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Schwiddessen R, Malinova V, von Steinbüchel N, Mielke D, Rohde V, von der Brelie C. Spontaneous intracerebral hemorrhage - patients retrospectively consent to fibrinolytic surgery despite poor neurological outcome and reduced health-related quality of life. Neurosurg Rev 2024; 47:268. [PMID: 38862774 PMCID: PMC11166777 DOI: 10.1007/s10143-024-02479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/24/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024]
Abstract
Spontaneous intracerebral hemorrhage (ICH) might lead to devastating consequences. Nonetheless, subjective interpretation of life circumstances might vary. Recent data from ischemic stroke patients show that there might be a paradox between clinically rated neurological outcome and self-reported satisfaction with quality of life. Our hypothesis was that minimally invasive surgically treated ICH patients would still give their consent to stereotactic fibrinolysis despite experiencing relatively poor neurological outcome. In order to better understand the patients' perspective and to enhance insight beyond functional outcome, this is the first study assessing disease-specific health-related quality of life (hrQoL) in ICH after fibrinolytic therapy. We conducted a retrospective analysis of patients with spontaneous ICH treated minimally invasive by stereotactic fibrinolysis. Subsequently, using standardized telephone interviews, we evaluated functional outcome with the modified Rankin Scale (mRS), health-related Quality of Life with the Quality of life after Brain Injury Overall scale (QOLIBRI-OS), and assessed retrospectively if the patients would have given their consent to the treatment. To verify the primary hypothesis that fibrinolytic treated ICH patients would still retrospectively consent to fibrinolytic therapy despite a relatively poor neurological outcome, we conducted a chi-square test to compare good versus poor outcome (mRS) between consenters and non-consenters. To investigate the association between hrQoL (QOLIBRI-OS) and consent, we conducted a Mann-Whitney U-test. Moreover, we did a Spearman correlation to investigate the correlation between functional outcome (mRS) and hrQoL (QOLIBRI-OS). The analysis comprised 63 data sets (35 men, mean age: 66.9 ± 11.8 years, median Hemphill score: 3 [2-3]). Good neurological outcome (mRS 0-3) was achieved in 52% (33/63) of the patients. Patients would have given their consent to surgery retrospectively in 89.7% (52/58). These 52 consenting patients comprised all 33 patients (100%) who achieved good functional outcome and 19 of the 25 patients (76%) who achieved poor neurological outcome (mRS 4-6). The mean QOLIBRI-OS value was 49.55 ± 27.75. A significant association between hrQoL and retrospective consent was found (p = 0.004). This study supports fibrinolytic treatment of ICH even in cases when poor neurological outcome would have to be assumed since subjective perception of deficits could be in contrast with the objectively measured neurological outcome. HrQoL serves as a criterion for success of rtPa lysis therapy in ICH.
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Affiliation(s)
- Regina Schwiddessen
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Göttingen, Germany.
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Göttingen, Germany
| | - Nicole von Steinbüchel
- Department of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Göttingen, Germany
- Department of Neurosurgery, University Medical Center Augsburg, Augsburg, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Göttingen, Germany
| | - Christian von der Brelie
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Göttingen, Germany
- Department of Neurosurgery and Spine Surgery, Johanniter-Kliniken Bonn, Bonn, Germany
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Vreeburg RJG, Singh RD, van Erp IAM, Korhonen TK, Yue JK, Mee H, Timofeev I, Kolias A, Helmy A, Depreitere B, Moojen WA, Younsi A, Hutchinson P, Manley GT, Steyerberg EW, de Ruiter GCW, Maas AIR, Peul WC, van Dijck JTJM, den Boogert HF, Posti JP, van Essen TA. Early versus delayed cranioplasty after decompressive craniectomy in traumatic brain injury: a multicenter observational study within CENTER-TBI and Net-QuRe. J Neurosurg 2024:1-13. [PMID: 38669706 DOI: 10.3171/2024.1.jns232172] [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: 09/20/2023] [Accepted: 01/26/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE The aim of this study was to compare the outcomes of early (≤ 90 days) and delayed (> 90 days) cranioplasty following decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). METHODS The authors analyzed participants enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and the Neurotraumatology Quality Registry (Net-QuRe) studies who were diagnosed with TBI and underwent DC and subsequent cranioplasty. These prospective, multicenter, observational cohort studies included 5091 patients enrolled from 2014 to 2020. The effect of cranioplasty timing on functional outcome was evaluated with multivariable ordinal regression and with propensity score matching (PSM) in a sensitivity analysis of functional outcome (Glasgow Outcome Scale-Extended [GOSE] score) and quality of life (Quality of Life After Brain Injury [QOLIBRI] instrument) at 12 months following DC. RESULTS Among 173 eligible patients, 73 (42%) underwent early cranioplasty and 100 (58%) underwent delayed cranioplasty. In the ordinal logistic regression and PSM, similar 12-month GOSE scores were found between the two groups (adjusted odds ratio [aOR] 0.87, 95% CI 0.61-1.21 and 0.88, 95% CI 0.48-1.65, respectively). In the ordinal logistic regression, early cranioplasty was associated with a higher risk for hydrocephalus than that with delayed cranioplasty (aOR 4.0, 95% CI 1.2-16). Postdischarge seizure rates (early cranioplasty: aOR 1.73, 95% CI 0.7-4.7) and QOLIBRI scores (β -1.9, 95% CI -9.1 to 9.6) were similar between the two groups. CONCLUSIONS Functional outcome and quality of life were similar between early and delayed cranioplasty in patients who had undergone DC for TBI. Neurosurgeons may consider performing cranioplasty during the index admission (early) to simplify the patient's chain of care and prevent readmission for cranioplasty but should be vigilant for an increased possibility of hydrocephalus. Clinical trial registration nos.: CENTER-TBI, NCT02210221 (clinicaltrials.gov); Net-QuRe, NTR6003 (trialsearch.who.int) and NL5761 (onderzoekmetmensen.nl).
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Affiliation(s)
- Rick J G Vreeburg
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Ranjit D Singh
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Inge A M van Erp
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Tommi K Korhonen
- 2Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
- 3Neurocenter, Department of Neurosurgery and Research Unit of Clinical Neuroscience, Neurosurgery, Oulu University Hospital and University of Oulu, Finland
| | - John K Yue
- 4Department of Neurosurgery, University of California, San Francisco, California
| | - Harry Mee
- 2Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ivan Timofeev
- 2Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Angelos Kolias
- 2Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Adel Helmy
- 2Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Bart Depreitere
- 5Department of Neurosurgery, University Hospital Leuven, Belgium
| | - Wouter A Moojen
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Alexander Younsi
- 6Department of Neurosurgery, University Hospital Heidelberg, Germany
| | - Peter Hutchinson
- 2Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Geoffrey T Manley
- 4Department of Neurosurgery, University of California, San Francisco, California
| | - Ewout W Steyerberg
- 7Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Godard C W de Ruiter
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Andrew I R Maas
- 8Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- 9Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Wilco C Peul
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Jeroen T J M van Dijck
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Hugo F den Boogert
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Jussi P Posti
- 10Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Finland; and
| | - Thomas A van Essen
- 1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
- 11Department of Surgery, Division of Neurosurgey, QEII Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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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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van Erp IAM, van Essen TA, Lingsma H, Pisica D, Singh RD, van Dijck JTJM, Volovici V, Kolias A, Peppel LD, Heijenbrok-Kal M, Ribbers GM, Menon DK, Hutchinson P, Depreitere B, Steyerberg EW, Maas AIR, de Ruiter GCW, Peul WC. Early surgery versus conservative treatment in patients with traumatic intracerebral hematoma: a CENTER-TBI study. Acta Neurochir (Wien) 2023; 165:3217-3227. [PMID: 37747570 PMCID: PMC10624744 DOI: 10.1007/s00701-023-05797-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Evidence regarding the effect of surgery in traumatic intracerebral hematoma (t-ICH) is limited and relies on the STITCH(Trauma) trial. This study is aimed at comparing the effectiveness of early surgery to conservative treatment in patients with a t-ICH. METHODS In a prospective cohort, we included patients with a large t-ICH (< 48 h of injury). Primary outcome was the Glasgow Outcome Scale Extended (GOSE) at 6 months, analyzed with multivariable proportional odds logistic regression. Subgroups included injury severity and isolated vs. non-isolated t-ICH. RESULTS A total of 367 patients with a large t-ICH were included, of whom 160 received early surgery and 207 received conservative treatment. Patients receiving early surgery were younger (median age 54 vs. 58 years) and more severely injured (median Glasgow Coma Scale 7 vs. 10) compared to those treated conservatively. In the overall cohort, early surgery was not associated with better functional outcome (adjusted odds ratio (AOR) 1.1, (95% CI, 0.6-1.7)) compared to conservative treatment. Early surgery was associated with better outcome for patients with moderate TBI and isolated t-ICH (AOR 1.5 (95% CI, 1.1-2.0); P value for interaction 0.71, and AOR 1.8 (95% CI, 1.3-2.5); P value for interaction 0.004). Conversely, in mild TBI and those with a smaller t-ICH (< 33 cc), conservative treatment was associated with better outcome (AOR 0.6 (95% CI, 0.4-0.9); P value for interaction 0.71, and AOR 0.8 (95% CI, 0.5-1.0); P value for interaction 0.32). CONCLUSIONS Early surgery in t-ICH might benefit those with moderate TBI and isolated t-ICH, comparable with results of the STITCH(Trauma) trial.
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Affiliation(s)
- Inge A M van Erp
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands.
| | - Thomas A van Essen
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
| | - Hester Lingsma
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Dana Pisica
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Ranjit D Singh
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
| | - Jeroen T J M van Dijck
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
| | - Victor Volovici
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Lianne D Peppel
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Majanka Heijenbrok-Kal
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital KU Leuven, Leuven, Belgium
| | - Ewout W Steyerberg
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre and Haaglanden Medical Centre, Leiden and The Hague, The Netherlands
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Antwerp, Belgium
| | - Godard C W de Ruiter
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Centre Holland, LUMC, HMC, HAGA, Leiden and The Hague, The Netherlands
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Valaas LJV, Soberg HL, Rasmussen MS, Steenstrup SE, Andelic N, Kleffelgård I. Sub-symptom threshold aerobic exercise for patients with persisting post-concussion symptoms and exercise intolerance after mild traumatic brain injury - a study protocol with a nested feasibility study for a randomized controlled trial. BMC Neurol 2023; 23:179. [PMID: 37138202 PMCID: PMC10155435 DOI: 10.1186/s12883-023-03221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Persistent post-concussion symptoms (PPCS) affect between 34 and 46% after a mild traumatic brain injury (mTBI). Many also experience exercise intolerance. Sub-symptom threshold aerobic exercise, SSTAE (exercise at an intensity level that does not increase symptoms) is proposed as a treatment to both reduce the symptom burden and increase the exercise tolerance after the injury. It is unclear if this also applies in a more chronic phase after mTBI. MAIN PURPOSE The main purpose of this study is to evaluate whether SSTAE in addition to ordinary rehabilitation will lead to clinically meaningful improvement of symptom burden, normalize exercise tolerance, increase physical activity, improve health-related quality of life, and reduce patient-specific activity limitations compared to a control group that only receives ordinary rehabilitation. DESIGN Randomized, controlled, single-blind parallel-group study with three measurement times; T0 at baseline, T1 after the intervention and T2 six months after T1. METHODS Patients between the ages of 18 and 60 with exercise intolerance and persistent PPCS (> 3 months) will be recruited to the study and randomized to two groups. All patients will receive follow-up at the outpatient TBI clinic. The intervention group will in addition receive SSTAE for 12 weeks with exercise diaries and a retest every 3 weeks for optimal dosage and progression. The Rivermead post-concussion symptoms questionnaire will be the main outcome measure. The secondary outcome measure will be a test of exercise tolerance-the Buffalo Concussion Treadmill Test. Other outcome measures include the patient-specific functional scale that measures patient-specific activity limitations, as well as outcome measures for diagnosis-specific health-related quality of life, anxiety and depression, specific symptoms such as dizziness, headache and fatigue, and physical activity. DISCUSSION This study will add knowledge about the effect of SSTAE and whether it should be implemented in rehabilitation for the adult population with persistent PPCS after mTBI. The nested feasibility trial showed that the SSTAE intervention was safe and that the study procedures and delivery of the intervention overall were feasible. However, minor amendments to the study protocol were made prior to the commencement of the RCT. TRIAL REGISTRATION Clinical Trials.gov, NCT05086419. Registered on September 5th, 2021.
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Affiliation(s)
- Lars-Johan V Valaas
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Helene L Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Mari S Rasmussen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Sophie E Steenstrup
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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Zeldovich M, Hahm S, Mueller I, Krenz U, Bockhop F, von Steinbuechel N. Longitudinal Internal Validity of the Quality of Life after Brain Injury: Response Shift and Responsiveness. J Clin Med 2023; 12:jcm12093197. [PMID: 37176640 PMCID: PMC10179561 DOI: 10.3390/jcm12093197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
The Quality of Life after Brain Injury (QoLIBRI) questionnaire was developed and validated to assess disease-specific health-related quality of life (HRQoL) in individuals after TBI. The present study aims to determine its longitudinal validity by assessing its responsiveness and response shift from 3 to 6 months post-injury. Analyses were based on data from the European longitudinal observational cohort Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. A total of 1659 individuals recovering from TBI were included in the analyses. Response shift was assessed using longitudinal measurement invariance testing within the confirmatory factor analyses framework. Responsiveness was analyzed using linear regression models that compared changes in functional recovery as measured by the Glasgow Outcome Scale-Extended (GOSE) with changes in the QoLIBRI scales from 3 to 6 months post-injury. Longitudinal tests of measurement invariance and analyses of discrepancies in practical significance indicated the absence of response shift. Changes in functional recovery status from three to six months were significantly associated with the responsiveness of the QoLIBRI scales over the same time period. The QoLIBRI can be used in longitudinal studies and is responsive to changes in an individual's functional recovery during the first 6 months after TBI.
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Affiliation(s)
- Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Stefanie Hahm
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Isabelle Mueller
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
- Department of Psychiatry, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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8
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Hoogslag VDN, van Essen TA, Dijkman MD, Moudrous W, Schoonman GG, Peul WC. A multicentre retrospective cohort study on health-related quality of life after traumatic acute subdural haematoma: does cranial laterality affect long-term recovery? BMC Neurol 2022; 22:287. [PMID: 35915402 PMCID: PMC9341107 DOI: 10.1186/s12883-022-02790-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic acute subdural haematoma is a debilitating condition. Laterality intuitively influences management and outcome. However, in contrast to stroke, this research area is rarely studied. The aim is to investigate whether the hemisphere location of the ASDH influences patient outcome. Methods For this multicentre observational retrospective cohort study, patients were considered eligible when they were treated by a neurosurgeon for traumatic brain injury between 2008 and 2012, were > 16 years of age, had sustained brain injury with direct presentation to the emergency room and showed a hyperdense, crescent shaped lesion on the computed tomography scan. Patients were followed for a duration of 3-9 months post-trauma for functional outcome and 2-6 years for health-related quality of life. Main outcomes and measures included mortality, Glasgow Outcome Scale and the Quality of Life after Brain Injury score. The hypothesis was formulated after data collection. Results Of the 187 patients included, 90 had a left-sided ASDH and 97 had a right-sided haematoma. Both groups were comparable at baseline and with respect to the executed treatment. Furthermore, both groups showed no significant difference in mortality and Glasgow Outcome Scale score. Health-related quality of life, assessed 59 months (IQR 43-66) post-injury, was higher for patients with a right-sided haematoma (Quality of Life after Brain Injury score: 80 vs 61, P = 0.07). Conclusions This study suggests patients with a right-sided acute subdural haematoma have a better long-term health-related quality of life compared to patients with a left-sided acute subdural haematoma. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02790-3.
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James A, Ravaud P, Riveros C, Raux M, Tran VT. Completeness and Mismatch of Patient-Important Outcomes After Trauma. ANNALS OF SURGERY OPEN 2022; 3:e211. [PMID: 37600291 PMCID: PMC10406046 DOI: 10.1097/as9.0000000000000211] [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: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
To assess the completeness of the collection of patient-important outcomes and the mismatch between outcomes measured in research and patients' important issues after trauma. Summary Background Data To date, severe trauma has mainly been assessed using in-hospital mortality. Yet, with 80 to 90% survivors discharged from hospital, it is critical to assess the collection of patient important long-term outcomes of trauma. Methods Mixed methods study combining a systematic review of outcomes and their comparison with domains elicited by patients during a qualitative study. We searched Medline, EMBASE and clinicaltrials.gov from January 1, 2014 to September 30, 2019 and extracted all outcomes from reports including severe trauma. We compared these outcomes with 97 domains that matter to trauma survivors identified in a previous qualitative study. We defined as patient-important outcome as the 10 most frequently elicited domains in the qualitative study. We assessed the number of domains captured in each report to illustrate the completeness of the collection of patient-important outcomes. We also assessed the mismatch between outcomes collected and what matters to patients. Findings Among the 116 reports included in the systematic review, we identified 403 outcomes collected with 154 unique measurements tools. Beside mortality, measurement tools most frequently used were the Glasgow Outcome Scale (31.0%, n=36), questions on patients' return to work (20,7%, n=24) and the EQ-5D (19.0%, n=22). The comparison between the outcomes identified in the systematic review and the domains from the qualitative study found that 10.3% (n=12) reports did not collect any patient-important domains and one collected all 10 patient-important domains. By examining each of the 10 patient-important domains, none was collected in more than 72% of reports and only five were among the ten most frequently measured domains in studies. Conclusion The completeness of the collection of the long-term patient-important outcomes after trauma can be improved. There was a mismatch between the domains used in the literature and those considered important by patients during a qualitative study.
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Affiliation(s)
- Arthur James
- Centre d’Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
- Département d’Anesthésie Réanimation, Sorbonne Université, GRC 29, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
| | - Philippe Ravaud
- Centre d’Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
| | - Carolina Riveros
- Centre d’Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
| | - Mathieu Raux
- Département d’Anesthésie Réanimation, Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Viet-Thi Tran
- Centre d’Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
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Lotfalla A, Halm J, Schepers T, Giannakópoulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). Eur J Trauma Emerg Surg 2022; 49:747-761. [PMID: 36445397 PMCID: PMC10175342 DOI: 10.1007/s00068-022-02178-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Introduction
Throughout the years, a decreasing trend in mortality rate has been demonstrated in patients suffering severe trauma. This increases the relevance of documentation of other outcomes for this population, including patient-reported outcome measures (PROMs), such as health-related quality of life (HRQoL). The aim of this review was to summarize the results of the studies that have been conducted regarding HRQoL in severely injured patients (as defined by the articles’ authors). Also, we present the instruments that are used most frequently to assess HRQoL in patients suffering severe trauma.
Methods
A literature search was conducted in the Cochrane Library, EMBASE, PubMed, and Web of Science for articles published from inception until the 1st of January 2022. Reference lists of included articles were reviewed as well. Studies were considered eligible when a population of patients with major, multiple or severe injury and/or polytrauma was included, well-defined by means of an ISS-threshold, and the outcome of interest was described in terms of (HR)QoL. A narrative design was chosen for this review.
Results
The search strategy identified 1583 articles, which were reduced to 113 after application of the eligibility criteria. In total, nineteen instruments were used to assess HRQoL. The SF-36 was used most frequently, followed by the EQ-5D and SF-12. HRQoL in patients with severe trauma was often compared to normative population norms or pre-injury status, and was found to be reduced in both cases, regardless of the tool used to assess this outcome. Some studies demonstrated higher scoring of the patients over time, suggesting improved HRQoL after considerable time after severe trauma.
Conclusion
HRQoL in severely injured patients is overall reduced, regardless of the instrument used to assess it. The instruments that were used most frequently to assess HRQoL were the SF-36 and EQ-5D. Future research is needed to shed light on the consequences of the reduced HRQoL in this population. We recommend routine assessment and documentation of HRQoL in severely injured patients.
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Mascialino G, Cañadas V, Valdiviezo-Oña J, Rodríguez-Lorenzana A, Arango-Lasprilla JC, Paz C. Self-concept 6 months after traumatic brain injury and its relationship with emotional functioning. Front Psychol 2022; 13:995436. [DOI: 10.3389/fpsyg.2022.995436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
This is an observational exploratory study assessing self-concept and its association with depression, anxiety, satisfaction with life, and quality of life 6 months after experiencing a traumatic brain injury. Participants were 33 patients who suffered a traumatic brain injury 6 months before the assessment. The measures used in this study were the Repertory Grid Technique, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Satisfaction With Life Scale, and the Quality of Life after Brain Injury. We calculated Euclidean distances to assess differences in pre-and post-injury self-perception, as well as the proportion of opposed pole construct rating and polarization to understand how they are associated with the scores of the other offered measures. We found that the distance between the present and ideal self, as well as the distance between the present self and the self before the lesion showed moderate positive correlations with depression, and negative correlations with satisfaction with life and quality of life. Also, for the present and self before the lesion, the proportion of opposed pole ratings was correlated with depression symptoms, quality, and satisfaction with life, while for the present self and the ideal self this proportion was correlated with all the measures. The proportion of polarization of the present self and the total polarization was negatively correlated with symptom measures. The repertory grid might facilitate a greater understanding of self-concept after traumatic brain injury. This information could be used to guide treatments that address the emotions related to distances observed in the perception of the self.
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van Essen TA, Lingsma HF, Pisică D, Singh RD, Volovici V, den Boogert HF, Younsi A, Peppel LD, Heijenbrok-Kal MH, Ribbers GM, Walchenbach R, Menon DK, Hutchinson P, Depreitere B, Steyerberg EW, Maas AIR, de Ruiter GCW, Peul WC, Åkerlund C, Amrein K, Andelic N, Andreassen L, Anke A, Antoni A, Audibert G, Azouvi P, Azzolini ML, Bartels R, Barzó P, Beauvais R, Beer R, Bellander BM, Belli A, Benali H, Berardino M, Beretta L, Blaabjerg M, Bragge P, Brazinova A, Brinck V, Brooker J, Brorsson C, Buki A, Bullinger M, Cabeleira M, Caccioppola A, Calappi E, Calvi MR, Cameron P, Carbayo Lozano G, Carbonara M, Castaño-León AM, Cavallo S, Chevallard G, Chieregato A, Citerio G, Clusmann H, Coburn MS, Coles J, Cooper JD, Correia M, Čović A, Curry N, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Dark P, Dawes H, De Keyser V, Degos V, Della Corte F, Đilvesi Đ, Dixit A, Donoghue E, Dreier J, Dulière GL, Ercole A, Esser P, Ezer E, Fabricius M, Feigin VL, Foks K, Frisvold S, Furmanov A, Gagliardo P, Galanaud D, Gantner D, Gao G, George P, Ghuysen A, Giga L, Glocker B, Golubović J, Gomez PA, Gratz J, Gravesteijn B, Grossi F, Gruen RL, Gupta D, Haagsma JA, Haitsma I, Helbok R, Helseth E, Horton L, Huijben J, Jacobs B, Jankowski S, Jarrett M, Jiang JY, Johnson F, Jones K, Karan M, Kolias AG, Kompanje E, Kondziella D, Kornaropoulos E, Koskinen LO, Kovács N, Lagares A, Lanyon L, Laureys S, Lecky F, Ledoux D, Lefering R, Legrand V, Lejeune A, Levi L, Lightfoot R, Maegele M, Majdan M, Manara A, Manley G, Maréchal H, Martino C, Mattern J, McMahon C, Melegh B, Menovsky T, Mikolic A, Misset B, Muraleedharan V, Murray L, Nair N, Negru A, Nelson D, Newcombe V, Nieboer D, Nyirádi J, Oresic M, Ortolano F, Otesile O, Palotie A, Parizel PM, Payen JF, Perera N, Perlbarg V, Persona P, Piippo-Karjalainen A, Pirinen M, Ples H, Polinder S, Pomposo I, Posti JP, Puybasset L, Rădoi A, Ragauskas A, Raj R, Rambadagalla M, Rehorčíková V, Retel Helmrich I, Rhodes J, Richardson S, Richter S, Ripatti S, Rocka S, Roe C, Roise O, Rosand J, Rosenfeld J, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Rueckert D, Rusnák M, Sahuquillo J, Sakowitz O, Sanchez-Porras R, Sandor J, Schäfer N, Schmidt S, Schoechl H, Schoonman G, Schou RF, Schwendenwein E, Sewalt C, Skandsen T, Smielewski P, Sorinola A, Stamatakis E, Stanworth S, Kowark A, Stevens R, Stewart W, Stocchetti N, Sundström N, Takala R, Tamás V, Tamosuitis T, Taylor MS, Te Ao B, Tenovuo O, Theadom A, Thomas M, Tibboel D, Timmers M, Tolias C, Trapani T, Tudora CM, Unterberg A, Vajkoczy P, Valeinis E, Vallance S, Vámos Z, Van der Jagt M, van der Naalt J, Van der Steen G, van Dijck JT, Van Hecke W, van Heugten C, Van Praag D, Van Veen E, van Wijk R, Vande Vyvere T, Vargiolu A, Vega E, Velt K, Verheyden J, Vespa PM, Vik A, Vilcinis R, von Steinbüchel N, Voormolen D, Vulekovic P, Wang KK, Wiegers E, Williams G, Wilson L, Winzeck S, Wolf S, Yang Z, Ylén P, Zeiler FA, Ziverte A, Zoerle T. Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study. Lancet Neurol 2022; 21:620-631. [DOI: 10.1016/s1474-4422(22)00166-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/05/2023]
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Singh RD, van Dijck JTJM, van Essen TA, Lingsma HF, Polinder SS, Kompanje EJO, van Zwet EW, Steyerberg EW, de Ruiter GCW, Depreitere B, Peul WC. Randomized Evaluation of Surgery in Elderly with Traumatic Acute SubDural Hematoma (RESET-ASDH trial): study protocol for a pragmatic randomized controlled trial with multicenter parallel group design. Trials 2022; 23:242. [PMID: 35351178 PMCID: PMC8962939 DOI: 10.1186/s13063-022-06184-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapidly increasing number of elderly (≥ 65 years old) with TBI is accompanied by substantial medical and economic consequences. An ASDH is the most common injury in elderly with TBI and the surgical versus conservative treatment of this patient group remains an important clinical dilemma. Current BTF guidelines are not based on high-quality evidence and compliance is low, allowing for large international treatment variation. The RESET-ASDH trial is an international multicenter RCT on the (cost-)effectiveness of early neurosurgical hematoma evacuation versus initial conservative treatment in elderly with a t-ASDH METHODS: In total, 300 patients will be recruited from 17 Belgian and Dutch trauma centers. Patients ≥ 65 years with at first presentation a GCS ≥ 9 and a t-ASDH > 10 mm or a t-ASDH < 10 mm and a midline shift > 5 mm, or a GCS < 9 with a traumatic ASDH < 10 mm and a midline shift < 5 mm without extracranial explanation for the comatose state, for whom clinical equipoise exists will be randomized to early surgical hematoma evacuation or initial conservative management with the possibility of delayed secondary surgery. When possible, patients or their legal representatives will be asked for consent before inclusion. When obtaining patient or proxy consent is impossible within the therapeutic time window, patients are enrolled using the deferred consent procedure. Medical-ethical approval was obtained in the Netherlands and Belgium. The choice of neurosurgical techniques will be left to the discretion of the neurosurgeon. Patients will be analyzed according to an intention-to-treat design. The primary endpoint will be functional outcome on the GOS-E after 1 year. Patient recruitment starts in 2022 with the exact timing depending on the current COVID-19 crisis and is expected to end in 2024. DISCUSSION The study results will be implemented after publication and presented on international conferences. Depending on the trial results, the current Brain Trauma Foundation guidelines will either be substantiated by high-quality evidence or will have to be altered. TRIAL REGISTRATION Nederlands Trial Register (NTR), Trial NL9012 . CLINICALTRIALS gov, Trial NCT04648436 .
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Affiliation(s)
- Ranjit D Singh
- University Neurosurgical Center Holland, LUMC, HMC and Haga Teaching Hospital, Leiden and The Hague, J11 Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jeroen T J M van Dijck
- University Neurosurgical Center Holland, LUMC, HMC and Haga Teaching Hospital, Leiden and The Hague, J11 Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Thomas A van Essen
- University Neurosurgical Center Holland, LUMC, HMC and Haga Teaching Hospital, Leiden and The Hague, J11 Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hester F Lingsma
- Centre for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Suzanne S Polinder
- Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Erwin J O Kompanje
- Department of Intensive Care, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Godard C W de Ruiter
- University Neurosurgical Center Holland, LUMC, HMC and Haga Teaching Hospital, Leiden and The Hague, J11 Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | | | - Wilco C Peul
- University Neurosurgical Center Holland, LUMC, HMC and Haga Teaching Hospital, Leiden and The Hague, J11 Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Schlemmer E, Nicholson N. Vestibular Rehabilitation Effectiveness for Adults With Mild Traumatic Brain Injury/Concussion: A Mini-Systematic Review. Am J Audiol 2022; 31:228-242. [PMID: 35077655 DOI: 10.1044/2021_aja-21-00165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Millions of people suffer from traumatic brain injuries every year with common sequelae, including dizziness, disequilibrium, compromised vision, and gait abnormalities. Individuals suffering a mild traumatic brain injury (mTBI) or concussion may be prescribed bed rest, but for some, symptoms may persist and require different treatment options. The aim of this mini-systematic review was to synthesize the best available evidence regarding the effectiveness of vestibular rehabilitation therapy (VRT) as a treatment option for adults with mTBIs. METHOD A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search term concepts were VRT and mTBI. Records meeting the inclusion criteria were extracted from the following databases: PubMed and CINAHL. A manual search of reference lists identified additional studies. Inclusion criteria were (a) participants with mTBI/concussion characterized by dizziness, balance, and/or other vestibular symptoms; (b) VRT as the primary treatment; and (c) self-reported and/or performance-based outcome measures. Data were extracted using a standardized tool, and studies were critically appraised. RESULTS Five studies were included in the systematic review: one randomized controlled trial, two retrospective chart reviews, one pre-/post-intervention study, and one case series. Four of the five studies found VRT to be effective at reducing postconcussion symptoms after head injury. Self-reported measures were included in all studies; performance-based measures were included in four out of five studies. None of the studies reported adverse effects of intervention. CONCLUSIONS Results suggest VRT is an effective treatment option for patients with persistent/lingering symptoms after concussion/mTBI, as demonstrated by self-reported and performance-based outcome measures. Results of this study emphasize the need for audiologists to be thoroughly familiar with VRT as an effective treatment for patients with persistent symptoms following mTBI.
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Affiliation(s)
- Erica Schlemmer
- Department of Audiology, Nova Southeastern University, Fort Lauderdale, FL
| | - Nannette Nicholson
- Department of Audiology, Nova Southeastern University, Fort Lauderdale, FL
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Mostert CQB, Singh RD, Gerritsen M, Kompanje EJO, Ribbers GM, Peul WC, van Dijck JTJM. Long-term outcome after severe traumatic brain injury: a systematic literature review. Acta Neurochir (Wien) 2022; 164:599-613. [PMID: 35098352 DOI: 10.1007/s00701-021-05086-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI. METHODS A systematic search was conducted using PubMed from 2008 to 2020. Studies were included when reporting long-term outcome ≥ 2 years after sTBI (GCS 3-8 or AIS head score ≥ 4), using standardized outcome measures. Study quality and risk of bias were assessed using the QUIPS tool. RESULTS Twenty observational studies were included. Studies showed substantial variation in study objectives and study methodology. GOS-E (n = 12) and GOS (n = 8) were the most frequently used outcome measures. Mortality was reported in 46% of patients (range 18-75%). Unfavourable outcome rates ranged from 29 to 100% and full recovery was seen in 21-27% of patients. Most surviving patients reported SF-36 scores lower than the general population. CONCLUSION Literature on long-term outcome after sTBI was limited and heterogeneous. Mortality and unfavourable outcome rates were high and persisting sequelae on multiple domains common. Nonetheless, a considerable proportion of survivors achieved favourable outcome. Future studies should incorporate standardized multidimensional and temporal long-term outcome measures to strengthen the evidence-base for acute and subacute decision-making. HIGHLIGHTS 1. Expectation of long-term outcome is an important factor in treatment decision-making for patients with severe traumatic brain injury (sTBI). 2. Favourable outcome and full recovery after sTBI are possible, but mortality and unfavourable outcome rates are high. 3. sTBI survivors are likely to suffer from a wide range of long-term consequences, underscoring the need for long-term and multi-modality outcome assessment in future studies. 4. The quality of the scientific literature on long-term outcome after sTBI can and should be improved to advance treatment decision-making.
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Affiliation(s)
- Cassidy Q B Mostert
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands.
| | - Ranjit D Singh
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Maxime Gerritsen
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Erwin J O Kompanje
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Jeroen T J M van Dijck
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
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van Erp IAM, van Essen TA, Fluiter K, van Zwet E, van Vliet P, Baas F, Haitsma I, Verbaan D, Coert B, de Ruiter GCW, Moojen WA, van der Jagt M, Peul WC. Safety and efficacy of C1-inhibitor in traumatic brain injury (CIAO@TBI): study protocol for a randomized, placebo-controlled, multi-center trial. Trials 2021; 22:874. [PMID: 34863258 PMCID: PMC8642972 DOI: 10.1186/s13063-021-05833-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/15/2021] [Indexed: 01/21/2023] Open
Abstract
Background Traumatic brain injury (TBI) is a major cause of death and disability across all ages. After the primary impact, the pathophysiologic process of secondary brain injury consists of a neuroinflammation response that critically leads to irreversible brain damage in the first days after the trauma. A key catalyst in this inflammatory process is the complement system. Inhibiting the complement system could therefore be a therapeutic target in TBI. Objective To study the safety and efficacy of C1-inhibitor (C1-INH) compared to placebo in patients with TBI. By temporarily blocking the complement system, we hypothesize a decrease in the posttraumatic neuroinflammatory response resulting in a less unfavorable clinical outcome for TBI patients. Methods CIAO@TBI is a multicenter, randomized, blinded, phase II placebo-controlled trial. Adult TBI patients with GCS < 13 requiring intracranial pressure (ICP) monitoring will be randomized, using block randomization, within 12 h after trauma to one dose 6000 IU C1-INH or placebo. A total of 106 patients will be included, and follow-up will occur up to 12 months. The primary endpoints are (1) Therapy Intensity Level (TIL) Scale, (2) Glasgow Outcome Scale-Extended (GOSE) at 6 months, and (3) complication rate during hospitalization. Outcomes will be determined by a trial nurse blinded for the treatment allocation. Analyses will be conducted in an intention-to-treat analysis. Discussion We expect that C1-INH administration will be safe and potentially effective to improve clinical outcomes by reducing neuroinflammation in TBI patients. Trial registration ClinicalTrials.gov NCT04489160. Registered on 27 July 2020. EudraCT 2020-000140-58 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05833-1.
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Affiliation(s)
- Inge A M van Erp
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, Hague, The Netherlands.
| | - Thomas A van Essen
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, Hague, The Netherlands
| | - Kees Fluiter
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik van Zwet
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter van Vliet
- Department of Intensive Care, Haaglanden Medical Center, The Hague, The Netherlands
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Iain Haitsma
- Department of Neurosurgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Dagmar Verbaan
- Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bert Coert
- Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Godard C W de Ruiter
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, Hague, The Netherlands
| | - Wouter A Moojen
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, Hague, The Netherlands
| | - Mathieu van der Jagt
- Department of Intensive Care Adults, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, Hague, The Netherlands
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Falkowska Z, Heider N, Resch K, Royko J, Büttner-Kunert J. Die Erhebung von kommunikativ-pragmatischen Fähigkeiten und Lebensqualität nach Schädel-Hirn-Trauma. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2021. [DOI: 10.1024/1016-264x/a000336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund: Kommunikationsstörungen nach Schädel-Hirn-Trauma (SHT) können die Betroffenen langfristig in der sozialen Teilhabe und damit in der Lebensqualität (LQ) beeinträchtigen. Der Erfassung dieser Störungen liegt aktuell kein einheitliches Vorgehen zugrunde. Ziele: Ziel des vorliegenden Scoping Reviews war die Erfassung von Diagnostikverfahren, welche die kommunikativ-pragmatischen Kompetenzen und die Auswirkung möglicher kommunikativer Defizite auf soziale Teilhabe und LQ bei Menschen mit SHT überprüfen. Ergebnisse: Eine systematische Datenbankrecherche für den Veröffentlichungszeitraum 2010 bis 2020 identifizierte 14 relevante Testverfahren (6 auf Deutsch verfügbar). Eine inhaltliche und methodische Analyse stellte Verfahren zur Überprüfung der Kommunikationsfähigkeit (z. B. La Trobe Communication Questionnaire [LCQ]) und Verfahren zur Erfassung von Partizipation und LQ (z. B. Quality of Life after Brain Injury [QOLIBRI]) heraus. Zusammenfassung: Trotz der hohen Auftretenshäufigkeit und Persistenz kommunikativer Störungen nach SHT stehen im deutschsprachigen Raum bislang wenige geeignete Diagnostikverfahren zur Ermittlung von Kommunikationsfähigkeiten und LQ zur Verfügung. Eine weiterführende Entwicklung erscheint unerlässlich.
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Affiliation(s)
- Zofia Falkowska
- Masterstudiengang Sprachtherapie, Schwerpunkt „Neurogene Sprach- und Sprechstörungen“, LMU München
| | - Nathalie Heider
- Masterstudiengang Sprachtherapie, Schwerpunkt „Neurogene Sprach- und Sprechstörungen“, LMU München
| | - Katharina Resch
- Masterstudiengang Sprachtherapie, Schwerpunkt „Neurogene Sprach- und Sprechstörungen“, LMU München
| | - Julia Royko
- Masterstudiengang Sprachtherapie, Schwerpunkt „Neurogene Sprach- und Sprechstörungen“, LMU München
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18
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Mann G, Troeung L, Wagland J, Martini A. Cohort profile: the Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT), Western Australia, 1991-2020. BMJ Open 2021; 11:e052728. [PMID: 34475189 PMCID: PMC8413932 DOI: 10.1136/bmjopen-2021-052728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/06/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Transition back into the community following acute management of acquired brain injury (ABI) is a critical part of recovery. Post-acute rehabilitation and transitional care can significantly improve outcomes. The Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT) is a novel whole-population cohort formed to better understand the needs of individuals with ABI receiving post-acute rehabilitation and disability services in Western Australia (WA), and to improve their outcomes. To do this a unique combination of (1) internal clinical/rehabilitation data, and (2) externally linked health data from the WA Data Linkage System was used, including hospitalisations, emergency department presentations, mental health service use and death records, to measure longitudinal needs and outcomes of individuals with ABI over 29 years, making this the largest, most diverse post-acute ABI cohort in Australia to date. PARTICIPANTS Whole-population cohort of individuals (n=1011) with an ABI who received post-acute community-based neurorehabilitation or disability support services through Brightwater Care Group from 1991 to 2020. FINDINGS TO DATE Comprehensive baseline demographic, clinical and rehabilitation data, outcome measures and linked health data have been collected and analysed. Non-traumatic brain injury (eg, stroke, hypoxia) was the main diagnostic group (54.9%, n=555), followed by traumatic brain injury (34.9%, n=353) and eligible neurological conditions (10.2%, n=103). Mean age at admission was 45.4 years, and 67.5% were men (n=682). The cohort demonstrated significant heterogeneity, socially and clinically, with differences between ABI groups across a number of domains. FUTURE PLANS ABI-RESTaRT is a dynamic whole-population cohort that will be updated over time as individuals enrol in the service. Future analyses will assess longitudinal brain injury outcomes, the changing health and social needs of individuals with ABI and evaluate and inform post-acute services to best support these individuals. REGISTRATION This cohort is not linked to a clinical trial, and is not registered.
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Affiliation(s)
- Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
- School of Social Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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Fure SCR, Howe EI, Spjelkavik Ø, Røe C, Rike PO, Olsen A, Ponsford J, Andelic N, Løvstad M. Post-concussion symptoms three months after mild-to-moderate TBI: characteristics of sick-listed patients referred to specialized treatment and consequences of intracranial injury. Brain Inj 2021; 35:1054-1064. [PMID: 34314269 DOI: 10.1080/02699052.2021.1953593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To present pre-injury, injury-related, work-related and post-injury characteristics, and to compare patients with and without traumatic intracranial abnormalities, in a treatment-seeking sample with persistent post-concussion symptoms (PPCS) after mild-to-moderate TBI.Methods: Cross-sectional design in the context of a specialized TBI outpatient clinic. Eligible patients were aged 18-60 years, employed ≥ 50% at time of injury, and sick listed ≥ 50% at inclusion due to PPCS. Data were collected 8-12 weeks after injury through review of medical records, semi-structured interviews, questionnaires, and neuropsychological screening.Results: The study included 116 patients, of whom 60% were women, and predominantly white-collar workers in full-time positions. Ninety-four percent had a mild TBI, and 23% had intracranial abnormalities. The full sample reported high somatic, emotional, and cognitive symptom burden, and decreased health-related quality of life. Patients with normal CT/MRI results reported higher overall symptom burden, while patients with intracranial abnormalities had worse memory function.Conclusion: Injury severity and traumatic intracranial radiological findings should not be the sole ground for planning of rehabilitation service provision in patients with PPCS, as subjective complaints do not necessarily co-vary with these variables.
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Affiliation(s)
- Silje Christine Reistad Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway
| | - Per-Ola Rike
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Technology and Science, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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20
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Riemann L, Voormolen DC, Rauen K, Zweckberger K, Unterberg A, Younsi A. Persistent postconcussive symptoms in children and adolescents with mild traumatic brain injury receiving initial head computed tomography. J Neurosurg Pediatr 2021; 27:538-547. [PMID: 33636701 DOI: 10.3171/2020.9.peds20421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment. METHODS Patients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13-15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. HRQOL was compared in patients with and without PCS using the Quality of Life after Brain Injury (QOLIBRI) questionnaire. RESULTS A total of 196 adolescent or pediatric mTBI patients requiring head CT imaging were included. High-energy trauma was prevalent in more than half of cases (54%), abnormalities on head CT scans were detected in 41%, and admission to the regular ward or intensive care unit was necessary in 78%. Six months postinjury, 36% of included patients had experienced at least one moderate or severe symptom on the RPQ. PCS was present in 13% of adolescents and children when considering symptoms of at least moderate severity, and those patients had significantly lower QOLIBRI total scores, indicating lower HRQOL, compared with young patients without PCS (57 vs 83 points, p < 0.001). CONCLUSIONS Adolescent and pediatric mTBI patients requiring head CT imaging show signs of increased trauma severity. Postconcussive symptoms are present in up to one-third of those patients, and PCS can be diagnosed in 13% 6 months after injury. Moreover, PCS is significantly associated with decreased HRQOL.
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Affiliation(s)
- Lennart Riemann
- 1Department of Neurosurgery, University Hospital Heidelberg, Germany
| | - Daphne C Voormolen
- 2Department of Public Health, Erasmus MC-University Medical Center Rotterdam, The Netherlands; and
| | - Katrin Rauen
- 3University Hospital of Psychiatry Zurich, Department of Geriatric Psychiatry and Institute for Regenerative Medicine, University of Zurich, Switzerland
| | - Klaus Zweckberger
- 1Department of Neurosurgery, University Hospital Heidelberg, Germany
| | - Andreas Unterberg
- 1Department of Neurosurgery, University Hospital Heidelberg, Germany
| | - Alexander Younsi
- 1Department of Neurosurgery, University Hospital Heidelberg, Germany
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21
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King R, Seeger T, Wang M, Li Pi Shan R, McGovern C, Knox J, Patel L, Fung T, Sajobi T, Debert C. Early Supported Discharge for Neurorehabilitation Following Acquired Brain Injury. Front Neurol 2021; 11:596526. [PMID: 33424748 PMCID: PMC7793829 DOI: 10.3389/fneur.2020.596526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: Early Supported Discharge (ESD) is a clinical flow management service offering interdisciplinary rehabilitation, wherein patients are provided supported in-home rehabilitation treatment; in comparison to conventional hospital-based rehabilitation model of service delivery. There has been little research into the functional outcomes for other types of acquired brain injury (ABI). Methods: In this prospective cohort study, ABI patients presenting at a level I trauma center in Calgary, Canada were placed in either an ESD program or conventional inpatient rehabilitation (IPR) program based on their medical history and presentation. A small number of patients completed both programs (ESD+IPR group). ESD therapies were designed to emulate IPR. Participants completed professionally-rated Mayo-Portland Adaptability Index-4 (MPAI), Quality of Life after Brain Injury (QOLIBRI), Generalized Anxiety Questionnaire-7 (GAD7), Montreal Cognitive Assessment (MoCA), and Patient Health Questionnaire-9 (PHQ9) surveys at 1, 3, and 6 months following initial assessment pre-rehabilitation. Caregivers completed the Zarit Burden Interview (ZBI) at the same time points. The Supervision Rating Scale (SRS) and Disability Rating Scale (DRS) were completed at admission to rehabilitation and all follow-ups. Generalized estimate equations models were used to describe the three groups over time, including age as a covariate. Results: Significant effects of time were reported in the MPAI participant sub-score in the ESD and IPR groups (χ(2)2 = 42.429, p < 0.000; χ(2)2 = 9.773, p = 0.008), showing significantly higher scores between 1 and 3 month timepoints for both groups. ZBI scores were significantly lower in the ESD group at 1 month compared to 3 and 6 months (χ(2)2 = 31.252, p < 0.001). The proportion of patients with medical complications during rehabilitation was 25.3% in ESD compared to 74.7% patients in IPR. Conclusions: Improvements in functional outcomes were evident in patients participating in ESD and IPR, with more medical complications reported in the IPR group. Caregiver burden lessened over time in the ESD group but not in the IPR group. Both ESD and ESD+IPR groups can be considered viable alternatives to traditional inpatient rehabilitation. A randomized control trial would be required to properly compare rehabilitation streams. Further investigation into affective and lifestyle elements of ABI recovery would also improve our understanding of targeted neurorehabilitation in this population.
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Affiliation(s)
- Regan King
- Calgary Brain Injury Program, Alberta Health Services, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Trevor Seeger
- Calgary Brain Injury Program, Alberta Health Services, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Rodney Li Pi Shan
- Calgary Brain Injury Program, Alberta Health Services, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine McGovern
- Calgary Brain Injury Program, Alberta Health Services, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jason Knox
- Calgary Brain Injury Program, Alberta Health Services, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lisa Patel
- Calgary Brain Injury Program, Alberta Health Services, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tak Fung
- Department of Nursing, University of Calgary, Calgary, AB, Canada
| | - Tolulope Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Chantel Debert
- Calgary Brain Injury Program, Alberta Health Services, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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22
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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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23
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Houben F, Ghysels R, Mennen D, Bosmans R, Nuyts E, Spooren A. A tool for measuring burden in activities and participation of clients with acquired brain injury: the FINAH-instrument. Brain Inj 2020; 34:1245-1252. [PMID: 32755421 DOI: 10.1080/02699052.2020.1802658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study was to design an instrument to screen for burden in the daily life of both the client with acquired brain injury (ABI) and their nonprofessional caregiver. RESEARCH DESIGN Exploratory research Methods and Procedures: Based on a survey amongst stakeholder organizations, the FINAH-instrument is designed as a digital self-assessment questionnaire, based on ICF-framework. A test survey of the FINAH instrument is conducted on both clients, nonprofessional caregivers and healthcare professionals. MAIN OUTCOMES AND RESULTS The relative burden per item for clients and nonprofessional caregivers is most prominent in the domains of fatigue, cognitive and emotional consequences, self-care and mobility. The estimation of burden for clients and nonprofessional caregiver by healthcare professionals showed an overall 65% correct estimation by the healthcare professional. 19% of the items showed underestimation of burden, while 16% showed overestimation. CONCLUSIONS These results show that FINAH can ameliorate the estimation of the health care professional on the self-assessed burden of clients and nonprofessional caregivers, thus substantiating a more client-centred approach.
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Affiliation(s)
- Frederik Houben
- Department of Healthcare, PXL University College , Hasselt, Belgium
| | - Rudi Ghysels
- Department of Healthcare, PXL University College , Hasselt, Belgium
| | - Danny Mennen
- Department of Neurology, Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek, The Netherlands
| | - Roel Bosmans
- Department of Technology, PXL University College , Hasselt, Belgium
| | - Erik Nuyts
- Department of Healthcare, PXL University College , Hasselt, Belgium.,Faculty of Architecture and Arts, Hasselt University , Hasselt, Belgium
| | - Annemie Spooren
- Department of Healthcare, PXL University College , Hasselt, Belgium.,Faculty of Rehabilitation Sciences, Hasselt University , Hasselt, Belgium
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24
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Voormolen DC, Polinder S, von Steinbuechel N, Feng Y, Wilson L, Oppe M, Haagsma JA. Health-related quality of life after traumatic brain injury: deriving value sets for the QOLIBRI-OS for Italy, The Netherlands and The United Kingdom. Qual Life Res 2020; 29:3095-3107. [PMID: 32671617 PMCID: PMC7591447 DOI: 10.1007/s11136-020-02583-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2020] [Indexed: 11/30/2022]
Abstract
Purpose The Quality of Life after Brain Injury overall scale (QOLIBRI-OS) measures health-related quality of life (HRQoL) after traumatic brain injury (TBI). The aim of this study was to derive value sets for the QOLIBRI-OS in three European countries, which will allow calculation of utility scores for TBI health states. Methods A QOLIBRI-OS value set was derived by using discrete choice experiments (DCEs) and visual analogue scales (VAS) in general population samples from the Netherlands, United Kingdom and Italy. A three-stage procedure was used: (1) A selection of health states, covering the entire spectrum of severity, was defined; (2) General population samples performed the health state valuation task using a web-based survey with three VAS questions and an at random selection of sixteen DCEs; (3) DCEs were analysed using a conditional logistic regression and were then anchored on the VAS data. Utility scores for QOLIBRI-OS health states were generated resulting in estimates for all potential health states. Results The questionnaire was completed by 13,623 respondents. The biggest weight increase for all attributes is seen from “slightly” to “not at all satisfied”, resulting in the largest impact on HRQoL. “Not at all satisfied with how brain is working” should receive the greatest weight in utility calculations in all three countries. Conclusion By transforming the QOLIBRI-OS into utility scores, we enabled the application in economic evaluations and in summary measures of population health, which may be used to inform decision-makers on the best interventions and strategies for TBI patients. Electronic supplementary material The online version of this article (10.1007/s11136-020-02583-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daphne C. Voormolen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, Georg-August-University, Waldweg 37, 37073 Göttingen, Germany
| | - Yan Feng
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Lindsay Wilson
- Department of Psychology, University of Stirling, Stirling, UK
| | - Mark Oppe
- Axentiva Solutions, C/Calvario, 271-B 1º IZQ, Tacoronte, 38350 Santa Cruz de Tenerife, Spain
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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25
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Voormolen DC, Zeldovich M, Haagsma JA, Polinder S, Friedrich S, Maas AIR, Wilson L, Steyerberg EW, Covic A, Andelic N, Plass AM, Wu YJ, Asendorf T, von Steinbüechel N. Outcomes after Complicated and Uncomplicated Mild Traumatic Brain Injury at Three-and Six-Months Post-Injury: Results from the CENTER-TBI Study. J Clin Med 2020; 9:jcm9051525. [PMID: 32443573 PMCID: PMC7291134 DOI: 10.3390/jcm9051525] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to provide a comprehensive examination of the relation of complicated and uncomplicated mild traumatic brain injury (mTBI) with multidimensional outcomes at three- and six-months after TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) research project. Patients after mTBI (Glasgow Coma scale (GCS) score of 13-15) enrolled in the study were differentiated into two groups based on computed tomography (CT) findings: complicated mTBI (presence of any traumatic intracranial injury on first CT) and uncomplicated mTBI (absence of any traumatic intracranial injury on first CT). Multidimensional outcomes were assessed using seven instruments measuring generic and disease-specific health-related quality of life (HRQoL) (SF-36 and QOLIBRI), functional outcome (GOSE), and psycho-social domains including symptoms of post-traumatic stress disorder (PTSD) (PCL-5), depression (PHQ-9), and anxiety (GAD-7). Data were analyzed using a multivariate repeated measures approach (MANOVA-RM), which inspected mTBI groups at three- and six-months post injury. Patients after complicated mTBI had significantly lower GOSE scores, reported lower physical and mental component summary scores based on the SF-36 version 2, and showed significantly lower HRQoL measured by QOLIBRI compared to those after uncomplicated mTBI. There was no difference between mTBI groups when looking at psychological outcomes, however, a slight improvement in PTSD symptoms and depression was observed for the entire sample from three to six months. Patients after complicated mTBI reported lower generic and disease specific HRQoL and worse functional outcome compared to individuals after uncomplicated mTBI at three and six months. Both groups showed a tendency to improve from three to six months after TBI. The complicated mTBI group included more patients with an impaired long-term outcome than the uncomplicated group. Nevertheless, patients, clinicians, researchers, and decisions-makers in health care should take account of the short and long-term impact on outcome for patients after both uncomplicated and complicated mTBI.
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Affiliation(s)
- Daphne C. Voormolen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.)
- Correspondence: (D.C.V.); (M.Z.); Tel.: +31-628683742 (D.C.V.); Tel.: +49-551398195 (M.Z.)
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
- Correspondence: (D.C.V.); (M.Z.); Tel.: +31-628683742 (D.C.V.); Tel.: +49-551398195 (M.Z.)
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.)
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.)
| | - Sarah Friedrich
- Department of Medical Statistics, University Medical Center Göttingen, 37073 Göttingen, Germany; (S.F.); (T.A.)
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Neurosurgery, University of Antwerp, 2650 Edegem, Belgium
| | - Lindsay Wilson
- Department of Psychology, University of Stirling, Stirling FK9 4LJ, UK;
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.)
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway;
- Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, 0373 Oslo, Norway
| | - Anne Marie Plass
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
| | - Yi-Jhen Wu
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, 37073 Göttingen, Germany; (S.F.); (T.A.)
| | - Nicole von Steinbüechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
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Borgen IMH, Løvstad M, Andelic N, Hauger S, Sigurdardottir S, Søberg HL, Sveen U, Forslund MV, Kleffelgård I, Lindstad MØ, Winter L, Røe C. Traumatic brain injury-needs and treatment options in the chronic phase: Study protocol for a randomized controlled community-based intervention. Trials 2020; 21:294. [PMID: 32216840 PMCID: PMC7099773 DOI: 10.1186/s13063-020-4195-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/20/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is often associated with life-long medical, cognitive, emotional, and behavioral changes. Although long-lasting disabilities are expected, research on effective treatment options in the chronic phase of TBI is scarce. METHODS/DESIGN This study protocol describes a randomized controlled trial (RCT) aimed at evaluating the effectiveness of a goal-oriented and community-based intervention for increasing community integration, quality of life, and functional independence in the chronic phase of complicated mild to severe TBI. Participants will be recruited from Oslo University Hospital, Norway. Patients aged 18-72 years living at home with MRI/CT-verified intracranial abnormalities, a TBI diagnosis, a time since injury of ≥ 2 years, and who experience either current TBI-related problems or restrictions in community integration will be included. The 120 participants will be randomized 1:1 to either (a) an intervention group, which will receive an in-home intervention program over 4 months, or (b) a control group receiving standard care in the municipalities. The intervention will consist of six home visits and two telephone contacts with a rehabilitation professional. A SMART-goal approach will be adopted to target the individual's self-reported TBI difficulties in everyday life. Primary outcomes will be self-reported quality of life and participation. Secondary outcomes include symptom burden, emotional functioning, and clinician-assessed global outcome and need for rehabilitation services. Outcomes will be evaluated at baseline and 4-5 and 12 months after baseline. Caregiver burden and general health will be assessed in participating family members. Goal attainment and acceptability will be evaluated in the intervention group. A process evaluation will be carried out to evaluate protocol adherence, and a cost-effectiveness analysis will be applied if the intervention is found to be effective. DISCUSSION The current study provides an innovative approach to rehabilitation in the chronic phase of TBI evaluated using an RCT design that may inform treatment planning, health policies, and coordination of patient care. Further, the study may demonstrate new modes of establishing collaboration and knowledge transition between specialized rehabilitation facilities and local rehabilitation services that may improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT03545594. Registered on June 4th, 2018.
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Affiliation(s)
- Ida Maria H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Solveig Hauger
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | | | - Helene L. Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marte Ørud Lindstad
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Laraine Winter
- Philadelphia Research and Education Foundation, Philadelphia, PA USA
- Nursing Service, Department of Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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27
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Borgen IMH, Løvstad M, Røe C, Forslund MV, Hauger SL, Sigurdardottir S, Winter L, Kleffelgård I. Needs and treatment options in chronic traumatic brain injury: A feasibility trial of a community-based intervention. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1731222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Ida Maria H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Oslo Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo Oslo Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo Oslo Norway
- Department of Research, Sunnaas Rehabilitation Hospital Nesoddtangen Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo Oslo Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo Oslo Norway
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Oslo Norway
| | - Solveig L. Hauger
- Department of Psychology, Faculty of Social Sciences, University of Oslo Oslo Norway
- Department of Research, Sunnaas Rehabilitation Hospital Nesoddtangen Norway
| | | | - Laraine Winter
- Philadelphia Research and Education Foundation Philadelphia PA USA
- Nursing Service, Department of Veterans Affairs Medical Center Philadelphia PA USA
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Oslo Norway
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von Steinbüchel N, Meeuwsen M, Zeldovich M, Vester JC, Maas A, Koskinen S, Covic A. Differences in Health-Related Quality of Life after Traumatic Brain Injury between Varying Patient Groups: Sensitivity of a Disease-Specific (QOLIBRI) and a Generic (SF-36) Instrument. J Neurotrauma 2020; 37:1242-1254. [PMID: 31801408 DOI: 10.1089/neu.2019.6627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Factors associated with health-related quality of life (HRQOL) in patients after traumatic brain injury (TBI) include severity of initial injury, different grades of trauma recovery, sociodemographic status, and psychological characteristics. Yet, sensitivity of HRQOL instruments to such effects is often underexplored. Thus, we aimed to compare the capacity of the disease-specific QOLIBRI (Quality of Life after Brain Injury) and the generic Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey(SF-36) to detect significant differences in HRQOL between patients. Patients (n = 795) completed HRQOL, sociodemographic, clinical, psychological, and health status questionnaires. Univariate (Wilcoxon-Mann-Whitney) and multi-variate (Wei-Lachin) non-parametric analyses were conducted using the Wilcoxon-Mann-Whitney approach to compare the sensitivity of the QOLIBRI and the SF-36. For both instruments, HRQOL was particularly influenced by patients' reliance on others, depression, anxiety, and recovery status, whereas smaller effects were found for living arrangements and participation in leisure activities. Both HRQOL instruments were sensitive to group differences, but the QOLIBRI was able to detect a greater number of and finer differences between specific patient groups, which is particularly important in clinical and therapeutic contexts. This finding is likely explained by the QOLIBRI's greater specificity to disease-specific aspects of consequences of TBI. This head-to-head HRQOL instrument comparison resulted in a recommendation for the use of the QOLIBRI when detailed insight in the subjective consequences and impact of TBI on patients is required.
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Affiliation(s)
- Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Mirjam Meeuwsen
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Sanna Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
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29
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Yeo YX, Pestell CF, Bucks RS, Allanson F, Weinborn M. Metacognitive knowledge and functional outcomes in adults with acquired brain injury: A meta-analysis. Neuropsychol Rehabil 2019; 31:453-478. [PMID: 31876262 DOI: 10.1080/09602011.2019.1704421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pronounced difficulties in functional outcomes often follow acquired brain injury (ABI), and may be due, in part, to deficits in metacognitive knowledge (being unaware of one's cognitive strengths and limitations). A meta-analytic review of the literature investigating the relationship between metacognitive knowledge and functional outcomes in ABI is timely, particularly given the presence of apparently inconsistent findings. Twenty-two articles revealed two distinct methods of measuring metacognitive knowledge: (1) absolute (the degree of inaccurate self-appraisal regardless of whether the error tends towards under- or over-confident estimations) and (2) relative (the degree and the direction of the inaccuracy) discrepancy. Separate meta-analyses were conducted for absolute and relative discrepancy studies to assess the relationship between metacognitive knowledge and functional outcomes (affect-related quality of life, family and community integration, and work outcomes). The pattern of results found suggested that better metacognitive knowledge is related to better overall functional outcomes, but the relationship may differ depending on the outcome domain. These findings generally support the importance of focusing on metacognitive knowledge to improve outcomes following ABI. Nonetheless, the relatively small effect sizes observed suggest that other predictors of functional outcome should be investigated, including other subdomains of metacognition.
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Affiliation(s)
- Yong Xiang Yeo
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Fiona Allanson
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Perth, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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30
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Gertler P, Tate RL. Behavioural activation therapy to improve participation in adults with depression following brain injury: A single-case experimental design study. Neuropsychol Rehabil 2019; 31:369-391. [PMID: 31793383 DOI: 10.1080/09602011.2019.1696212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Following brain injury, the risk of depression increases. There are few studies of non-pharmacological interventions for this problem. Behavioural Activation (BA) could help because it has been demonstrated to be as effective as cognitive-behaviour therapy but is less cognitively demanding and more suitable for people with brain impairment. The current study evaluated BA using a multiple-baseline design across behaviours with replication. Three male participants with clinically significant depressive symptoms (two with traumatic brain injury aged 26 and 46, one who experienced strokes in infancy, aged 26) engaged in a 10-14-week trial of BA focusing on three activity domains: physical, social and functional activities. Participants completed an online form three times a day which recorded activity participation and responses to a single-item mood scale. There was little evidence in support of BA for increasing participation. There was also a lack of change in average mood, but some positive effects were found on measures of depression symptoms and quality of life in these participants. Various factors affected participation which might have been mitigated by extended treatment contact, greater use of prompts or electronic aids or the addition of other therapy modes.
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Affiliation(s)
- Paul Gertler
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robyn L Tate
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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31
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Van Essen TA, Volovici V, Cnossen MC, Kolias A, Ceyisakar I, Nieboer D, Peppel LD, Heijenbrok-Kal M, Ribbers G, Menon D, Hutchinson P, Depreitere B, de Ruiter GCW, Lingsma HF, Steyerberg EW, Maas AI, Peul WC. Comparative effectiveness of surgery in traumatic acute subdural and intracerebral haematoma: study protocol for a prospective observational study within CENTER-TBI and Net-QuRe. BMJ Open 2019; 9:e033513. [PMID: 31619435 PMCID: PMC6797419 DOI: 10.1136/bmjopen-2019-033513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Controversy exists about the optimal treatment for patients with a traumatic acute subdural haematoma (ASDH) and an intracerebral haematoma/contusion (t-ICH). Treatment varies largely between different regions. The effect of this practice variation on patient outcome is unknown. Here, we present the protocol for a prospective multicentre observational study aimed at comparing the effectiveness of different treatment strategies in patients with ASDH and/or t-ICH. Specifically, the aims are to compare (1) an acute surgical approach to an expectant approach and (2) craniotomy to decompressive craniectomy when evacuating the haematoma. METHODS AND ANALYSIS Patients presenting to the emergency room with an ASDH and/or an t-ICH are eligible for inclusion. Standardised prospective data on patient and injury characteristics, treatment and outcome will be collected on 1000 ASDH and 750 t-ICH patients in 60-70 centres within two multicentre prospective observational cohort studies: the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and Neurotraumatology Quality Registry (Net-QuRe). The interventions of interest are acute surgery, defined as surgery directly after the first CT at presentation versus late or no surgery and craniotomy versus decompressive craniectomy. The primary outcome measure is the Glasgow Outcome Score-Extended at 6 months. Secondary outcome measures include in-hospital mortality, quality of life and neuropsychological tests. In the primary analysis, the effect of treatment preference (eg, proportion of patients in which the intervention under study is preferred) per hospital will be analysed with random effects ordinal regression models, adjusted for casemix and stratified by study. Such a hospital-level approach reduces confounding by the indication. Sensitivity analyses will include propensity score matching, with treatment defined on patient level. This study is designed to determine the best acute management strategy for ASDH and t-ICH by exploiting the existing between-hospital variability in surgical management. ETHICS AND DISSEMINATION Ethics approval was obtained in all participating countries. Results of surgical management of ASDH and t-ICH/contusion will separately be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02210221 and NL 5761.
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Affiliation(s)
- Thomas A Van Essen
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
- Centre for Medical Decision Sciences, Department of Public Health, ErasmusMC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Victor Volovici
- Centre for Medical Decision Sciences, Department of Public Health, ErasmusMC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Neurosurgery, ErasmusMC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Maryse C Cnossen
- Centre for Medical Decision Sciences, Department of Public Health, ErasmusMC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Iris Ceyisakar
- Centre for Medical Decision Sciences, Department of Public Health, ErasmusMC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Daan Nieboer
- Centre for Medical Decision Sciences, Department of Public Health, ErasmusMC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lianne D Peppel
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, ErasmusMC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Majanka Heijenbrok-Kal
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, ErasmusMC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerard Ribbers
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, ErasmusMC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David Menon
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital KU Leuven, Leuven, Belgium
| | - Godard C W de Ruiter
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Hester F Lingsma
- Centre for Medical Decision Sciences, Department of Public Health, ErasmusMC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
- Centre for Medical Decision Sciences, Department of Public Health, ErasmusMC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre and Haaglanden Medical Centre, Leiden and The Hague, The Netherlands
| | - Andrew I Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Wilco C Peul
- University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
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Gorgoraptis N, Zaw-Linn J, Feeney C, Tenorio-Jimenez C, Niemi M, Malik A, Ham T, Goldstone AP, Sharp DJ. Cognitive impairment and health-related quality of life following traumatic brain injury. NeuroRehabilitation 2019; 44:321-331. [DOI: 10.3233/nre-182618] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nikos Gorgoraptis
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Joanna Zaw-Linn
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Claire Feeney
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross and St. Mary’s Hospitals, London, UK
| | - Carmen Tenorio-Jimenez
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Mari Niemi
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Aysha Malik
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Timothy Ham
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Anthony P. Goldstone
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross and St. Mary’s Hospitals, London, UK
| | - David J. Sharp
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
- Department of Medicine, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
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Qureshi KL, Upthegrove R, Toman E, Sawlani V, Davies DJ, Belli A. Post-traumatic stress disorder in UK civilians with traumatic brain injury: an observational study of TBI clinic attendees to estimate PTSD prevalence and its relationship with radiological markers of brain injury severity. BMJ Open 2019; 9:e021675. [PMID: 30782864 PMCID: PMC6377568 DOI: 10.1136/bmjopen-2018-021675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of post-traumatic stress disorder (PTSD) in a large civilian population with traumatic brain injury (TBI), and to assess whether brain injury severity is correlated with PTSD symptoms. DESIGN Observational, cross-sectional study. SETTING AND PARTICIPANTS Outpatient clinic in a major UK trauma centre and secondary care hospital. Estimates of PTSD prevalence are based on 171 sampled individuals attending TBI clinic within an 18-month period. Analysis of the relationship between TBI severity and PTSD was performed on the subset of 127 patients for whom injury severity data were also available. METHODS Civilian TBI clinic attendees completed validated self-report questionnaires assessing PTSD (PTSD Checklist Civilian Version (PCL-C)) and other psychiatric symptoms. From this, the prevalence of PTSD was estimated in our cohort. Postresuscitation Glasgow Coma Score and Marshall grade on CT brain scan were recorded as indicators of brain injury severity. A hierarchical regression explored whether TBI severity may predict PTSD scores. RESULTS A high prevalence of PTSD was estimated (21% with PCL-C score >50). Higher Marshall grading displayed a slight negative correlation with PTSD symptoms. This statistically significant relationship persisted after confounding factors such as depression and postconcussion symptoms were controlled for. CONCLUSIONS PTSD and TBI frequently coexist, share antecedents and overlap in their resultant symptoms. This complexity has given rise to conflicting hypotheses about relationships between the two. This research reveals that PTSD is common in civilians with TBI (adding to evidence drawn from military populations). The analysis indicated that more severe brain injury may exert a slight protective influence against the development of PTSD-potentially by disrupting implicit access to traumatic memories, or via overlapping neuropsychiatric symptoms that impede diagnosis. The association suggests that further research is warranted to explore the reuse of routine clinical and neuroimaging data-investigating its potential to predict risk of psychiatric morbidity.
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Affiliation(s)
- Kasim L Qureshi
- Department of Psychiatry, School of Psychology and College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Department of Psychiatry, School of Psychology and College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Emma Toman
- National Institute for Health Research, Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Vijay Sawlani
- Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK
| | - David James Davies
- National Institute for Health Research, Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Antonio Belli
- Institute of Inflammation and Aging, University of Birmingham, Birmingham, UK
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Waqas M, Malik N, Shamim MS, Nathani KR, Abbasi SA. Quality of Life Among Patients Undergoing Decompressive Craniectomy for Traumatic Brain Injury Using Glasgow Outcome Scale Extended and Quality of Life After Brain Injury Scale. World Neurosurg 2018; 116:e783-e790. [DOI: 10.1016/j.wneu.2018.05.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/13/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
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Heiberg G, Pedersen SG, Friborg O, Nielsen JF, Holm HS, Steinbüchel von N, Arntzen C, Anke A. Can the health related quality of life measure QOLIBRI- overall scale (OS) be of use after stroke? A validation study. BMC Neurol 2018; 18:98. [PMID: 30021558 PMCID: PMC6052666 DOI: 10.1186/s12883-018-1101-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 07/09/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brief measures of health-related quality of life (HRQOL) that assess both patient-reported functioning and well-being after stroke are scarce. The objective of this study was to examine reliability and validity of one of these measures, the patient-reported Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS), in patients after stroke. METHODS Stroke survivors were examined prospectively using survey methods. Core survey data (n = 125) and retest data (n = 36) were obtained at 3 and 12 months, respectively. Item properties (distribution, floor and ceiling effects), psychometric properties (reliability and model fit), and validity (correlations with established measures of anxiety, depression and HRQOL) of the QOLIBRI-OS were examined. RESULTS Missing responses on the questionnaire were low (0.5%). All items were positively skewed. No floor effects were present, whereas five out of six items showed ceiling effects. The summary QOLIBRI-OS score exhibited no floor or ceiling effects, and had excellent internal consistency (Cronbach's α =0.93). All item-total correlations were high (0.73-0.88). The test-retest reliability of single items varied from 0.74 to 0.91 and was 0.93 for the overall score. The confirmatory factor analysis yielded an excellent fit for a five-item version and provided tentative support for the original six-item version. The convergent validity correlations were in the hypothesized directions, thus supporting the construct validity. CONCLUSIONS The brief QOLIBRI-OS is a valid and reliable brief health-related outcome measure that is appropriate for screening HRQOL in patients after stroke.
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Affiliation(s)
- Guri Heiberg
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway- Harstad, 9480 Harstad, Norway
| | - Synne Garder Pedersen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø The Artic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health Sciences, University of Tromsø, the Artic University of Norway, Tromsø, Norway
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Henriette Stabel Holm
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | | | - Cathrine Arntzen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø The Artic University of Norway, Tromsø, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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Born K, Amsler F, Gross T. Prospective evaluation of the Quality of Life after Brain Injury (QOLIBRI) score: minor differences in patients with major versus no or mild traumatic brain injury at one-year follow up. Health Qual Life Outcomes 2018; 16:136. [PMID: 29986710 PMCID: PMC6038178 DOI: 10.1186/s12955-018-0966-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/02/2018] [Indexed: 02/02/2023] Open
Abstract
Background The Quality of Life after Brain Injury (QOLIBRI) score was developed to assess disease-specific health-related quality of life (HRQoL) after traumatic brain injury (TBI). So far, validation studies on the QOLIBRI were only conducted in cohorts with traumatic brain injury. This study investigated the longer-term residuals in severely injured patients, focusing specifically on the possible impact of major TBI. Methods In a prospective questionnaire investigation, 199 survivors with an injury severity score (ISS) > 15 participated in one-year follow-up. Patients who had sustained major TBI (abbreviated injury scale, AIS head > 2) were compared with patients who had no or only mild TBI (AIS head ≤ 2). Univariate analysis (ANOVA, Cohen’s kappa, Pearson’s r) and stepwise linear regression analysis (B with 95% CI, R, R2) were used. Results The total QOLIBRI revealed no differences in one-year outcomes between patients with versus without major TBI (75 and 76, resp.; p = 0.68). With regard to the cognitive subscore, the group with major TBI demonstrated significantly more limitations than the one with no or mild TBI (p < 0.05). The AIS head correlated significantly with the cognitive dimension of the QOLIBRI (r = − 0.16; p < 0.05), but not with the mental components of the SF-36 or the TOP. In multivariate analysis, the influence of the severity of head injury (AIS head) on total QOLIBRI was weaker than that of injured extremities (R2 = 0.02; p < 0.05 vs. R2 = 0.04; p = 0.001) and equal to the QOLIBRI cognitive subscore (R2 = 0.03, p < 0.01 each). Conclusions Given the unexpected result of similar mean QOLIBRI total score values and only minor differences in cognitive deficits following major trauma independently of whether patients sustained major brain injury or not, further studies should investigate whether the QOLIBRI actually has the discriminative capacity to detect specific residuals of major TBI. In effect, the score appears to indicate mental deficits following different types of severe trauma, which should be evaluated in more detail. Trial registration NCT02165137; retrospectively registered 11 June 2014.
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Affiliation(s)
- Konstantin Born
- Department of Traumatology, Cantonal Hospital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | | | - Thomas Gross
- Department of Traumatology, Cantonal Hospital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland.
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37
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Abstract
OBJECTIVE The Quality of Life after Brain Injury (QOLIBRI), a cross-cultural instrument, has been validated in several languages; however, traditional psychometric approaches have critical limitations. Therefore, we applied the Rasch model for validating the 37-item QOLIBRI scale among a Chinese population with traumatic brain injury. PARTICIPANTS AND SETTING In total, 587 participants (mean age: 44.2 ± 15.4 years; women, 46.3%) were surveyed in neurosurgery departments at 6 hospitals in Taipei, Taiwan. MAIN OUTCOME MEASURE The QOLIBRI. RESULTS Of the 6 subscales of the QOLIBRI, 4 (cognition, self, daily life and autonomy, and social relationships) were unidimensional, valid, and reliable, whereas the remaining 2 (emotions and physical problems) exhibited poor unidimensionality, item and person reliability, and person-item targeting. Five items (energy, concentrating, getting out and about, sex life, and achievements) showed considerable differential item functioning among age groups, disability levels, and time since traumatic brain injury. CONCLUSION According to item response theory, we identified psychometric issues in the emotions and physical problems subscales of the QOLIBRI as well as several differential item functioning items. Future research is required to determine whether similar results are observed in other language versions of the QOLIBRI or in other countries.
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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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Howe EI, Langlo KPS, Terjesen HCA, Røe C, Schanke AK, Søberg HL, Sveen U, Aas E, Enehaug H, Alves DE, Klethagen P, Sagstad K, Moen CM, Torsteinsbrend K, Linnestad AM, Nordenmark TH, Rismyhr BS, Wangen G, Lu J, Ponsford J, Twamley EW, Ugelstad H, Spjelkavik Ø, Løvstad M, Andelic N. Combined cognitive and vocational interventions after mild to moderate traumatic brain injury: study protocol for a randomized controlled trial. Trials 2017; 18:483. [PMID: 29041954 PMCID: PMC5645893 DOI: 10.1186/s13063-017-2218-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces. Methods/design This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment (SE) on RTW and related outcomes for patients with mild to moderate TBI in real-life competitive work settings. The study will be carried out in the southeastern region of Norway and thereby be performed within the Norwegian welfare system. Patients aged 18–60 years with mild to moderate TBI who are employed in a minimum 50% position at the time of injury and sick-listed 50% or more for postconcussive symptoms 2 months postinjury will be included in the study. A comprehensive assessment of neurocognitive function, self-reported symptoms, emotional distress, coping style, and quality of life will be performed at baseline, immediately after CCT (3 months after inclusion), following the end of SE (6 months after inclusion), and 12 months following study inclusion. The primary outcome measures are the proportion of participants who have returned to work at 12-month follow-up and length of time until RTW, in addition to work stability as well as work productivity over the first year following the intervention. Secondary outcomes include changes in self-reported symptoms, emotional and cognitive function, and quality of life. Additionally, a qualitative RTW process evaluation focused on organizational challenges at the workplace will be performed. Discussion The proposed study will combine cognitive and vocational rehabilitation and explore the efficacy of increased cross-sectoral collaboration between specialized health care services and the labor and welfare system. If the intervention proves effective, the project will describe the cost-effectiveness and utility of the program and thereby provide important information for policy makers. In addition, knowledge about the RTW process for persons with TBI and their workplaces will be provided. Trial registration ClinicalTrials.gov, NCT03092713. Registered on 10 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2218-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emilie I Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Knut-Petter S Langlo
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Helene L Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Eline Aas
- Department of Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Heidi Enehaug
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Daniele E Alves
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Pål Klethagen
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Kjersti Sagstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Christine M Moen
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Karin Torsteinsbrend
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | | | - Tonje Haug Nordenmark
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Birte Sand Rismyhr
- The Norwegian User Organization (Personskadeforbundet LTN), Oslo, Norway
| | - Grete Wangen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennie Ponsford
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Faculty of Medicine, Nursing and Health Sciences , Clayton, Victoria, Australia
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Helene Ugelstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Øystein Spjelkavik
- The Work Research Institute, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Effectiveness of a Treatment for Impairments in Social Cognition and Emotion Regulation (T-ScEmo) After Traumatic Brain Injury: A Randomized Controlled Trial. J Head Trauma Rehabil 2017; 32:296-307. [DOI: 10.1097/htr.0000000000000332] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Outcome Measures for Persons With Moderate to Severe Traumatic Brain Injury: Recommendations From the American Physical Therapy Association Academy of Neurologic Physical Therapy TBI EDGE Task Force. J Neurol Phys Ther 2017; 40:269-80. [PMID: 27576089 DOI: 10.1097/npt.0000000000000145] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The use of standardized outcome measures (OMs) is essential in assessing the effectiveness of physical therapy (PT) interventions. The purposes of this article are (1) to describe the process used by the TBI EDGE task force to assess the psychometrics and clinical utility of OMs used with individuals with moderate to severe traumatic brain injury (TBI); (2) to describe the consensus recommendations for OM use in clinical practice, research, and professional (entry-level) PT education; and (3) to make recommendations for future work. METHODS An 8-member task force used a modified Delphi process to develop recommendations on the selection of OMs for individuals with TBI. A 4-point rating scale was used to make recommendations based on practice setting and level of ambulation. Recommendations for appropriateness for research use and inclusion in entry-level education were also provided. RESULTS The TBI EDGE task force reviewed 88 OMs across the International Classification of Functioning, Disability, and Health (ICF) domains: 15 measured body functions/structure only, 21 measured activity only, 23 measured participation only, and 29 OMs covered more than 1 ICF domain. DISCUSSION AND CONCLUSIONS Recommendations made by the TBI EDGE task force provide clinicians, researchers, and educators with guidance for the selection of OMs. The use of these recommendations may facilitate identification of appropriate OMs in the population with moderate to severe TBI. TBI EDGE task force recommendations can be used by clinicians, researchers, and educators when selecting OMs for their respective needs. Future efforts to update the recommendations are warranted in order to ensure that recommendations remain current and applicable.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A140).
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Castaño-León AM, Navarro-Main B, Gomez PA, Gil A, Soler MD, Lagares A, Bernabeu M, V Steinbüchel N, Real RGL. Quality of Life After Brain Injury: Psychometric Properties of the Spanish Translation of the QoLIBRI. Eval Health Prof 2017; 41:456-473. [PMID: 30376738 DOI: 10.1177/0163278717702696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic brain injury (TBI) is frequently followed by a variety of physical, emotional, and cognitive symptoms, which affect the patient's daily life, their social relations, and their work/educational status. In addition to function measures, health-related quality of life (HRQoL) has received increasing attention as an important outcome after TBI, as it may guide rehabilitation and evaluate treatment success. Here, we report on psychometric properties of a Spanish translation of the quality of life after brain injury (QoLIBRI) questionnaire, a disease-specific instrument to assess HRQoL in patients after TBI. Classical test theory, item response theory, and structural equation modeling were used to evaluate psychometric properties of the Spanish QoLIBRI translation in a convenience sample of N = 155 patients with TBI. A subset of n = 23 patients were tested twice with a test-retest interval of ≤2 weeks. Internal consistency and test-retest reliabilities were high (Cronbach's α: 0.78-0.96; ICCs: 0.81-0.96). Rasch analysis infit (range 0.52-1.20) and outfit indices (range 0.50-1.17) supported unidimensionality of subscales, whereas SEM analysis tended to support a correlated six-factor model (CFI = .88, RMSEA = .068, 95% confidence interval [.061, .075]). Results show favorable psychometric properties of the Spanish translation of the QoLIBRI, comparable to the international version. It is, thus, a useful instrument for clinicians and researchers assessing the impact of TBI on quality of life, the outcomes of rehabilitation, and may be included in epidemiological surveys.
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Affiliation(s)
| | | | - Pedro A Gomez
- 1 Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
| | - Angel Gil
- 2 Institut Guttmann, Neurorehabilitation Hospital, Badalona, Spain
| | - M Dolors Soler
- 2 Institut Guttmann, Neurorehabilitation Hospital, Badalona, Spain
| | - Alfonso Lagares
- 1 Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
| | | | - Nicole V Steinbüchel
- 3 Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Ruben G L Real
- 3 Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
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Cnossen MC, Polinder S, Vos PE, Lingsma HF, Steyerberg EW, Sun Y, Ye P, Duan L, Haagsma JA. Comparing health-related quality of life of Dutch and Chinese patients with traumatic brain injury: do cultural differences play a role? Health Qual Life Outcomes 2017; 15:72. [PMID: 28410593 PMCID: PMC5391570 DOI: 10.1186/s12955-017-0641-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/27/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is growing interest in health related quality of life (HRQoL) as an outcome measure in international trials. However, there might be differences in the conceptualization of HRQoL across different socio-cultural groups. The objectives of current study were: (I) to compare HRQoL, measured with the short form (SF)-36 of Dutch and Chinese traumatic brain injury (TBI) patients 1 year after injury and; (II) to assess whether differences in SF-36 profiles could be explained by cultural differences in HRQoL conceptualization. TBI patients are of particular interest because this is an important cause of diverse impairments and disabilities in functional, physical, emotional, cognitive, and social domains that may drastically reduce HRQoL. METHODS A prospective cohort study on adult TBI patients in the Netherlands (RUBICS) and a retrospective cohort study in China were used to compare HRQoL 1 year post-injury. Differences on subscales were assessed with the Mann-Whitney U-test. The internal consistency, interscale correlations, item-internal consistency and item-discriminate validity of Dutch and Chinese SF-36 profiles were examined. Confirmatory factor analysis was performed to assess whether Dutch and Chinese data fitted the SF-36 two factor-model (physical and mental construct). RESULTS Four hundred forty seven Dutch and 173 Chinese TBI patients were included. Dutch patients obtained significantly higher scores on role limitations due to emotional problems (p < .001) and general health (p < .001), while Chinese patients obtained significantly higher scores on physical functioning (p < .001) and bodily pain (p = .001). Scores on these subscales were not explained by cultural differences in conceptualization, since item- and scale statistics were all sufficient. However, differences among Dutch and Chinese patients were found in the conceptualization of the domains vitality, mental health and social functioning. CONCLUSIONS One year after TBI, Dutch and Chinese patients reported a different pattern of HRQoL. Further, there might be cultural differences in the conceptualization of some of the SF-36 subscales, which has implications for outcome evaluation in multi-national trials.
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Affiliation(s)
- Maryse C Cnossen
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Suzanne Polinder
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Pieter E Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Hester F Lingsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Yanming Sun
- Beijing Centers for Disease Control and Prevention, Beijng, People's Republic of China
| | - Pengpeng Ye
- NCDC, China CDC, Beijing, People's Republic of China
| | - Leilei Duan
- NCDC, China CDC, Beijing, People's Republic of China.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Juanita A Haagsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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van Essen TA, de Ruiter GC, Kho KH, Peul WC. Neurosurgical Treatment Variation of Traumatic Brain Injury: Evaluation of Acute Subdural Hematoma Management in Belgium and The Netherlands. J Neurotrauma 2017; 34:881-889. [DOI: 10.1089/neu.2016.4495] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Thomas A. van Essen
- Neurosurgical Cooperative Holland, Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Neurosurgical Cooperative Holland, Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Godard C.W. de Ruiter
- Neurosurgical Cooperative Holland, Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Kuan H. Kho
- Department of Neurosurgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Wilco C. Peul
- Neurosurgical Cooperative Holland, Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Neurosurgical Cooperative Holland, Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
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Soberg HL, Roe C, Brunborg C, von Steinbüchel N, Andelic N. The Norwegian version of the QOLIBRI - a study of metric properties based on a 12 month follow-up of persons with traumatic brain injury. Health Qual Life Outcomes 2017; 15:14. [PMID: 28103876 PMCID: PMC5248455 DOI: 10.1186/s12955-017-0589-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/13/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Consequences after Traumatic brain injury (TBI) affect the injured person's self-image and quality of life. The purpose was to assess the health related quality of life (HRQoL) at 12 months after a TBI in patients admitted to regional trauma centres, and to evaluate the metric properties of the Norwegian version of the Quality of Life After Brain Injury (QOLIBRI) questionnaire. METHODS Two hundred four patients with TBI of all severities were included. HRQoL at 12 months post-injury was measured by the QOLIBRI. It has a total scale and 6 subscales (satisfied with Cognition, Self, Daily Life and Autonomy and Social Relationships, and bothered by Emotions and Physical Problems). Demographic and injury related data were registered. Disability was registered by Glasgow Outcome Scale Extended (GOSE) and Rivermead Post-Concussion Questionnaire, and mental health by Hospital Anxiety and Depression Scale. Descriptive statistics, internal consistency by Cronbach's alpha and Corrected Item-Total Correlations were calculated. Rasch analysis, Principal Component Analysis (PCA) and Structural Equation Modelling (SEM) were applied. RESULTS Mean age was 37.6 (SD 15.4) years; 72% were men, and 41% had higher education. Over 60% were severely injured. Mean Glasgow Coma Scale score was 9.3 (SD 4.5). According to the GOSE 5.9% had severe disability, 45.5% had moderate disability, and 48.5% had good recovery at 12 months post-injury. The QOLIBRI scales had a high internal consistency (α = 0.75-0.96), and only Physical Problems had an α < 0.85. In the Rasch analysis all subscales and their items fit the Rasch model, except for the depression item in the Emotion subscale. PCA and SEM analyses supported a six-factor structure in a second-order latent model. The QOLIBRI supports an underlying unidimensional HRQoL model. The SEM model fit statistics of the second-order model indicated a moderate fit to the observed data (CFI = 0.86, TLI = 0.85, RMSEA = 0.076, SRMR = 0.061, χ2 = 1315.76, df = 623, p-value < 0.001). CONCLUSION The Norwegian QOLIBRI has favourable psychometric properties, but there were some weaknesses related to its measurement properties of the total score when tested on a TBI population where many had severe TBI, and many had good recovery.
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Affiliation(s)
- Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Postbox 4950, Nydalen 0424 Oslo, Norway
| | - Cecilie Roe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Postbox 4950, Nydalen 0424 Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Centre Göttingen, Göttingen, Germany
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Postbox 4950, Nydalen 0424 Oslo, Norway
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Gopaul R, Wei ZD, Yan J, Gong FY, Xiao SW. Clinical study of quality of life of traumatic brain injury patients after decompressive craniectomy and related influencing factors. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0044-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Holleman M, Vink M, Nijland R, Schmand B. Effects of intensive neuropsychological rehabilitation for acquired brain injury. Neuropsychol Rehabil 2016; 28:649-662. [PMID: 27487525 DOI: 10.1080/09602011.2016.1210013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of the study was to examine the effects of a comprehensive neuropsychological rehabilitation programme (Intensive NeuroRehabilitation, INR) on the emotional and behavioural consequences of acquired brain injury (ABI). The participants were 75 adult patients suffering from ABI (33 traumatic brain injury, 14 stroke, 10 tumour, 6 hypoxia, 12 other), all of whom were admitted to the INR treatment programme. The main outcome measures were: general psychological well-being (Symptom-Checklist-90), depression and anxiety (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, State Trait Anxiety Inventory), and quality of life (Quality of Life in Brain Injury). The study was a non-blinded, waiting-list controlled trial. During the waiting-list period no or minimal care was provided. Multivariate analysis of the main outcome measures showed large effect sizes for psychological well-being (partial η2 = .191, p < .001), depression (partial η2 = .168, p < .001), and anxiety (partial η2 = .182, p < .001), and a moderate effect size for quality of life (partial η2 = .130, p = .001). Changes on neuropsychological tests did not differ between the groups. It was concluded that the INR programme improved general psychological well-being, depressive symptoms, anxiety, and quality of life. The programme does not affect cognitive functioning.
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Affiliation(s)
- Meike Holleman
- a Amsterdam Rehabilitation Research Centre , Reade , Amsterdam , The Netherlands.,b Department of Medical Psychology , Jeroen Bosch Hospital , 's-Hertogenbosch , The Netherlands
| | - Martie Vink
- a Amsterdam Rehabilitation Research Centre , Reade , Amsterdam , The Netherlands
| | - Rinske Nijland
- a Amsterdam Rehabilitation Research Centre , Reade , Amsterdam , The Netherlands
| | - Ben Schmand
- c Department of Medical Psychology , Academic Medical Centre at the University of Amsterdam , Amsterdam , The Netherlands.,d Programmagroep Brein en Cognitie, Faculty of Social and Behavioural Sciences , University of Amsterdam , Amsterdam , The Netherlands
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Tornås S, Løvstad M, Solbakk AK, Schanke AK, Stubberud J. Goal Management Training Combined With External Cuing as a Means to Improve Emotional Regulation, Psychological Functioning, and Quality of Life in Patients With Acquired Brain Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 97:1841-1852.e3. [PMID: 27424292 DOI: 10.1016/j.apmr.2016.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether goal management training (GMT) expanded to include external cuing and an emotional regulation module is associated with improved emotional regulation, psychological functioning, and quality of life (QOL) after chronic acquired brain injury (ABI). DESIGN Randomized controlled trial with blinded outcome assessment at baseline, posttraining, and 6-month follow-up. SETTING Outpatient. PARTICIPANTS Persons with ABI and executive dysfunction (N=70; 64% traumatic brain injury; 52% men; mean age ± SD, 43±13y; mean time since injury ± SD, 8.1±9.4y). INTERVENTION Eight sessions of GMT in groups, including a new module addressing emotional regulation, and external cuing. A psychoeducative control condition (Brain Health Workshop) was matched on amount of training, therapist contact, and homework. MAIN OUTCOME MEASURES Emotional regulation was assessed with the Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire, the Emotional Control subscale and the Emotion Regulation factor (Behavior Rating Inventory of Executive Function-Adult Version), and the Positive and Negative Affect subscales from the Dysexecutive Questionnaire. Secondary outcome measures included psychological distress (Hopkins Symptom Checklist-25) and QOL (Quality of Life After Brain Injury Scale). RESULTS Findings indicated beneficial effects of GMT on emotional regulation skills in everyday life and in QOL 6 months posttreatment. No intervention effects on measures of psychological distress were registered. CONCLUSIONS GMT is a promising intervention for improving emotional regulation after ABI, even in the chronic phase. More research using objective measures of emotional regulation is needed to investigate the efficacy of this type of training.
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Affiliation(s)
| | - Marianne Løvstad
- Sunnaas Rehabilitation Hospital, Nesodden, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Anne-Kristin Solbakk
- Department of Psychology, University of Oslo, Oslo, Norway; Division of Surgery and Clinical Neuroscience, Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
| | - Anne-Kristine Schanke
- Sunnaas Rehabilitation Hospital, Nesodden, Norway; Department of Psychology, University of Oslo, Oslo, Norway
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Lin YN, Hwang HF, Chen YJ, Cheng CH, Liang WM, Lin MR. Suitability of the Quality of Life after Brain Injury Instrument for Older People with Traumatic Brain Injury. J Neurotrauma 2016; 33:1363-70. [PMID: 26482926 DOI: 10.1089/neu.2015.4094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We prospectively investigated the psychometric properties of the Quality of Life after Brain Injury (QOLIBRI) instrument among older patients with traumatic brain injury (TBI). The 37-item QOLIBRI comprises six domains (cognition, self, daily life and autonomy, social relationships, emotions, and physical problems). We recruited 333 patients ≥60 years of age with TBI from the neurosurgery clinics and emergency departments of three hospitals in Taipei, Taiwan. The ceiling and floor values for most QOLIBRI domains were <5%, and the internal consistency and test-retest reliability ranged from 0.84 to 0.97 and 0.83 to 0.96, respectively. For the known-groups validity, patients with TBI attained lower scores for all QOLIBRI domains, except physical problems, compared with those with soft-tissue injuries. Patients with intact cognition who had higher levels on the Glasgow Outcome Scale Extended (GOSE) and the Glasgow Coma Scale, fewer limitations in activities of daily living, and fewer chronic conditions obtained higher scores for almost all the QOLIBRI domains, compared with their counterparts. For convergent validity, the correlation coefficients for the QOLIBRI domains and the selected functional measures conceptually related to that domain were all ≥0.4. A confirmatory factor analysis revealed that the original six-domain structure fit the data with a comparative fit index of ≥0.9. Effect sizes for changes in the GOSE over a 6-month follow-up period were clinically meaningful (≥ 0.2) for all the QOLIBRI domains except emotions. For older people with TBI, the use of the QOLIBRI is generally appropriate, and adding the domain of environment to the scale would be beneficial.
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Affiliation(s)
- Yen-Nung Lin
- 1 Institute of Injury Prevention and Control, Taipei Medical University , Taipei, Taiwan .,2 Department of Physical Medicine and Rehabilitation, Wan Fang Hospital , Taipei, Taiwan
| | - Hei-Fen Hwang
- 3 Department of Nursing, National Taipei University of Nursing and Health Science , Taipei, Taiwan
| | - Yi-Ju Chen
- 4 Department of Nursing, Cathay General Hospital , Taipei, Taiwan
| | - Chui-Hsuan Cheng
- 5 Department of Emergency Medicine, Taichung Branch, Buddhist Tzu Chi General Hospital , Taichung, Taiwan
| | - Wen-Miin Liang
- 6 Biostatistics Center, China Medical University , Taichung, Taiwan
| | - Mau-Roung Lin
- 1 Institute of Injury Prevention and Control, Taipei Medical University , Taipei, Taiwan
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Barthélemy EJ, Melis M, Gordon E, Ullman JS, Germano IM. Decompressive Craniectomy for Severe Traumatic Brain Injury: A Systematic Review. World Neurosurg 2015; 88:411-420. [PMID: 26732949 DOI: 10.1016/j.wneu.2015.12.044] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Systematic review of the literature to evaluate the role of decompressive craniectomy (DC) after severe traumatic brain injury (TBI), comparing the first major randomized clinical trial on this topic (DECRA) with subsequent literature. METHODS A systematic literature search was performed from 2011 to 2015. Citations were selected using the following inclusion criteria: closed severe TBI and DC. Exclusion criteria included most patients ≤18 years old, ≤20 participants, review articles, DC for reasons other than TBI, or surgical procedures other than DC. Primary outcomes included mortality and Glasgow Outcome Scale (GOS) at discharge, 6 months, and 1 year after injury. Assessment of risk of bias of the randomized controlled trials was also performed. RESULTS Only 12 of 5528 articles satisfied the eligibility criteria; of these studies, 3 were randomized controlled trials. DC in specific populations does not offer GOS or mortality advantages compared with medical treatment; on the other hand, when DC with open dural flap was compared with an alternative means of decompression, e.g., DC with multiple dural stabs, the latter showed significant advantage in mortality and GOS. Nonrandomized studies showed decreased mortality and increased GOS in patients aged ≤50 years when DC was performed <5 hours after TBI and with Glasgow Coma Scale score >5. CONCLUSIONS Our study underscores the importance of continued international prospective data collection for assessing types of surgical interventions in addition to DC and their timing in patients who have severe TBI. In addition, in geographic areas with limited access to advanced medical treatment for severe TBI, DC is of benefit when performed <5 hours after injury in younger patients with Glasgow Coma Scale >5.
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Affiliation(s)
| | - Marta Melis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Neurology, University of Cagliari, Sardinia, Italy
| | - Errol Gordon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jamie S Ullman
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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