: The study describes functional outcomes and health-related quality of life (HRQL) in patients with traumatic brain injury (TBI) 20 years postinjury.

Materials and methods: Forty-four survivors who acquired moderate and severe TBI during 1995-1996 were followed 10 and 20 years postinjury. Outcomes were Glasgow Outcome Scale Extended (GOSE), Community Integration Questionnaire (CIQ), and SF-36 questionnaire (SF-36). Multiple regressions were performed to examine the relationship between follow-up measurements, controlling for baseline demographics and injury severity.

Results: There were no significant differences in baseline age and civil status between moderate and severe TBI, but patients with severe injury had significantly lower employment rates (p = 0.05). Mean age at 20-years follow-up was 50.8 (SD 11.4) years, and 73% were males. Most patients showed good recovery (52%) or moderate disability (43%). Disability levels remained stable between and within severity groups from 10 to 20 years. Community integration including social integration improved from 10 to 20 years (p = 0.01 and p = 0.005, respectively). HRQL remained stable, except for subscales Bodily Pain and Role Emotional (p = 0.02 and p = 0.06). Depression at 10 years and females were associated with poorer mental health, while productive activity at 10 years indicated better physical and mental health at 20 years postinjury, respectively.

Conclusions: Functional limitations persist even decades after moderate and severe TBI, with poorer prognosis for females and persons who were depressed at the 10-year follow-up. Development and evaluation of targeted long-term follow-up programs and access to rehabilitation services for these groups should be highlighted. Improved community integration despite stable functional limitations draws attention to long-term adaptation to adversity and illness.

Keywords: functional outcomes; long-term follow-up; quality of life; traumatic brain injury.

MeSH terms

Activities of Daily Living
Adult
Brain Injuries, Traumatic / complications*
Depressive Disorder / etiology
Disabled Persons / statistics & numerical data*
Emotions
Female
Follow-Up Studies
Glasgow Outcome Scale
Humans
Male
Middle Aged
Musculoskeletal Pain / etiology
Quality of Life*
Surveys and Questionnaires
Young Adult