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O'Neil-Pirozzi TM, Sevigny M, Pinto SM, Hammond FM, Juengst SB. 10-year variability in high and low life satisfaction trajectories post-traumatic brain injury: a TBI model systems study. Brain Inj 2024; 38:796-806. [PMID: 38682889 DOI: 10.1080/02699052.2024.2347567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE To determine how life satisfaction changes across the first 10 years following traumatic brain injury (TBI). METHODS Participants included 1,941 individuals from the TBI Model Systems database with life satisfaction data at 1-, 5-, and 10-years post-TBI. Based on Satisfaction With Life Scale scores, individuals were characterized as having one of the five 10-year life satisfaction trajectories: 'Stable High,' 'Stable Low,' 'Increased to High,' 'Decreased to Low,' and 'Unstable.' These were analyzed for group differences in demographics and psychosocial and functional outcomes. RESULTS Sixty percent participants had 'Stable High' or 'Increasing to High' trajectories. Approximately 25% had "Stable Low' or 'Decreasing to Low' trajectories, and approximately 15% had unstable trajectories. Higher life satisfaction trajectories were associated with the best psychosocial and functional outcomes whereas lower trajectories were associated with the worst psychosocial and functional outcomes. Trajectories were indistinguishable based on demographics. CONCLUSION Life satisfaction over the first 10 years following TBI is dynamic, with most individuals reporting high life satisfaction by 10 years post-TBI. Examination of psychosocial and functional factors related to life satisfaction trajectories may inform community-based intervention recommendations, resources, and supports to maximize long-term satisfaction with life.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - Mitch Sevigny
- Research Department, Craig Hospital, Denver, Colorado
| | - Shanti M Pinto
- Department of Physical Medicine and Rehabilitation; O'Donnell Brain Institute Clinical Neuroscience Scholar, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Flora M Hammond
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine; Rehabilitation Hospital of Indiana, Indianapolis, Indiana
| | - Shannon B Juengst
- Brain Injury Research Center, TIRR Memorial Hermann; Department of Physical Medicine & Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas
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2
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Mutlucan UO, Orhun Ö, Özcan-Ekşi EE, Ekşi MŞ, Uçar T. Health-related quality of life measures in patients undergoing decompressive craniectomy for severe traumatic brain injury: a 6-year follow-up analysis. Int J Neurosci 2024:1-9. [PMID: 38446112 DOI: 10.1080/00207454.2024.2327400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/02/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE We aimed to assess the long-term neurological outcomes and the functionality and QoL in patients undergoing decompressive craniectomy for severe traumatic brain injury, respectively. MATERIALS AND METHODS Among the 120 patients who underwent decompressive craniectomy for severe TBI between 2002 and 2007, 101 were included based on the inclusion criteria. Long-term follow-up results (minimum 3 years) were available for 22 patients. The outcomes were assessed using the Glasgow Outcome Scale (GOS) and the functionality and HRQoL were assessed using the Short Form-36 (SF-36) (v2) and Quality of Life After Brain Injury (QoLIBRI) questionnaires. RESULTS Among the patients with severe TBI, 62 (61.4%) died and 39 (38.6%) were discharged to either home or a physical therapy facility. Eleven of the thirty-nine patients could not be reached and were excluded from the final analysis. The mean GOS of the remaining 28 patients was 4.14 ± 0.8 after 6.46 ± 1.64 years of follow-up. The HRQoL was assessed in 22 of the 28 patients. The HRQoL scores were lower in patients with TBI than in healthy controls. Furthermore, there was a significant difference in the HRQoL scores in patients with improved GOS scores than in those with unimproved GOS scores. CONCLUSIONS Health-related outcome scores could help clinicians understand the requirements of survivors of severe TBI to create a realistic rehabilitation target for them. QoLIBRI served as a good way of communication in these subjects.
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Affiliation(s)
- Umut Ogün Mutlucan
- Department of Neurosurgery, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ömer Orhun
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Physical Medicine and Rehabilitation Unit, Acıbadem Bağdat Caddesi Medical Center, Istanbul, Turkey
| | - Murat Şakir Ekşi
- Department of Neurosurgery, School of Medicine, Health Sciences University, Istanbul, Turkey
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Tanju Uçar
- Department of Neurosurgery, Akdeniz University, School of Medicine, Antalya, Turkey
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3
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Renne A, Proaño-Zamudio JA, Pinkes N, Sanchez SE, Velmahos GC, Salim A, Herrera-Escobar JP, Hwabejire JO. Loss of independence after traumatic injury: A patient-centered study. Surgery 2023; 174:1021-1025. [PMID: 37517894 DOI: 10.1016/j.surg.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/23/2023] [Accepted: 06/18/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Patient-reported outcomes of postdischarge functional status can provide insight into patient recovery experiences not typically reflected in trauma registries. Injuries may be characterized by a long-term loss of independence. We sought to examine factors predictive of patient-reported, postdischarge loss of independence in trauma patients. METHODS Trauma patients admitted to 1 of 3 level I trauma centers were contacted by phone between 6 to 12 months after hospital discharge to complete the Revised Trauma Quality of Life survey. Loss of independence was defined as a new need for assistance with at least one activity of daily living or transition to living in an institutional setting. Patients with severe traumatic brain injury or spinal cord injury were excluded. Multivariable logistic regression analyses were performed to identify predictors of loss of independence. RESULTS 801 patients were included. The median age was 65 (interquartile range: 46-76) years, 46.1% were female, and the median Injury Severity Score was 9 (interquartile range: 9-13). Two hundred seventy-one patients (33.8%) experienced a loss of independence, most commonly requiring assistance walking up stairs. The main predictors of loss of independence were persistent daily pain (odds ratio: 3.83, 95% confidence interval: [2.90-5.04], P < .001), length of hospital stay (odds ratio: 1.04, 95% confidence interval: [1.01-1.09], P = .021) and income below the national median (odds ratio: 1.46, 95% confidence interval: [1.12-1.91], P = .006). Perceived social support (odds ratio: 0.75, 95% confidence interval: [0.66-0.85], P < .001) was protective against loss of independence. CONCLUSION Injury is associated with a relatively high rate of long-term loss of independence. Ensuring adequate social support systems for patients postdischarge may help them regain functional independence after injury.
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Affiliation(s)
- Angela Renne
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. https://www.twitter.com/Jefferson
| | - Nathaniel Pinkes
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Sabrina E Sanchez
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Ali Salim
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Juan Pablo Herrera-Escobar
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.
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4
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Carlson JM, Lin DJ. Prognostication in Prolonged and Chronic Disorders of Consciousness. Semin Neurol 2023; 43:744-757. [PMID: 37758177 DOI: 10.1055/s-0043-1775792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Patients with prolonged disorders of consciousness (DOCs) longer than 28 days may continue to make significant gains and achieve functional recovery. Occasionally, this recovery trajectory may extend past 3 (for nontraumatic etiologies) and 12 months (for traumatic etiologies) into the chronic period. Prognosis is influenced by several factors including state of DOC, etiology, and demographics. There are several testing modalities that may aid prognostication under active investigation including electroencephalography, functional and anatomic magnetic resonance imaging, and event-related potentials. At this time, only one treatment (amantadine) has been routinely recommended to improve functional recovery in prolonged DOC. Given that some patients with prolonged or chronic DOC have the potential to recover both consciousness and functional status, it is important for neurologists experienced in prognostication to remain involved in their care.
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Affiliation(s)
- Julia M Carlson
- Division of Neurocritical Care, Department of Neurology, University of North Carolina Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Division of Neurocritical Care and Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Neurorestoration and Neurotechnology, Rehabilitation Research and Development Service, Department of Veterans Affairs, Providence, Rhode Island
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5
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Elser H, Gottesman RF, Walter AE, Coresh J, Diaz-Arrastia R, Mosley TH, Schneider ALC. Head Injury and Long-term Mortality Risk in Community-Dwelling Adults. JAMA Neurol 2023; 80:260-269. [PMID: 36689218 PMCID: PMC9871946 DOI: 10.1001/jamaneurol.2022.5024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/18/2022] [Indexed: 01/24/2023]
Abstract
Importance Head injury is associated with significant short-term morbidity and mortality. Research regarding the implications of head injury for long-term survival in community-dwelling adults remains limited. Objective To evaluate the association of head injury with long-term all-cause mortality risk among community-dwelling adults, with consideration of head injury frequency and severity. Design, Setting, and Participants This cohort study included participants with and without head injury in the Atherosclerosis Risk in Communities (ARIC) study, an ongoing prospective cohort study with follow-up from 1987 through 2019 in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of 15 792 ARIC participants initially enrolled, 1957 were ineligible due to self-reported head injury at baseline; 103 participants not of Black or White race and Black participants at the Minnesota and Maryland field centers were excluded due to race-site aliasing; and an additional 695 participants with missing head injury date or covariate data were excluded, resulting in 13 037 eligible participants. Exposures Head injury frequency and severity, as defined via self-report in response to interview questions and via hospital-based International Classification of Diseases diagnostic codes (with head injury severity defined in the subset of head injury cases identified using these codes). Head injury was analyzed as a time-varying exposure. Main Outcomes and Measures All-cause mortality was ascertained via linkage to the National Death Index. Data were analyzed between August 5, 2021, and October 23, 2022. Results More than one-half of participants were female (57.7%; 42.3% men), 27.9% were Black (72.1% White), and the median age at baseline was 54 years (IQR, 49-59 years). Median follow-up time was 27.0 years (IQR, 17.6-30.5 years). Head injuries occurred among 2402 participants (18.4%), most of which were classified as mild. The hazard ratio (HR) for all-cause mortality among individuals with head injury was 1.99 (95% CI, 1.88-2.11) compared with those with no head injury, with evidence of a dose-dependent association with head injury frequency (1 head injury: HR, 1.66 [95% CI, 1.56-1.77]; 2 or more head injuries: HR, 2.11 [95% CI, 1.89-2.37]) and severity (mild: HR, 2.16 [95% CI, 2.01-2.31]; moderate, severe, or penetrating: HR, 2.87 [95% CI, 2.55-3.22]). Estimates were similar by sex and race, with attenuated associations among individuals aged 54 years or older at baseline. Conclusions and Relevance In this community-based cohort with more than 3 decades of longitudinal follow-up, head injury was associated with decreased long-term survival time in a dose-dependent manner, underscoring the importance of measures aimed at prevention and clinical interventions to reduce morbidity and mortality due to head injury.
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Affiliation(s)
- Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Alexa E. Walter
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ramon Diaz-Arrastia
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - Thomas H. Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson
| | - Andrea L. C. Schneider
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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6
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Pasipanodya EC, Teranishi R, Dirlikov B, Duong T, Huie H. Characterizing Profiles of TBI Severity: Predictors of Functional Outcomes and Well-Being. J Head Trauma Rehabil 2023; 38:E65-E78. [PMID: 35617636 DOI: 10.1097/htr.0000000000000791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To identify profiles of acute traumatic brain injury (TBI) severity and relate profiles to functional and well-being outcomes. SETTING Acute inpatient rehabilitation and general community settings. PARTICIPANTS Three hundred and seventy-nine individuals with moderate-severe TBI participating in the Traumatic Brain Injury Model Systems. DESIGN Longitudinal observational study. MAIN MEASURES At discharge-length of stay, Functional Independence Measure (FIM), and Disability Rating Scale (DRS). One-year post-injury-Glasgow Outcome Scale-Extended (GOS-E), FIM, and Satisfaction with Life Scale (SWLS). RESULTS Latent profile analysis (LPA) was used to identify subgroups with similar patterns across 12 indicators of acute injury severity, including duration of posttraumatic amnesia, Glasgow Coma Scale, time to follow commands, and head CT variables. LPA identified 4 latent classes, least to most severe TBI (Class 1: n = 75, 20.3%; Class 2: n = 124, 33.5%; Class 3: n = 144, 38.9%; Class 4: n = 27, 7.3%); younger age, lower education, rural residence, injury in motor vehicle accidents, and earlier injury years were associated with worse acute severity. Latent classes were related to outcomes. Compared with Class 1, hospital stays were longer, FIM scores lower, and DRS scores larger at discharge among individuals in Class 3 and Class 4 (all P s < .01). One-year post-injury, GOS-E and FIM scores were significantly lower among individuals in Class 3 and Class 4 than those in Class 1 ( P s < .01). SWLS scores were lower only among individuals in Class 3 ( P = .036) compared with Class 1; other comparisons relative to Class 1 were not significant. CONCLUSIONS Meaningful profiles of TBI severity can be identified from acute injury characteristics and may suggest etiologies, like injury in motor vehicle accidents, and premorbid characteristics, including younger age, rural residence, and lower education, that heighten risk for worse injuries. Improving classification may help focus on those at elevated risk for severe injury and inform clinical management and prognosis.
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Affiliation(s)
- Elizabeth C Pasipanodya
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California (Dr Pasipanodya and Mr Dirlikov); Department of Physical Medicine and Rehabilitation, Atrium Health Carolinas Rehabilitation, Charlotte, North Carolina (Dr Teranishi); and Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California (Drs Duong and Huie)
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7
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Gidda R, Bandyopadhyay S, Peter N, Lakhoo K. Decompressive Craniectomy for Pediatric Traumatic Brain Injury in Low-and-Middle Income and High Income Countries. World Neurosurg 2022; 166:251-260.e1. [PMID: 35872132 DOI: 10.1016/j.wneu.2022.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
Traumatic brain injury is one of the leading causes of mortality and morbidity in children worldwide. In severe cases, high intracranial pressure is the most frequent cause of death. When first-line medical management fails, the neurosurgical procedure of decompressive craniectomy (DC) has been proposed for controlling intracranial pressure and improving the long-term outcomes for children with severe traumatic brain injury. However, the use of this procedure is controversial. The evidence from clinical trials shows some promise for the use of DC as an effective second-line treatment. However, it is limited by conflicting trial results, a lack of trials, and a high risk of bias. Furthermore, most research comes from retrospective observational studies and case series. This narrative review considers the strength of evidence for the use of DC in both a high income country and low-and-middle income country setting and examine how we can improve study design to better assess the efficacy of this procedure and increase the clinical translatability of results to centers worldwide. Specifically, we argue for a need for further studies with higher pediatric participant numbers, multicenter collaboration, and the use of a more consistent methodology to enable comparability of results among settings.
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Affiliation(s)
- Ryan Gidda
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
| | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Noel Peter
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Kokila Lakhoo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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8
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Bernstein JPK, Fonda J, Currao A, Kim S, Milberg WP, McGlinchey RE, Fortier CB. Post-traumatic stress disorder and depression are uniquely associated with disability and life dissatisfaction in post-9/11 veterans. Psychiatry Res 2022; 313:114589. [PMID: 35533471 DOI: 10.1016/j.psychres.2022.114589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 02/09/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2022]
Abstract
Veterans who served in post-9/11 conflicts and experience deployment trauma sequelae frequently endorse disability and dissatisfaction with life. Although correlated, disability and life dissatisfaction represent distinct constructs with separate implications for quality of life. We examined associations between deployment trauma sequelae, disability and life dissatisfaction in 288 post-9/11 Veterans. Participants completed assessments of psychiatric, somatic and social functioning. Self-reports evaluating disability and life dissatisfaction were used to group participants based on established criteria (i.e., Disability and Dissatisfaction, Disability Only, Dissatisfaction Only, or No Disability or Dissatisfaction). Multinomial logistic regressions revealed that greater post-traumatic stress disorder (PTSD) and depressive symptom severity were independently associated with increased odds of being in the Disability and Dissatisfaction group, the Disability Only group and the Dissatisfaction Only group, relative to the No Disability or Dissatisfaction group. Number of prior mild traumatic brain injuries (mTBI) was not associated with disability or dissatisfaction after accounting for other trauma sequelae. Social support attenuated the relationship between depression and membership in the Disability and Dissatisfaction group. Participants who reported greater dissatisfaction than disability endorsed greater depression and mTBI frequency. Overall, PTSD and depression convey a heightened risk of both disability and life dissatisfaction, while social support may be protective.
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Affiliation(s)
- John P K Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States.
| | - Jennifer Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Alyssa Currao
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States
| | - Sahra Kim
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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9
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Retel Helmrich IRA, van Klaveren D, Andelic N, Lingsma H, Maas A, Menon D, Polinder S, Røe C, Steyerberg EW, Van Veen E, Wilson L. Discrepancy between disability and reported well-being after traumatic brain injury. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-326615. [PMID: 35537823 PMCID: PMC9279746 DOI: 10.1136/jnnp-2021-326615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Following traumatic brain injury (TBI), the clinical focus is often on disability. However, patients' perceptions of well-being can be discordant with their disability level, referred to as the 'disability paradox'. We aimed to examine the relationship between disability and health-related quality of life (HRQoL) following TBI, while taking variation in personal, injury-related and environment factors into account. METHODS We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. Disability was assessed 6 months post-injury by the Glasgow Outcome Scale-Extended (GOSE). HRQoL was assessed by the SF-12v2 physical and mental component summary scores and the Quality of Life after Traumatic Brain Injury overall scale. We examined mean total and domain HRQoL scores by GOSE. We quantified variance in HRQoL explained by GOSE, personal, injury-related and environment factors with multivariable regression. RESULTS Six-month outcome assessments were completed in 2075 patients, of whom 78% had mild TBI (Glasgow Coma Scale 13-15). Patients with severe disability had higher HRQoL than expected on the basis of GOSE alone, particularly after mild TBI. Up to 50% of patients with severe disability reported HRQoL scores within the normative range. GOSE, personal, injury-related and environment factors explained a limited amount of variance in HRQoL (up to 29%). CONCLUSION Contrary to the idea that discrepancies are unusual, many patients with poor functional outcomes reported well-being that was at or above the boundary considered satisfactory for the normative sample. These findings challenge the idea that satisfactory HRQoL in patients with disability should be described as 'paradoxical' and question common views of what constitutes 'unfavourable' outcome.
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Affiliation(s)
| | - David van Klaveren
- Department of Public Health, Center for Medical Decision Making, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies/Tufts Medical Center, Boston, Massachusetts, USA
| | - Nada Andelic
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Department of Health and Society, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Hester Lingsma
- Department of Public Health, Center for Medical Decision Making, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Andrew Maas
- Department of Neurosurgery, University Hospital Antwerp, Edegem, Antwerp, Belgium
| | - David Menon
- Division of Anaesthesia, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Cecilie Røe
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Department of Health and Society, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Ewout W Steyerberg
- Department of Public Health, Center for Medical Decision Making, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Ernest Van Veen
- Department of Public Health, Center for Medical Decision Making, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
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10
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Young MJ, Bodien YG, Giacino JT, Fins JJ, Truog RD, Hochberg LR, Edlow BL. The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain 2021; 144:3291-3310. [PMID: 34347037 PMCID: PMC8883802 DOI: 10.1093/brain/awab290] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 07/10/2021] [Indexed: 11/12/2022] Open
Abstract
Neuroethical questions raised by recent advances in the diagnosis and treatment of disorders of consciousness are rapidly expanding, increasingly relevant and yet underexplored. The aim of this thematic review is to provide a clinically applicable framework for understanding the current taxonomy of disorders of consciousness and to propose an approach to identifying and critically evaluating actionable neuroethical issues that are frequently encountered in research and clinical care for this vulnerable population. Increased awareness of these issues and clarity about opportunities for optimizing ethically responsible care in this domain are especially timely given recent surges in critically ill patients with prolonged disorders of consciousness associated with coronavirus disease 2019 around the world. We begin with an overview of the field of neuroethics: what it is, its history and evolution in the context of biomedical ethics at large. We then explore nomenclature used in disorders of consciousness, covering categories proposed by the American Academy of Neurology, the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research, including definitions of terms such as coma, the vegetative state, unresponsive wakefulness syndrome, minimally conscious state, covert consciousness and the confusional state. We discuss why these definitions matter, and why there has been such evolution in this nosology over the years, from Jennett and Plum in 1972 to the Multi-Society Task Force in 1994, the Aspen Working Group in 2002 and the 2018 American and 2020 European Disorders of Consciousness guidelines. We then move to a discussion of clinical aspects of disorders of consciousness, the natural history of recovery and ethical issues that arise within the context of caring for people with disorders of consciousness. We conclude with a discussion of key challenges associated with assessing residual consciousness in disorders of consciousness, potential solutions and future directions, including integration of crucial disability rights perspectives.
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Affiliation(s)
- Michael J Young
- Center for Neurotechnology and Neurorecovery,
Department of Neurology, Massachusetts General Hospital, Harvard Medical
School, Boston, MA 02114, USA
- Edmond J. Safra Center for Ethics, Harvard
University, Cambridge, MA 02138, USA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery,
Department of Neurology, Massachusetts General Hospital, Harvard Medical
School, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation,
Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA
02129, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation,
Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA
02129, USA
| | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical
College, New York, NY 10021, USA
- Yale Law School, New Haven,
Connecticut 06511, USA
| | - Robert D Truog
- Center for Bioethics, Harvard Medical
School, Boston, MA 02115, USA
| | - Leigh R Hochberg
- Center for Neurotechnology and Neurorecovery,
Department of Neurology, Massachusetts General Hospital, Harvard Medical
School, Boston, MA 02114, USA
- School of Engineering and Carney Institute for Brain
Science, Brown University, Providence, RI 02906, USA
- VA RR&D Center for Neurorestoration and
Neurotechnology, Department of Veterans Affairs Medical Center,
Providence, RI 02908, USA
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery,
Department of Neurology, Massachusetts General Hospital, Harvard Medical
School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging,
Massachusetts General Hospital, Charlestown, MA 02129, USA
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11
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Abstract
Disorders of consciousness (DOC) continue to profoundly challenge both families and medical professionals. Once a brain-injured patient has been stabilized, questions turn to the prospect of recovery. However, what “recovery” means in the context of patients with prolonged DOC is not always clear. Failure to recognize potential differences of interpretation—and the assumptions about the relationship between health and well-being that underlie these differences—can inhibit communication between surrogate decisionmakers and a patient’s clinical team, and make it difficult to establish the goals of care. The authors examine the relationship between health and well-being as it pertains to patients with prolonged DOC. They argue that changes in awareness or other function should not be equated to changes in well-being, in the absence of a clear understanding of the constituents of well-being for that particular patient. The authors further maintain that a comprehensive conception of recovery for patients with prolonged DOC should incorporate aspects of both experienced well-being and evaluative well-being.
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12
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Vallat-Azouvi C, Swaenepoël M, Ruet A, Bayen E, Ghout I, Nelson G, Pradat-Diehl P, Meaude L, Aegerter P, Charanton J, Jourdan C, Azouvi P. Relationships between neuropsychological impairments and functional outcome eight years after severe traumatic brain injury: Results from the PariS-TBI study. Brain Inj 2021; 35:1001-1010. [PMID: 34283665 DOI: 10.1080/02699052.2021.1933180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVES The objective was to assess the relationships between neuropsychological impairments, functional outcome and life satisfaction in a longitudinal study of patients after a severe traumatic brain injury (TBI) (PariS-TBI study). PATIENTS Out of 243 survivors, 86 were evaluated 8 years post-injury. They did not significantly differ from patients lost-to-follow up except for the latter being more frequently students or unemployed before the injury. METHODS Outcome measures included the Glasgow Outcome Scale-Extended (GOS-E), a functional independence questionnaire, employment, mood, fatigue and satisfaction with life. Neuropsychological outcome was assessed by two ways: performance-based outcome measures, using neuropsychological tests and patient and relative-based measures. RESULTS Neuropsychological measures were not significantly related to initial injury severity nor to gender, but were significantly related to age and education. After statistical correction for multiple comparisons, cognitive testing and cognitive questionnaires were significantly correlated with most outcome measures. By contrast, satisfaction with life was only related with patient-rated questionnaires. A regression analysis showed that the Trail-Making-Test-A was the best predictor of functional outcome, in addition to education duration. CONCLUSIONS Cognitive measures, particularly slowed information processing speed, were significant indicators of functional outcome at a long-term post-injury, beyond and above demographics or injury severity measures.
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Affiliation(s)
- Claire Vallat-Azouvi
- UR Fonctionnement et Dysfonctionnement Cognitifs : les âges de la vie (DYSCO), Université Paris 8-Saint-Denis, Saint-Denis, France.,Antenne UEROS- UGECAM IDF, Hôpital Raymond Poincaré, Garches, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Swaenepoël
- Antenne UEROS- UGECAM IDF, Hôpital Raymond Poincaré, Garches, France
| | - Alexis Ruet
- Centre Hospitalier Universitaire De Caen, Service De Médecine Physique Et De Réadaptation, Caen, France
| | - Eleonore Bayen
- Assistance Publique-Hôpitaux De Paris, Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Physique Et Réadaptation, Paris, and Paris Sorbonne Université, Paris, France
| | - Idir Ghout
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - Gaelle Nelson
- Centre Ressources Francilien Du Traumatisme Crânien (CRFTC), Paris, France
| | - Pascale Pradat-Diehl
- Assistance Publique-Hôpitaux De Paris, Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Physique Et Réadaptation, Paris, and Paris Sorbonne Université, Paris, France
| | - Layide Meaude
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - Philippe Aegerter
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - James Charanton
- Centre Ressources Francilien Du Traumatisme Crânien (CRFTC), Paris, France
| | - Claire Jourdan
- Centre Hospitalier Universitaire De Montpellier, Service De Médecine Physique Et De Réadaptation, Montpellier, France
| | - Philippe Azouvi
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France.,Assistance Publique-Hôpitaux De Paris, Hôpital Raymond Poincaré, Service De Médecine Physique Et De Réadaptation, Garches, France
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13
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Agtarap SD, Campbell-Sills L, Jain S, Sun X, Dikmen S, Levin H, McCrea MA, Mukherjee P, Nelson LD, Temkin N, Yuh EL, Giacino JT, Manley GT, Stein MB. Satisfaction with Life after Mild Traumatic Brain Injury: A TRACK-TBI Study. J Neurotrauma 2020; 38:546-554. [PMID: 33107371 DOI: 10.1089/neu.2020.7055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Identifying the principal determinants of life satisfaction following mild TBI (mTBI) may inform efforts to improve subjective well-being in this population. We examined life satisfaction among participants in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study who presented with mTBI (Glasgow Coma Scale [GCS] score = 13-15; n = 1152). An L1-regularization path algorithm was used to select optimal sets of baseline and concurrent symptom measures for prediction of scores on the Satisfaction with Life Scale (SWLS) at 2 weeks and 3, 6, and 12 months post-injury. Multi-variable linear regression models (all n = 744-894) were then fit to evaluate associations between the empirically selected predictors and SWLS scores at each follow-up visit. Results indicated that emotional post-TBI symptoms (all b = -1.27 to -0.77, all p < 0.05), anhedonia (all b = -1.59 to -1.08, all p < 0.01), and pain interference (all b = -1.38 to -0.89, all p < 0.001) contributed to the prediction of lower SWLS scores at all follow-ups. Insomnia predicted lower SWLS scores at 2 weeks, 3 months, and 6 months (all b = -1.11 to -0.83, all ps < 0.01); and negative affect predicted lower SWLS scores at 2 weeks, 3 months, and 12 months (all b = -1.38 to -0.80, all p < 0.005). Other post-TBI symptom domains and baseline socio-demographic, injury-related, and clinical characteristics did not emerge as robust predictors of SWLS scores during the year after mTBI. Efforts to improve satisfaction with life following mTBI may benefit from a focus on the detection and treatment of affective symptoms, pain, and insomnia. The results reinforce the need for tailoring of evidence-based treatments for these conditions to maximize efficacy in patients with mTBI.
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Affiliation(s)
- Stephanie D Agtarap
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Michael A McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Bioengineering and Therapeutic Services, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nancy Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington, USA
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Bioengineering and Therapeutic Services, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA.,Psychiatry Service, VA San Diego Healthcare System, San Diego, California, USA
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14
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A Comparison of Satisfaction With Life and the Glasgow Outcome Scale-Extended After Traumatic Brain Injury: An Analysis of the TRACK-TBI Pilot Study. J Head Trauma Rehabil 2020; 34:E10-E17. [PMID: 30499935 DOI: 10.1097/htr.0000000000000457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the relationship between satisfaction with life (SWL) and functional outcome after traumatic brain injury (TBI). SETTING AND PARTICIPANTS The Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study (TRACK-TBI Pilot) enrolled patients at 3 US Level I trauma centers within 24 hours of TBI. DESIGN Patients were grouped by outcome measure concordance (good-recovery/good-satisfaction, impaired-recovery/impaired-satisfaction) and discordance (good-recovery/impaired-satisfaction, impaired-recovery/good-satisfaction). Logistic regression was utilized to determine predictors of discordance. MAIN MEASURES Functional outcome: Glasgow Outcome Scale-Extended (GOSE); SWL: Satisfaction with Life Scale (SWLS). RESULTS Of the 586 enrolled subjects, 298 had completed both outcome measures at 6-month follow-up; the correlation between GOSE and SWLS was 0.380. Patients with impaired-recovery (GOSE < 7)/impaired-satisfaction (SWLS < 20) were more likely to have mild TBI (83% vs 62%, P = .012), baseline depression (42% vs 15%, P < .0001), and 6-month depression (59% vs 21%, P < .0001) when compared with patients with impaired-recovery/good-satisfaction. Patients with good-recovery/impaired-satisfaction were more likely to have baseline depression (31% vs 13%, P < .0001) and 6-month depression (33% vs 6%, P < .0001) compared with good-recovery/good-satisfaction. CONCLUSION Correlation between SWL and functional outcome was not strong, and depression may modulate the association. Future research should account for functional, mental health, and patient-centered outcomes when assessing TBI recovery.
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15
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Bradley SE, Haun J, Powell-Cope G, Haire S, Belanger HG. Qualitative assessment of the use of a smart phone application to manage post-concussion symptoms in Veterans with traumatic brain injury. Brain Inj 2020; 34:1031-1038. [DOI: 10.1080/02699052.2020.1771770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sarah E. Bradley
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Jolie Haun
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Gail Powell-Cope
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Sharon Haire
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Heather G. Belanger
- Defense and Veterans Brain Injury Center (DVBIC), United States Special Operations Command, Tampa, Florida, USA
- Departments of Psychology, and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
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16
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Vos L, Poritz JMP, Ngan E, Leon-Novelo L, Sherer M. The relationship between resilience, emotional distress, and community participation outcomes following traumatic brain injury. Brain Inj 2019; 33:1615-1623. [PMID: 31456432 DOI: 10.1080/02699052.2019.1658132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose/Objective: To determine how resilience is associated with social participation outcomes in persons with traumatic brain injury (TBI), in the context of emotional distress, demographics, and injury-related factors.Setting: Individuals with a history of TBI recruited the following stay at three rehabilitation facilities in the USA.Participants: 201 community-dwelling persons with medically documented TBI ranging in severity from mild to severe.Design: Prospective cohort observational study. Data were collected at two time points, approximately 6 months apart.Main Measures: TBI-QOL; PART-OResults: Resilience at baseline was moderately to strongly correlated with baseline psychological distress variables (rs= -.66) and social participation variables (rs =.33 to.57). In regression analyses, resilience was directly associated with social participation outcomes and formed a significant interaction with emotional distress in some models. Resilience failed to show a relationship with social participation at 6-month follow-up, when controlling for baseline social participation.Conclusions: Though related to emotional distress, self-reported resilience makes a unique contribution to predicting outcomes over time following brain injury, and may impact the relationship between stress and negative participation outcomes. As such, it is possible interventions that promote resilience may mitigate distress and promote community integration.
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Affiliation(s)
- Leia Vos
- TIRR Memorial Hermann, Brain Injury Research Center.,Neuropsychology, Zablocki VA Medical Center, Milwaukee, WI, USA.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, USA
| | | | - Esther Ngan
- School of Public Health, Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston
| | - Luis Leon-Novelo
- School of Public Health, Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston
| | - Mark Sherer
- TIRR Memorial Hermann, Brain Injury Research Center.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, USA
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17
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Predictors of Satisfaction With Life in Veterans After Traumatic Brain Injury: A VA TBI Model Systems Study. J Head Trauma Rehabil 2018; 32:255-263. [PMID: 28520659 DOI: 10.1097/htr.0000000000000309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To identify predictors of satisfaction with life in Veterans 1 year after traumatic brain injury (TBI). SETTING The VA TBI Model Systems (TBIMS) project includes 5 Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS Veterans enrolled in the VA TBIMS study who completed the Satisfaction With Life Scale at year 1 follow-up. The sample is largely male (96%) and Caucasian (72%), with a median age of 27 years upon enrollment. DESIGN Prospective observational cohort study measuring including demographics (eg, education), preinjury variables (eg, mental health history and employment), and military variables (eg, injury during deployment and injury during active duty status). MAIN OUTCOME MEASURE Satisfaction With Life Scale. RESULTS Multivariate regression analyses revealed that age, marital status, preinjury employment status, preinjury mental health history, and active duty status at the time of injury were significant predictors of life satisfaction at year 1 follow-up. CONCLUSIONS Results of this study suggest that satisfaction with life in Veterans with TBI is mediated by several factors that might inform rehabilitation interventions and discharge recommendations. Preinjury variables and active duty status (a unique aspect of the Veteran population) influence life satisfaction at 1 year postinjury. Limitations and future clinical implications will be discussed.
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18
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Groswasser Z, Peled I, Ross S, Truelle JL, Von Steinbüchel N. Validation of the QOLIBRI - Quality of Life after Brain Injury questionnaire in patients after TBI in Israel. Brain Inj 2018; 32:879-888. [PMID: 29688070 DOI: 10.1080/02699052.2018.1466196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The QOLIBRI - Quality of Life after Brain Injury questionnaire was developed by the QOLIBRI Task Force (QTF). Our goal was to investigate the applicability, validity and reliability of the QOLIBRI in Israel. METHODS Validation of the Hebrew questionnaire was performed after it had been administered to 128 adults with traumatic brain injury (TBI), who were between 3 months' and 15 years' post-discharge from rehabilitation. RESULTS The internal consistency of the QOLIBRI subscales with the QOLIBRI Total scale was high (Cronbach's α = 0.92); the same was true regarding the correlations between each QOLIBRI subscale and its own items (α = 0.92-0.95). Significant and high Pearson's and Spearman's correlations of the QOLIBRI subscales with demographic and clinical characteristics of the GOSE, ADL, HADS, SF-36, and various aspects of self-reported health status were found. Factor analyses (FA) were applied to confirm the validity of the Hebrew version, using the maximum likelihood method. The six subscales explained 100% of the variance. CONCLUSION The Hebrew version of the QOLIBRI was found to be useful, meaningful and meeting psychometric criteria in persons after TBI in Israel. The findings support the cross-cultural applicability of the QOLIBRI, regardless of cultural and social differences.
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Affiliation(s)
- Zeev Groswasser
- a TBI Research Unit, Loewenstein Rehabilitation Hospital, Raanana, Clalit Health Services, and Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Israela Peled
- a TBI Research Unit, Loewenstein Rehabilitation Hospital, Raanana, Clalit Health Services, and Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Sharon Ross
- a TBI Research Unit, Loewenstein Rehabilitation Hospital, Raanana, Clalit Health Services, and Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Jean-Luc Truelle
- b Service de Medicine physique et réadaption , C.H.U. Raymond-Poincaré , Garches , France
| | - Nicole Von Steinbüchel
- c Department of Medical Psychology -and Medical Sociology , Georg-August University , Göttingen , Germany
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19
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Ditchman N, Sung C, Easton AB, Johnson KS, Batchos E. Symptom severity and life satisfaction in brain injury: The mediating role of disability acceptance and social self-efficacy. NeuroRehabilitation 2018; 40:531-543. [PMID: 28211823 DOI: 10.3233/nre-171440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although the negative impact of symptom severity on subjective well-being outcomes has been established among individuals with brain injury, the mediating and protective role that positive human traits might have on this relationship has not been adequately explored. OBJECTIVE The purpose of this study was to examine the impact of social self-efficacy and disability acceptance on the relationship between symptom severity and life satisfaction among individuals with brain injury. METHODS Hierarchical regression analysis and correlation techniques were used to test a hypothesized dual-mediation model of life satisfaction in a sample of 105 adults with acquired brain injury. RESULTS Results indicated that social self-efficacy and disability acceptance fully mediated the relationship between symptom severity and life satisfaction, lending support for a dual-mediation model with disability acceptance being the strongest contributor. CONCLUSIONS These findings suggest there may be considerable value for rehabilitation providers to develop strengths-based service strategies and/or specialized intervention programs that focus on capitalizing these positive human traits to promote life satisfaction and well-being for clients with brain injury. Implications for clinical practice and future research direction are also discussed.
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Affiliation(s)
- Nicole Ditchman
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Connie Sung
- Department of Counseling, Educational Psychology and Special Education, Michigan State University, East Lansing, MI, USA
| | - Amanda B Easton
- Department of Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ, USA
| | - Kristina S Johnson
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Elisabeth Batchos
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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20
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Vallat-Azouvi C, Paillat C, Bercovici S, Morin B, Paquereau J, Charanton J, Ghout I, Azouvi P. Subjective complaints after acquired brain injury: presentation of the Brain Injury Complaint Questionnaire (BICoQ). J Neurosci Res 2017; 96:601-611. [PMID: 28976025 DOI: 10.1002/jnr.24180] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 01/09/2023]
Abstract
The objective of the present study was to present a new complaint questionnaire designed to assess a wide range of difficulties commonly reported by patients with acquired brain injury. Patients (n = 619) had been referred to a community re-entry service at a chronic stage after brain injury, mainly traumatic brain injury (TBI). The Brain Injury Complaint Questionnaire (BICoQ) includes 25 questions in the following domains: cognition, behavior, fatigue and sleep, mood, and somatic problems. A self and a proxy questionnaire were given. An additional question was given to the relative, about the patient's awareness of his difficulties. The questionnaires had a good internal coherence, as measured with Cronbach's alpha. The most frequent complaints were, in decreasing order, mental slowness, memory troubles, fatigue, concentration difficulties, anxiety, and dual tasking problems. Principal component analysis with varimax rotation yielded six underlying factors explaining 50.5% of total variance: somatic concerns, cognition, and lack of drive, lack of control, psycholinguistic disorders, mood, and mental fatigue/slowness. About 52% of patients reported fewer complaints than their proxy, suggesting lack of awareness. The total complaint scores were not significantly correlated with any injury severity measure, but were significantly correlated with disability and poorer quality of life (Note: only factor 2 [cognition/lack of drive] was significantly related to disability.) The BICoQ is a simple scale that can be used in addition to traditional clinical and cognitive assessment measures, and to assess awareness of everyday life problems.
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Affiliation(s)
- Claire Vallat-Azouvi
- Laboratoire de Psychopathologie et Neuropsychologie, EA 2027, Université Paris 8, Saint-Denis, France.,Antenne UEROS-UGECAMIF, Hôpital Raymond Poincaré, Garches
| | | | | | | | - Julie Paquereau
- Antenne UEROS-UGECAMIF, Hôpital Raymond Poincaré, Garches.,Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches
| | - James Charanton
- Centre Ressource Francilien du Traumatisme Crânien (CRFTC), Paris
| | - Idir Ghout
- APHP - Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne
| | - Philippe Azouvi
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches.,EA 4047 HANDIReSP, Université de Versailles Saint-Quentin
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21
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van Delft-Schreurs CCHM, van Son MAC, de Jongh MAC, Lansink KWW, de Vries J, Verhofstad MHJ. The relationship between physical and psychological complaints and quality of life in severely injured patients. Injury 2017; 48:1978-1984. [PMID: 28551050 DOI: 10.1016/j.injury.2017.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/21/2017] [Accepted: 05/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was two-fold. The first goal was to investigate which variables were associated with the remaining physical limitations of severely injured patients after the initial rehabilitation phase. Second, we investigated whether physical limitations were attributable to the association between psychological complaints and quality of life in this patient group. METHODS Patients who were 18 years or older and who had an injury severity score (ISS)>15 completed a set of questionnaires at one time-point after their rehabilitation phase (15-53 months after their trauma). The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to determine physical limitations. The Hospital Anxiety and Depression Scale, the Dutch Impact of Event Scale and the Cognitive Failure Questionnaire were used to determine psychological complaints, and the World Health Organization Quality of Life assessment instrument-BREF was used to measure general Quality of Life (QOL). Differences in physical limitations were investigated for several trauma- and patient-related variables using non-parametric independent-sample Mann-Whitney U tests. Multiple linear regression was performed to investigate whether the decreased QOL of severely injured patients with psychological complaints could be explained by their physical limitations. RESULTS Older patients, patients with physical complaints before the injury, patients with higher ISS scores, and patients who had an injury of the spine or of the lower extremities reported significantly more physical problems. Additionally, patients with a low education level, patients who were living alone, and those who were unemployed reported significantly more long-term physical problems. Severely injured patients without psychological complaints reported significantly less physical limitations than those with psychological complaints. The SMFA factor of Lower extremity dysfunction was a confounder of the association between psychological complaints and QOL in all QOL domains. CONCLUSIONS Long-term physical limitations were mainly reported by patients with psychological complaints. The decreased QOL of severely injured patients with psychological complaints can partially be explained by physical limitations, particularly those involving lower extremity function. Experienced physical limitations were significantly different for some trauma and patient characteristics. These characteristics may be used to select patients for whom a rehabilitation programme would be useful.
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Affiliation(s)
| | - M A C van Son
- The Netherlands Society of Occupational Medicine-Centre of Excellence, The Netherlands.
| | - M A C de Jongh
- Network Emergency Care Brabant, Elisabeth-TweeSteden Hospital, The Netherlands.
| | - K W W Lansink
- Network Emergency Care Brabant, Elisabeth-TweeSteden Hospital, The Netherlands; Department of Surgery, Elisabeth-TweeSteden Hospital, The Netherlands.
| | - J de Vries
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital, The Netherlands; CoRPS, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands.
| | - M H J Verhofstad
- Department of Trauma Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
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22
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Grimm OTR LA. Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-Related Quality of Life in a Case-Study. ACTA ACUST UNITED AC 2017. [DOI: 10.15406/ijcam.2017.08.00247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Reciprocal Causation Between Functional Independence and Mental Health 1 and 2 Years After Traumatic Brain Injury. Am J Phys Med Rehabil 2017; 96:374-380. [DOI: 10.1097/phm.0000000000000644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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24
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von Steinbüchel N, Real RGL, Sasse N, Wilson L, Otto C, Mullins R, Behr R, Deinsberger W, Martinez-Olivera R, Puschendorf W, Petereit W, Rohde V, Schmidt H, Sehmisch S, Stürmer KM, von Wild K, Gibbons H. German validation of Quality of Life after Brain Injury (QOLIBRI) assessment and associated factors. PLoS One 2017; 12:e0176668. [PMID: 28542226 PMCID: PMC5443488 DOI: 10.1371/journal.pone.0176668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 04/12/2017] [Indexed: 01/07/2023] Open
Abstract
The consequences of traumatic brain injury (TBI) for health-related quality of life (HRQoL) are still poorly understood, and no TBI-specific instrument has hitherto been available. This paper describes in detail the psychometrics and validity of the German version of an internationally developed, self-rated HRQoL tool after TBI-the QOLIBRI (Quality of Life after Brain Injury). Factors associated with HRQoL, such as the impact of cognitive status and awareness, are specifically reported. One-hundred seventy-two participants after TBI were recruited from the records of acute clinics, most of whom having a Glasgow Coma Scale (GCS) 24-hour worst score and a Glasgow Outcome Scale (GOSE) score. Participants had severe (24%), moderate (11%) and mild (56%) injuries as assessed on the GCS, 3 months to 15 years post-injury. The QOLIBRI uses 37 items to measure "satisfaction" in the areas of "Cognition", "Self", "Daily Life and Autonomy", and "Social Relationships", and "feeling bothered" by "Emotions"and "Physical Problems". The scales meet standard psychometric criteria (α = .84 to .96; intra-class correlation-ICC = .72 to .91). ICCs (0.68 to 0.90) and αs (.83 to .96) were also good in a subgroup of participants with lower cognitive performance. The six-subscale structure of the international sample was reproduced for the German version using confirmatory factor analyses and Rasch analysis. Scale validity was supported by systematic relationships observed between the QOLIBRI and the GOSE, Patient Competency Rating Scale for Neurorehabilitation (PCRS-NR), Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Short Form 36 (SF-36), and Satisfaction with Life Scale (SWLS). The German QOLIBRI contains novel information not provided by other currently available measures and has good psychometric criteria. It is potentially useful for clinicians and researchers, in post-acute and rehabilitation studies, on a group and individual level.
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Affiliation(s)
- Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Ruben G. L. Real
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Nadine Sasse
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Lindsay Wilson
- Department of Psychology, University of Stirling, Stirling, United Kingdom
| | - Christiane Otto
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Ryan Mullins
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Robert Behr
- Department of Neurosurgery, Clinical Center Fulda, Fulda, Germany
| | | | - Ramon Martinez-Olivera
- Department of Neurosurgery & Neurotraumatology at Bergmannsheil University Hospital Bochum, Bochum, Germany
| | | | - Werner Petereit
- Department of Neurosurgery, Clinical Center Bernburg, Bernburg, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany
| | - Holger Schmidt
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Stephan Sehmisch
- Trauma surgery, plastic and reconstructive surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Klaus Michael Stürmer
- Trauma surgery, plastic and reconstructive surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Henning Gibbons
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Department of Psychology, University of Bonn, Bonn, Germany
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Quality of life in persons after traumatic brain injury as self-perceived and as perceived by the caregivers. Neurol Sci 2016; 38:279-286. [DOI: 10.1007/s10072-016-2755-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
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Azouvi P, Ghout I, Bayen E, Darnoux E, Azerad S, Ruet A, Vallat-Azouvi C, Pradat-Diehl P, Aegerter P, Charanton J, Jourdan C. Disability and health-related quality-of-life 4 years after a severe traumatic brain injury: A structural equation modelling analysis. Brain Inj 2016; 30:1665-1671. [DOI: 10.1080/02699052.2016.1201593] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Philippe Azouvi
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France
- EA 4047 HANDIReSP, Université de Versailles, Saint-Quentin, France
| | - Idir Ghout
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
| | - Eleonore Bayen
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation, Paris, France Université Pierre et Marie Curie, Paris, France
| | - Emmanuelle Darnoux
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France
| | - Sylvie Azerad
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
| | - Alexis Ruet
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France
- EA 4047 HANDIReSP, Université de Versailles, Saint-Quentin, France
| | - Claire Vallat-Azouvi
- EA 4047 HANDIReSP, Université de Versailles, Saint-Quentin, France
- Antenne UEROS-SAMSAH 92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France
| | - Pascale Pradat-Diehl
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation, Paris, France Université Pierre et Marie Curie, Paris, France
| | - Philippe Aegerter
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France
| | - James Charanton
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France
| | - Claire Jourdan
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France
- EA 4047 HANDIReSP, Université de Versailles, Saint-Quentin, France
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Rosengren L, Brogårdh C, Jacobsson L, Lexell J. Life satisfaction and associated factors in persons with mild to moderate Parkinson’s disease. NeuroRehabilitation 2016; 39:285-94. [DOI: 10.3233/nre-161359] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Lina Rosengren
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Physiotherapy Research Group, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Lars Jacobsson
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
- Department of Health Science, Luleå University of Technology, Luleå, Sweden
- Department of Rehabilitation Medicine, Sunderby Hospital, Luleå, Sweden
| | - Jan Lexell
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
- Department of Health Science, Luleå University of Technology, Luleå, Sweden
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McMillan T, Wilson L, Ponsford J, Levin H, Teasdale G, Bond M. The Glasgow Outcome Scale - 40 years of application and refinement. Nat Rev Neurol 2016; 12:477-85. [PMID: 27418377 DOI: 10.1038/nrneurol.2016.89] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Glasgow Outcome Scale (GOS) was first published in 1975 by Bryan Jennett and Michael Bond. With over 4,000 citations to the original paper, it is the most highly cited outcome measure in studies of brain injury and the second most-cited paper in clinical neurosurgery. The original GOS and the subsequently developed extended GOS (GOSE) are recommended by several national bodies as the outcome measure for major trauma and for head injury. The enduring appeal of the GOS is linked to its simplicity, short administration time, reliability and validity, stability, flexibility of administration (face-to-face, over the telephone and by post), cost-free availability and ease of access. These benefits apply to other derivatives of the scale, including the Glasgow Outcome at Discharge Scale (GODS) and the GOS paediatric revision. The GOS was devised to provide an overview of outcome and to focus on social recovery. Since the initial development of the GOS, there has been an increasing focus on the multidimensional nature of outcome after head injury. This Review charts the development of the GOS, its refinement and usage over the past 40 years, and considers its current and future roles in developing an understanding of brain injury.
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Affiliation(s)
- Tom McMillan
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 8RZ, UK
| | - Lindsay Wilson
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Victoria 3800, Australia
| | - Harvey Levin
- Department of Physical Medicine &Rehabilitation, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA
| | - Graham Teasdale
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 8RZ, UK
| | - Michael Bond
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 8RZ, UK
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Jourdan C, Bayen E, Pradat-Diehl P, Ghout I, Darnoux E, Azerad S, Vallat-Azouvi C, Charanton J, Aegerter P, Ruet A, Azouvi P. A comprehensive picture of 4-year outcome of severe brain injuries. Results from the PariS-TBI study. Ann Phys Rehabil Med 2016; 59:100-6. [DOI: 10.1016/j.rehab.2015.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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Juengst SB, Adams LM, Bogner JA, Arenth PM, O’Neil-Pirozzi TM, Dreer LE, Hart T, Bergquist TF, Bombardier CH, Dijkers MP, Wagner AK. Trajectories of life satisfaction after traumatic brain injury: Influence of life roles, age, cognitive disability, and depressive symptoms. Rehabil Psychol 2015; 60:353-364. [PMID: 26618215 PMCID: PMC4667543 DOI: 10.1037/rep0000056] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES (a) Identify life satisfaction trajectories after moderate to severe traumatic brain injury (TBI); (b) establish a predictive model for these trajectories across the first 5 years postinjury; and (c) describe differences in these life satisfaction trajectory groups, focusing on age, depressive symptoms, disability, and participation in specific life roles. RESEARCH METHOD Analysis of the longitudinal TBI Model Systems National Database was performed on data collected prospectively at 1-, 2-, and 5-years post-TBI. Participants (n = 3,012) had a moderate to severe TBI and were 16 years old and older. RESULTS Four life satisfaction trajectories were identified across the first 5 years postinjury, including: stable satisfaction, initial satisfaction declining, initial dissatisfaction improving, and stable dissatisfaction. Age, depressive symptoms, cognitive disability, and life role participation as a worker, leisure participant, and/ or religious participant at 1-year postinjury significantly predicted trajectory group membership. Life role participation and depressive symptoms were strong predictors of life satisfaction trajectories across the first 5 years post-TBI. CONCLUSIONS The previously documented loss of life roles and prevalence of depression after a moderate to severe TBI make this a vulnerable population for whom low or declining life satisfaction is a particularly high risk. Examining individual life role participation may help to identify relevant foci for community-based rehabilitation interventions or supports.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Leah M. Adams
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Patricia M. Arenth
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Therese M. O’Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA and Department of Speech-Language Pathology and Audiology, Northeastern University, Boston, MA
| | | | - Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | | | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Marcel P. Dijkers
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY
| | - Amy K. Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA and Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA
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Predictors of informal care burden 1 year after a severe traumatic brain injury: results from the PariS-TBI study. J Head Trauma Rehabil 2014; 28:408-18. [PMID: 22691963 DOI: 10.1097/htr.0b013e31825413cf] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate predictors of informal care burden 1 year after a severe traumatic brain injury (TBI). PARTICIPANTS Patients (N = 66) aged 15 years or older with severe TBI (Glasgow Coma Scale score of 8 or less) and their primary informal caregivers. SETTING Multicenter inception cohort study over 22 months in Paris and the surrounding area (PariS-TBI study). MAIN MEASURES Patients' preinjury characteristics; injury severity data; outcome measures at discharge from intensive care and 1 year after the injury; Dysexecutive Questionnaire; Medical Outcome Study Short Form-36; Zarit Burden Inventory. RESULTS Among the 257 survivors at discharge from acute care, 66 patient-caregiver couples were included. Primary informal caregivers were predominantly women (73%), of middle age (age, 50 years), supporting male patients (79%), of mean age of 38 years. The majority (56%) of caregivers experienced significant burden, and 44% were at risk of depression. Caregivers' impaired health status and perceived burden significantly correlated with patients' global disability (as assessed with the Glasgow Outcome Scale-Extended) and impairments of executive functions (as assessed with the Dysexecutive Questionnaire). A focused principal component analysis suggested that disability and executive dysfunctions were independent predictors of perceived burden, whereas demographics, injury severity, and Glasgow Outcome Scale at discharge from acute care did not significantly correlate with caregiver's burden. CONCLUSION Global handicap and impairments of executive functions are independent significant predictors of caregiver burden 1 year after TBI.
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Health-Related Quality of Life 3 Years After Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study. Arch Phys Med Rehabil 2014; 95:1268-76. [DOI: 10.1016/j.apmr.2014.02.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 11/18/2022]
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Li LM, Menon DK, Janowitz T. Cross-sectional analysis of data from the U.S. clinical trials database reveals poor translational clinical trial effort for traumatic brain injury, compared with stroke. PLoS One 2014; 9:e84336. [PMID: 24416218 PMCID: PMC3885561 DOI: 10.1371/journal.pone.0084336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/14/2013] [Indexed: 02/02/2023] Open
Abstract
Traumatic brain injury (TBI) is an important public health problem, comparable to stroke in incidence and prevalence. Few interventions have proven efficacy in TBI, and clinical trials are, therefore, necessary to advance management in TBI. We describe the current clinical trial landscape in traumatic brain injury and compare it with the trial efforts for stroke. For this, we analysed all stroke and TBI studies registered on the US Clinical Trials (www.clinicaltrials.gov) database over a 10-year period (01/01/2000 to 01/31/2013). This methodology has been previously used to analyse clinical trial efforts in other specialties. We describe the research profile in each area: total number of studies, total number of participants and change in number of research studies over time. We also analysed key study characteristics, such as enrolment number and scope of recruitment. We found a mismatch between relative public health burden and relative research effort in each disease. Despite TBI having comparable prevalence and higher incidence than stroke, it has around one fifth of the number of clinical trials and participant recruitment. Both stroke and TBI have experienced an increase in the number of studies over the examined time period, but the rate of growth for TBI is one third that for stroke. Small-scale (<1000 participants per trial) and single centre studies form the majority of clinical trials in both stroke and TBI, with TBI having significantly fewer studies with international recruitment. We discuss the consequences of these findings and how the situation might be improved. A sustained research effort, entailing increased international collaboration and rethinking the methodology of running clinical trials, is required in order to improve outcomes after traumatic brain injury.
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Affiliation(s)
- Lucia M. Li
- Division of Medicine, Imperial College London, London, United Kingdom
| | - David K. Menon
- Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Tobias Janowitz
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Affiliation(s)
| | - Sherman C Stein
- Department of NeurosurgeryUniversity of Pennsylvania, Philadelphia, PA, USA
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Modeling the prospective relationships of impairment, injury severity, and participation to quality of life following traumatic brain injury. BIOMED RESEARCH INTERNATIONAL 2013; 2013:102570. [PMID: 24199186 PMCID: PMC3807828 DOI: 10.1155/2013/102570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/14/2013] [Accepted: 08/28/2013] [Indexed: 11/17/2022]
Abstract
Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation--mobility and occupational activities--mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustment after TBI are discussed.
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McLean AM, Jarus T, Hubley AM, Jongbloed L. Associations between social participation and subjective quality of life for adults with moderate to severe traumatic brain injury. Disabil Rehabil 2013; 36:1409-18. [DOI: 10.3109/09638288.2013.834986] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Machamer J, Temkin N, Dikmen S. Health-related quality of life in traumatic brain injury: is a proxy report necessary? J Neurotrauma 2013; 30:1845-51. [PMID: 23731370 DOI: 10.1089/neu.2013.2920] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite its importance to care, clinicians and researchers often discount patient-reported outcomes in favor of proxy reports, in persons with traumatic brain injury (TBI). The rationale relates to concerns about lack of awareness of patients regarding their functioning. However, although lack of awareness occurs in some patients with severe TBI, or in TBI involving certain lesion locations, or very soon after injury, this conclusion has been overgeneralized. The objective of this study is to determine the validity of patient-reported health-related quality of life by evaluating its relationship to injury severity and more objective indices of outcome, in a representative series of adults with TBI. A consecutive sample of 374 persons with TBI at least 14 years old, and having a post-resuscitation Glasgow Coma Scale score ≤12, an acute seizure, or a CT scan showing TBI- related findings. Seventy-six percent (374/491) of the eligible survivors were assessed at 6 months post-injury on the Life Satisfaction Survey. The greatest decrease in satisfaction was in the ability to think and remember, work, receive adequate income, and participate in leisure and recreational activities. Dissatisfaction significantly related to the functional limitation in that area as judged by the patients themselves (p<0.001) or by someone who knew them well (p≤0.001). The most severely injured group reported the most dissatisfaction for 13 out of 17 areas assessed. Patients with TBI, in general, do not need a proxy to report on their behalf regarding their functional limitations or health-related quality of life.
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Affiliation(s)
- Joan Machamer
- 1 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington
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Pouliquen U, Etcharry-Bouyx F, Pinon K, Patureau F, Petit A, Lambert A, Richard I. Post-acute assessment programme for patients with traumatic brain injury: measuring the gap between patients' expectations on entering and end of programme recommendations. Brain Inj 2013; 27:789-92. [PMID: 23782304 DOI: 10.3109/02699052.2013.794960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the expectations of patients with brain injury (TBI) entering a post-acute programme to the recommendations made at the end. DESIGN Retrospective study (1997 and 2009). INTERVENTION This 12-week post-acute programme included ecological multidisciplinary assessment of physical and cognitive disabilities, independence in activities of daily living and work abilities. Recommendations made at the conclusion of the programme included advice regarding the ability to work in an unsheltered or a sheltered environment and possible social activities. RESULTS Two hundred and forty patients participated. The main objective of 95.8% was return-to-work: 93.7% expected a normal work environment, 2.1% considered a sheltered environment and 4% entered the programme with the aim of improving social abilities and integration in the community. The recommendations included return-to-work in 68.3% of cases, in an unsheltered environment in 44.2% and in a sheltered environment in 24.1% and advice for contact with social services in order to achieve better social integration in 31.7%. There was a discrepancy between expectations and recommendations in half of the cases. CONCLUSION The discrepancy between patients' expectations and recommendations is in part due to the cognitive disorders; long-term rehabilitation programmes should focus on this issue.
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Hogan M, Nangle N, Morrison TG, McGuire BE. Evaluation of thePatient Generated Indexas a measure of quality-of-life in people with severe traumatic brain injury. Brain Inj 2013; 27:273-80. [DOI: 10.3109/02699052.2012.743177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Silva SCFE, Settervall CHC, Sousa RMCD. Amnésia pós-traumática e qualidade de vida pós-trauma. Rev Esc Enferm USP 2012; 46 Spec No:30-7. [DOI: 10.1590/s0080-62342012000700005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/04/2012] [Indexed: 11/22/2022] Open
Abstract
Este estudo compara a qualidade de vida das vítimas que apresentaram amnésia pós-traumática de longa duração com as demais e analisa a relação entre qualidade de vida e duração da amnésia pós-traumática, computando ou não o período de coma. Estudo de coorte prospectivo, com coleta de dados durante a internação hospitalar e avaliação da qualidade de vida no período de estabilidade da recuperação pós-traumática. Participaram desta investigação vítimas de trauma crânio-encefálico contuso, maiores de 14 anos, sem antecedentes de demência ou trauma crânio-encefálico, internadas em hospital de referência para atendimento de trauma nas primeiras 12 horas pós-evento. Os resultados referentes à qualidade de vida foram mais desfavoráveis em três domínios do grupo com amnésia de longa duração. Correlações entre duração da amnésia e domínios de qualidade de vida foram mais expressivas quando excluído o período de coma, indicando que este tempo não deve ser computado na duração da amnésia pós-traumática.
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de Guise E, LeBlanc J, Abouassaly M, Lin H, Lamoureux J, Champoux MC, Couturier C, Maleki M, Roger EP, Feyz M. The Relationship between Acute Functional Status and Long-Term Ambulation after Severe Traumatic Brain Injury. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/534856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. To correlate long-term physical impairments of patients with severe traumatic brain injury (sTBI) based on their functional status in an acute care setting. Methods. 46 patients with sTBI participated in this prospective study. The Extended Glasgow Outcome Scale (GOSE) and the FIM instrument were rated at discharge from the acute care setting and at followup. The Functional Ambulation Classification (FAC), the Five-Meter Gait Speed, a quantified measure of negotiating stairs (Stair Climbing Speed and Rails used), and the functional reach test were rated at followup. Results. The subject with a score of 6 on the GOSE at discharge remained nonfunctional ambulator at followup. None of the subjects with a GOSE score of 5 became independent ambulators. Fifty percent of the subjects with a GOSE score of 4 were dependent ambulators. 100% of the subjects with a GOSE score of 2 or 3 at discharge were independent ambulators. A higher FIM score at discharge was associated with a greater chance of ambulating independently at 2 to 5 years after TBI (χKW22df). Conclusions. These data will allow physical health professionals in acute rehabilitation settings to provide more precise long-term physical outcome information to patients and families.
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Affiliation(s)
- Elaine de Guise
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 0G4
| | - Joanne LeBlanc
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Michel Abouassaly
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Howell Lin
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Julie Lamoureux
- Social and Preventive Medicine Department, University of Montreal, Montreal, QC, Canada H3C 3J7
| | - Marie-Claude Champoux
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Céline Couturier
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Mohammed Maleki
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 0G4
| | - Eric P. Roger
- Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, NY 14260-1660, USA
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
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Davis LC, Sherer M, Sander AM, Bogner JA, Corrigan JD, Dijkers MP, Hanks RA, Bergquist TF, Seel RT. Preinjury Predictors of Life Satisfaction at 1 Year After Traumatic Brain Injury. Arch Phys Med Rehabil 2012; 93:1324-30. [DOI: 10.1016/j.apmr.2012.02.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/21/2012] [Accepted: 02/22/2012] [Indexed: 11/30/2022]
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LeBlanc J, de Guise E, Lamoureux J, Meyer K, Duplantie J, Thomas H, Abouassaly M, Champoux MC, Couturier C, Lin H, Lu L, Robinson C, Roger E, Maleki M, Feyz M. Criterion validity of a functional cognitive task in patients with severe traumatic brain injury. Brain Inj 2012; 26:1143-54. [PMID: 22630136 DOI: 10.3109/02699052.2012.666922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To verify criterion validity of measures from a functional cognitive task (FCT) carried out with patients with severe traumatic brain injury (sTBI) at 2-5 years post-injury. METHODS AND PROCEDURES Forty-six patients with sTBI took part in a long-term outcome study where the FCT and the Neurobehavioural Rating Scale-Revised (NBRS-R) were administered and the FIM™ instrument was rated. The FCT is a telephone information gathering task for evaluating functional cognitive skills. RESULTS Ten of 16 measures of the FCT were significantly correlated with similar or related concepts from the NBRS-R. The FIM™ cognitive score and the individual items of this score were significantly correlated with 13 of the FCT measures and with the percentage of amount of information gathered. Internal consistency was good for 13 of 16 measures. Overall, patients generally had mild difficulty on the FCT concepts. CONCLUSION The FCT can be used with patients with sTBI to evaluate certain aspects of functional cognition. It has good criterion validity and internal consistency, but additional research is required to further measure reliability and its applicability to other severity of TBI and to other phases of recovery.
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Affiliation(s)
- Joanne LeBlanc
- McGill University Health Centre-Montreal General Hospital, Montreal, Québec, Canada.
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Kosty J, Macyszyn L, Lai K, McCroskery J, Park HR, Stein SC. Relating Quality of Life to Glasgow Outcome Scale Health States. J Neurotrauma 2012; 29:1322-7. [DOI: 10.1089/neu.2011.2222] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jennifer Kosty
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luke Macyszyn
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Lai
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James McCroskery
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hae-Ran Park
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sherman C. Stein
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Jourdan C, Bayen E, Bosserelle V, Azerad S, Genet F, Fermanian C, Aegerter P, Pradat-Diehl P, Weiss JJ, Azouvi P. Referral to Rehabilitation After Severe Traumatic Brain Injury. Neurorehabil Neural Repair 2012; 27:35-44. [DOI: 10.1177/1545968312440744] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. After a severe traumatic brain injury (TBI), some patients are discharged home without rehabilitation, although rehabilitation is assumed to improve outcome. Objective. To assess factors that predict referral to rehabilitation following acute care. This study is part of a larger inception cohort study assessing the care network in the Parisian area (France). Methods. Between July 2005 and April 2007, 504 adults with severe TBI (Glasgow Coma Scale score ≤8) were prospectively recruited by mobile emergency services. This study included 254 acute care survivors (80% male, median age 32 years). Data regarding demographics, injury severity, and acute care pathway were collected. The first analysis compared patients referred to a rehabilitation facility with patients discharged to a living place. The second analysis compared patients referred to a specialized neurorehabilitation (NR) facility with patients referred to nonspecialized rehabilitation. Univariate and multivariate statistics were computed. Results. In all, 162 patients (64%) were referred to rehabilitation, 115 (45%) of which were referred to NR and 47 (19%) to nonspecialized rehabilitation. The following factors were significantly predictive of nonreferral to rehabilitation: living alone, a lower income professional category, pretraumatic alcohol abuse, lower TBI severity, and transfer through a nonspecialized medical ward before discharge. Patients referred to specialized NR were significantly younger and from a higher income professional category. Conclusions. These results raise concern regarding care pathways because many patients were discharged to living places, probably without adequate assessment and management of rehabilitation needs. Injury severity and social characteristics influenced discharge destination.
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Affiliation(s)
- Claire Jourdan
- AP-HP, Hôpital R. Poincaré, Service de Médecine Physique et Réadaptation, Garches, France
- Université de Versailles St-Quentin, UFR de Médecine, Guyancourt, France
- Université Pierre et Marie Curie, Unité ER 6, Paris, France
| | - Eleonore Bayen
- Université Pierre et Marie Curie, Unité ER 6, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation, Paris, France
| | - Vanessa Bosserelle
- Centre Ressources Francilien du Traumatisme Crânien, Paris, France
- AP-HP, Hôpital A. Paré, Unité de Recherche Clinique Paris-Ouest, Boulogne-Billancourt, France
| | - Sylvie Azerad
- Centre Ressources Francilien du Traumatisme Crânien, Paris, France
- AP-HP, Hôpital A. Paré, Unité de Recherche Clinique Paris-Ouest, Boulogne-Billancourt, France
| | - François Genet
- AP-HP, Hôpital R. Poincaré, Service de Médecine Physique et Réadaptation, Garches, France
| | - Christophe Fermanian
- AP-HP, Hôpital A. Paré, Unité de Recherche Clinique Paris-Ouest, Boulogne-Billancourt, France
| | - Philippe Aegerter
- Université de Versailles St-Quentin, UFR de Médecine, Guyancourt, France
- AP-HP, Hôpital A. Paré, Unité de Recherche Clinique Paris-Ouest, Boulogne-Billancourt, France
| | - Pascale Pradat-Diehl
- Université Pierre et Marie Curie, Unité ER 6, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation, Paris, France
| | | | - Philippe Azouvi
- AP-HP, Hôpital R. Poincaré, Service de Médecine Physique et Réadaptation, Garches, France
- Université de Versailles St-Quentin, UFR de Médecine, Guyancourt, France
- Université Pierre et Marie Curie, Unité ER 6, Paris, France
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Hu XB, Feng Z, Fan YC, Xiong ZY, Huang QW. Health-related quality-of-life after traumatic brain injury: A 2-year follow-up study in Wuhan, China. Brain Inj 2012; 26:183-7. [DOI: 10.3109/02699052.2011.648707] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brands IMH, Wade DT, Stapert SZ, van Heugten CM. The adaptation process following acute onset disability: an interactive two-dimensional approach applied to acquired brain injury. Clin Rehabil 2012; 26:840-52. [DOI: 10.1177/0269215511432018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe a new model of the adaptation process following acquired brain injury, based on the patient’s goals, the patient’s abilities and the emotional response to the changes and the possible discrepancy between goals and achievements. Background: The process of adaptation after acquired brain injury is characterized by a continuous interaction of two processes: achieving maximal restoration of function and adjusting to the alterations and losses that occur in the various domains of functioning. Consequently, adaptation requires a balanced mix of restoration-oriented coping and loss-oriented coping. The commonly used framework to explain adaptation and coping, ‘The Theory of Stress and Coping’ of Lazarus and Folkman, does not capture this interactive duality. Relevant theories: This model additionally considers theories concerned with self-regulation of behaviour, self-awareness and self-efficacy, and with the setting and achievement of goals. The two-dimensional model: Our model proposes the simultaneous and continuous interaction of two pathways; goal pursuit (short term and long term) or revision as a result of success and failure in reducing distance between current state and expected future state and an affective response that is generated by the experienced goal-performance discrepancies. This affective response, in turn, influences the goals set. This two-dimensional representation covers the processes mentioned above: restoration of function and consideration of long-term limitations. We propose that adaptation centres on readjustment of long-term goals to new achievable but desired and important goals, and that this adjustment underlies re-establishing emotional stability. We discuss how the proposed model is related to actual rehabilitation practice.
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Affiliation(s)
- Ingrid MH Brands
- Blixembosch Rehabilitation Centre, Department of Neurorehabilitation, Eindhoven, The Netherlands
| | - Derick T Wade
- Department of Rehabilitation, School for Public Health and Primary Care, Maastricht University, The Netherlands
| | - Sven Z Stapert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
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Koskinen S, Hokkinen EM, Wilson L, Sarajuuri J, Von Steinbüchel N, Truelle JL. Comparison of subjective and objective assessments of outcome after traumatic brain injury using the International Classification of Functioning, Disability and Health (ICF). Disabil Rehabil 2011; 33:2464-78. [PMID: 21534850 DOI: 10.3109/09638288.2011.574776] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim is to examine two aspects of outcome after traumatic brain injury (TBI). Functional outcome was assessed by the Glasgow Outcome Scale - Extended (GOSE) and by clinician ratings, while health-related quality of life (HRQoL) was assessed by the Quality of Life after Brain Injury (QOLIBRI). METHOD The GOSE and the QOLIBRI were linked to the International Classification of Functioning, Disability and Health (ICF) to analyse their content. Functional outcome on ICF categories was assessed by rehabilitation clinicians in 55 participants with TBI and was compared to the participants' own judgements of their HRQoL. RESULTS The QOLIBRI was linked to 42 and the GOSE to 57 two-level ICF categories covering 78% of the categories on the ICF brief core set for TBI. The closest agreement in the views of the professionals and the participants was found on the Physical Problems and Cognition scales of the QOLIBRI. CONCLUSIONS The problems encountered after TBI are well covered by the QOLIBRI and the GOSE. They capture important domains that are not traditionally sufficiently documented, especially in the domains of interpersonal relationships, social and leisure activities, self and the environment. The findings indicate that they are useful and complementary outcome measures for TBI. In rehabilitation, they can serve as tools in assessment, setting meaningful goals and creating therapeutic alliance.
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Pascal’s Wager and Deciding About the Life-Sustaining Treatment of Patients in Persistent Vegetative State. NEUROETHICS-NETH 2011. [DOI: 10.1007/s12152-011-9113-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jacobsson LJ, Westerberg M, Malec JF, Lexell J. Sense of coherence and disability and the relationship with life satisfaction 6-15 years after traumatic brain injury in northern Sweden. Neuropsychol Rehabil 2011; 21:383-400. [PMID: 21480050 DOI: 10.1080/09602011.2011.566711] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of the study was to assess sense of coherence (SOC) many years after traumatic brain injury (TBI) and explore the relationship between SOC and self-rated life satisfaction (LS) as well as measures of functioning and disability, sex, age at injury, injury severity and time post-injury. Sixty-six individuals (aged 18-65 years) who were 6-15 years post-injury were interviewed. Data on SOC (SOC-13 item scale), measures of functioning and disability (Mayo-Portland Adaptability Inventory, MPAI-4), LS (Satisfaction with Life Scale, SWLS), and sex, age at injury, injury severity and time post-injury were analysed with hierarchical multiple regression analyses. The results showed that SOC in the study group did not differ from the general population and was strongly associated with LS. Regression analyses revealed that emotional factors, social participation, SOC, and time since injury, were more influential than sex, age at injury, and injury severity in explaining LS. It was concluded that SOC in this group of individuals with TBI who were many years post-injury was similar to nondisabled individuals. SOC, together with emotional factors, social participation and injury-related factors, were determinants of LS. These results confirm that LS after TBI is a complex phenomenon dependent on several factors that are important targets for rehabilitation professionals.
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Affiliation(s)
- L J Jacobsson
- Medical Rehabilitation Section, Department of General Medicine, Kalix Hospital, Sweden.
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