Measuring quality of life of patients of traumatic brain injury

Resilience in Families With Adolescents Suffering From Traumatic Brain Injuries

PURPOSE

This study aims to coconstruct the building blocks for an intervention program to support family resilience in conjunction with families with an adolescent suffering from traumatic brain injury and rehabilitation professionals.

DESIGN

This is a qualitative and inductive study, supported by a collaborative research approach.

METHODS

Based on the complex intervention design and validation model, the investigator follows a three-stage data collection process: (1) identifying the building blocks of the intervention program in the eyes of families and rehabilitation professionals, (2) prioritizing, and (3) validating the building blocks with the same participants.

FINDINGS

After analyzing the data, the investigator identifies five encompassing themes as the building blocks of the intervention program.

CONCLUSIONS/CLINICAL RELEVANCE

This study offers promising avenues for practitioners and researchers in nursing and other fields with respect to the implementation of concrete strategies to support the resilience process of families facing particularly difficult times in their lives.

Role of sertraline in posttraumatic brain injury depression and quality-of-life in TBI

INTRODUCTION

Traumatic brain injury (TBI) is a major cause of disability. Depression is one of the major squeal of TBI in both in-patient and out-patient populations. Depression is associated with numerous negative outcomes, thus affecting quality-of-life (QOL) adversely in these patients. Addressing depression in treatment regimen of TBI may improve QOL of these patients.

OBJECTIVE

The present study is designed to evaluate the role of sertraline in post TBI depression and its impact on QOL.

MATERIALS AND METHODS

Eighty male patients with post TBI depression were included in the study among the 250 male patients of mild to moderate TBI recruited for the evaluation. Half of the patients were given sertraline 50 mg PO, whereas other half served as control without sertraline treatment. Participants were assessed on Glasgow Coma scale, Patient Health Questionnaire-9 (PHQ-9) and World Health Organization QOL (WHOQOL) at regular interval till the end of 6 months.

RESULT

Depression was found in 35.6% of total patients recruited. Most of the patients (63.1%) were below 35 years of age. Depression was more common in mild TBI cases than those with moderate TBI (53.7% vs. 46.25%, P = 0.04). Left side brain injury (56.25%) with cerebral contusions was more commonly associated with depression (P = 0.04). Patients in sertraline group responded well to treatment with significant improvement in mod symptoms (PHQ-9 score 14.88 ± 3.603 vs. 5.33 ± 2.98, P = 0.04)). All the four domains of QOL improved significantly in sertraline group than the control group with sertraline treatment.

CONCLUSION

Management of TBI should also focus on treatment of associated mood symptoms, which is likely to be associated with poor QOL in these patients. Sertraline has been found to be effective in the treatment of depression with significant improvement in QOL in TBI patients.

Quantification of relevance of quality of life assessment for patients with cognitive impairment: the suitability indices

Background

The extent to which MS patients with cognitive dysfunction can accurately self-report outcomes has been a crucial issue. The aim of this study was to quantify and compare the relevance of the quality of life (QoL) assessment between two populations with a high occurrence of cognitive dysfunction, specifically in individuals with multiple sclerosis (MS) and in individuals suffering from schizophrenia (SCZ).

Methods

Design: A cross-sectional study was performed using the following inclusion criteria: MS and SCZ patients were diagnosed according to the McDonald criteria and DSM-IV criteria, respectively. Data on sociodemographic (age, gender, education level) and clinical (disease severity, disease duration) factors, QoL (disease-specific questionnaires, MusiQoL and SQoL) and cognitive performance (executive, memory, and attention functions) were collected. Non-impaired and impaired populations were defined according to the French norms. Psychometric properties were compared to those reported in reference populations, which were assessed in the respective validation studies. Suitability indices were provided used to quantitatively compare how the structures in the different populations matched with the initial structure of the questionnaires (reference populations).

Results

One hundred and twenty-four MS patients and 113 SCZ patients were enrolled. Factor analysis was performed on the impaired populations and revealed that the questionnaire structure adequately matched the initial structure of the disease-specific QoL questionnaires. All of the suitability indices of construct and external validity in the non-impaired populations ranged from 70 to 100%.

Conclusions

Our study suggested that cognitive dysfunction did not compromise the reliability or validity of the self-reported QoL questionnaires among subjects with cognitive dysfunction, such as MS and SCZ. Thus, this report may clarify the relevance of using self-reported QoL assessments in clinical practice.

Self-reported quality of life measure is reliable and valid in adult patients suffering from schizophrenia with executive impairment

BACKGROUND

Impaired executive functions are among the most widely observed in patients suffering from schizophrenia. The use of self-reported outcomes for evaluating treatment and managing care of these patients has been questioned. The aim of this study was to provide new evidence about the suitability of self-reported outcome for use in this specific population by exploring the internal structure, reliability and external validity of a specific quality of life (QoL) instrument, the Schizophrenia Quality of Life questionnaire (SQoL18).

DESIGN

cross-sectional study.

INCLUSION CRITERIA

age over 18 years, diagnosis of schizophrenia according to the DSM-IV criteria.

DATA COLLECTION

sociodemographic (age, gender, and education level) and clinical data (duration of illness, Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia); QoL (SQoL18); and executive performance (Stroop test, lexical and verbal fluency, and trail-making test). Non-impaired and impaired populations were defined for each of the three tests. For the six groups, psychometric properties were compared to those reported from the reference population assessed in the validation study.

RESULTS

One hundred and thirteen consecutive patients were enrolled. The factor analysis performed in the impaired groups showed that the questionnaire structure adequately matched the initial structure of the SQoL18. The unidimensionality of the dimensions was preserved, and the internal/external validity indices were close to those of the non-impaired groups and the reference population.

CONCLUSIONS

Our study suggests that executive dysfunction did not compromise the reliability or validity of self-reported disease-specific QoL questionnaire.

Amnésia pós-traumática e qualidade de vida pós-trauma

Este estudo compara a qualidade de vida das vítimas que apresentaram amnésia pós-traumática de longa duração com as demais e analisa a relação entre qualidade de vida e duração da amnésia pós-traumática, computando ou não o período de coma. Estudo de coorte prospectivo, com coleta de dados durante a internação hospitalar e avaliação da qualidade de vida no período de estabilidade da recuperação pós-traumática. Participaram desta investigação vítimas de trauma crânio-encefálico contuso, maiores de 14 anos, sem antecedentes de demência ou trauma crânio-encefálico, internadas em hospital de referência para atendimento de trauma nas primeiras 12 horas pós-evento. Os resultados referentes à qualidade de vida foram mais desfavoráveis em três domínios do grupo com amnésia de longa duração. Correlações entre duração da amnésia e domínios de qualidade de vida foram mais expressivas quando excluído o período de coma, indicando que este tempo não deve ser computado na duração da amnésia pós-traumática.

Les perceptions d’adolescents cérébrolésés, de leurs parents et des professionnels impliqués dans leur inclusion sociale

Cette étude qualitative a pour but d'explorer les perceptions d’adolescents, de leurs parents et de professionnelles quant à l'inclusion sociale d’adolescents ayant vécu un traumatisme craniocérébral (TCC) modéré. Le modèle écologique de Bronfenbrenner (1979, 1986), adapté par Lefebvre et Levert (2005) auprès de la clientèle TCC, est utilisé comme cadre de référence. Des entrevues semi-dirigées ont été réalisées auprès d’adolescents cérébrolésés et leurs parents. Les résultats montrent que les perceptions des familles portent sur différents aspects de leur vie, indiquant une multitude de répercussions qui facilitent ou contraignent l’inclusion sociale de l’adolescent TCC modéré. En général, les professionnelles partagent les mêmes perceptions qu’eux. Les résultats de cette étude devraient permettre aux professionnels de la santé une meilleure compréhension de l'inclusion sociale vécue par ces personnes, en plus d'offrir des balises permettant à ceux-ci de mieux soutenir l'inclusion sociale d’adolescents TCC et de venir en aide aux familles dans cette situation difficile.

Health services needs and quality of life assessment of individuals with brain injuries: a pilot cross-sectional study

BACKGROUND AND PURPOSE

Quality of Life (QoL) studies have received a substantial amount of attention in medical and rehabilitative practices. However, there is still a paucity of studies in the area, especially on persons with brain injuries (BI). This pilot study, on the QoL of individuals with brain injuries in Hong Kong, attempts to fill this void. It is hoped that the finding of this study will guide the development of programmes and services to people with brain injuries.

METHODS

Through the Self-help Group for People with Brain Damage in Hong Kong, 35 subjects (22 men and 13 women) were successfully recruited to participate in this study by convenience sampling. Demographic data were collected through face-to-face interviews guided by a questionnaire and QoL data were gathered using the Comprehensive Quality of Life Scale--Intellectual/Cognitive Disability--5th edition (ComQol-I5). The general emotional condition of the participants over the past 2 months was measured by a validated Chinese version of the Positive and Negative Affect Scale (PANAS). The participants' ratings on the importance of and their satisfaction with 20 health services areas were also collected.

RESULTS

Preliminary results show that the overall mean quality of life score, as measured by ComQol-I5, was slightly less than two-thirds of the maximum score. Among the seven QoL domains, health and safety received some of the highest scores, while the lowest scores were obtained in the area of material well-being, place in community and productivity. People whose injuries had occurred relatively recently (less than 5 years ago) were found to have higher intimacy QoL scores than their counterparts injured more than 5 years ago. In the domain of safety, persons with a brain injury who were employed scored significantly higher than those who were not. Positive affect scores and the total affect of PANAS scores correlated significantly with the overall QoL scores. Moreover, persons with a brain injury usually felt satisfied with the services they valued as important. The top five most important services were medical services, occupational therapy, physiotherapy, vocational counselling and social work.

DISCUSSION AND CONCLUSION

The QoL profile of people with brain injuries in Hong Kong was initially obtained and low scores in the ComQoL were identified in the domains of material well-being, community activities and responsibility and productivity. These might be the consequences of their physical and cognitive limitations due to brain injury. This implies that appropriate interventions to improve their daily life conditions and their social integration would be necessary to improve their QoL. On the other hand, the BI sample also rated relatively high scores in other ComQoL areas such as safety and health, reflecting a good living environment and probably good health care services. Those whose brain injuries had occurred less than 5 years ago tended to have a higher ComQoL intimacy score than those whose injuries occurred more than 5 years ago. In other words, their social relationships may deteriorate with the longer period post-injury so that this group may need more supportive services. In the safety domain, it was found that subjects who were employed after their brain injury scored significantly higher than those who were not, which matched studies about the significant contribution of work towards life satisfaction. The satisfaction of their needs in the services they received, which may affect their QoL, was also investigated. It is clear that they valued the medical and rehabilitation services they received and felt satisfied with them.

Traumatic brain injury research priorities: the Conemaugh International Brain Injury Symposium

In 2005, an international symposium was convened with over 100 neuroscientists from 13 countries and major research centers to review current research in traumatic brain injury (TBI) and develop a consensus document on research issues and priorities. Four levels of TBI research were the focus of the discussion: basic science, acute care, post-acute neurorehabilitation, and improving quality of life (QOL). Each working group or committee was charged with reviewing current research, discussion and prioritizing future research directions, identifying critical issues that impede research in brain injury, and establishing a research agenda that will drive research over the next five years, leading to significantly improved outcomes and QOL for individuals suffering brain injuries. This symposium was organized at the request of the Congressional Brain Injury Task Force, to follow up on the National Institutes of Health Consensus Conference on TBI as mandated by the TBI ACT of 1996. The goal was to review what progress had been made since the National Institutes of Health (NIH) Consensus Conference, and also to follow up on the 1990's Decade of the Brain Project. The major purpose of the symposium was to provide recommendations to the U.S. Congress on a priority basis for research, treatment, and training in TBI over the next five years.

Life beyond severe traumatic injury: an integrative review of the literature

It is only recently that recognition of the serious and debilitating sequelae of trauma has prompted exploration of outcomes beyond survival, such as disability, health status and quality of life. This paper aims to review the literature describing outcomes following severe traumatic injury to provide clinicians with a greater understanding of the recovery trajectory following severe trauma and highlight the issues faced by those recovering from such injury. Electronic databases, published reference lists and the Internet were searched to identify relevant literature. The heterogeneous nature of published literature in this area prohibited a systematic approach to inclusion of papers in this review. Trauma survivors report significant sequelae that influence functional status, psychological wellbeing, quality of life and return to productivity following severe injury. Key themes that emerge from the review include: current trauma systems which provide inadequate support along the recovery trajectory; rehabilitation referral which is affected by geographical location and provider preferences; a long-term loss of productivity in both society and the workplace; a high incidence of psychological sequelae; a link between poor recovery and increased drug and alcohol consumption; and valued social support which can augment recovery. Future research to evaluate interventions which target the recovery needs of the severely injured patients is recommended. Particular emphasis is required to develop systematic, sustainable and cost-effective follow-up to augment the successes of existing acute trauma services in providing high quality acute resuscitation and definitive trauma management.

Functional Status and Quality of Life in Survivors of Injury Treated at Tertiary Trauma Centers: What Are We Neglecting?

BACKGROUND

The purpose of this study was to describe the functional status and quality of life (QOL) of patients at 12 months after injury.

METHODS

Retrospective study consisting of patients treated at three tertiary trauma centers for injuries. Functional capacity (FC) was measured using the Sickness Impact Profile and QOL was measured using the Medical Outcomes Study Short Form (MOS SF-36) at approximately 12 months after the date of injury.

RESULTS

There were 144 patients that fulfilled the study inclusion and exclusion criteria. The mean duration of follow-up was 1.3 years, with a range of 0.8 to 1.5 years. Age and gender were not associated with the FC or QOL. The mean(standard deviation) Injury Severity Score (ISS) was 18.9(9.4), whereas ISS category distribution was 1 to 11 (22.9%), 12 to 24 (50.0%), and 25 to 49 (27.1%). Patients with an ISS of 25 to 49 had significantly worse physical (p = 0.008) and total (p = 0.023) Sickness Impact Profile scores and had more physical functioning (p = 0.096), emotional role functioning (p = 0.080), and energy (p = 0.017) impairments when compared with those with an ISS less than 24. Patients injured in motor vehicle collisions had significantly impaired psychosocial function (p = 0.031), whereas those injured in falls had reduced quality of life scores for physical function (p = 0.089), physical role (p = 0.066), and mental health (p = 0.081).

CONCLUSION

Patients who survive injuries experience residual impairments in FC and QOL for as long as 1 year after injury. Changes to the long-term management of these patients should be considered.

An instrument to assess mental patients' capacity to appraise and report subjective quality of life

Quality of life (QOL) is increasingly recognized as an important outcome measure in treatment studies and service evaluation. However, patients or service users may sometimes lack the capacity to either evaluate or express their subjective QOL, for example due to cognitive impairment, communication disorders, symptom distress or burden of completing the assessment itself. This paper describes the development of an instrument, the capacity to report subjective quality of life inventory (CapQOL), which evaluates the ability of patients to appraise their subjective QOL and to complete related measures. The CapQOL is a simple and brief screening tool, designed for use in people with a wide range of mental disabilities. It helps researchers to identify individuals who are unable to appraise or report their subjective quality of life. We administered the CapQOL to 442 patients with early psychosis. About 89% of the participants were assessed to be able to complete a subjective QOL measure. The CapQOL demonstrated satisfactory psychometric properties. Further validation studies in people with psychosis as well as other mental disabilities are indicated.

Community activities and individuals' satisfaction with them: quality of life in the first year after traumatic brain injury

OBJECTIVE

To investigate the relations between community activities and satisfaction with these activities, desires to change them, and global life satisfaction.

DESIGN

Interview study with follow-up 1 month after rehabilitation discharge and 12 months postinjury.

SETTING

Community.

PARTICIPANTS

One hundred sixty-two individuals hospitalized with mostly moderate-to-severe traumatic brain injury. About 90% were reached (mostly by phone) 1 month after rehabilitation discharge; 84.6%, at 12 months postinjury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Community Integration Questionnaire-2, augmented by individuals' ratings of satisfaction or dissatisfaction with and desire to change each activity; and the Satisfaction With Life Scale.

RESULTS

Although significant correlations were found for some items, most correlations between activities and ratings of global quality of life (QOL) were low and nonsignificant. Individuals reported that they were satisfied with most of their community activities, but there were exceptions (eg, paid work). Correlations between activity-specific satisfaction and general life satisfaction were generally weak and nonsignificant. Dissatisfaction with an activity correlated strongly with desire to change the activity, but general life satisfaction did not correlate with desire to change activities.

CONCLUSIONS

The lack of association between frequency of activities and subjective appraisals of them is a challenge to outcomes measurement and has implications for the targeting of rehabilitative interventions and evaluation of their worth. More research is needed to understand how individualizing functional objectives might maximize the effects of rehabilitation on the QOL of persons served.

Quality of life experienced by severely injured trauma survivors

Advances in technology and the expansion of the emergency medical system have made emergency care available to large numbers of people experiencing trauma. Assessing the quality of life experienced by trauma survivors may assist in the development of interventions to optimize the outcomes in this patient population. The purpose of this study was to assess the quality of life experienced by severely injured trauma survivors, and to determine if a relation exists between the severity of the injury and the quality of life, the impact on the family of survivors, and the community resources needed by the survivors. Severely injured survivors of trauma in this study were defined as patients with a severity of injury severity score (ISS) of 25 or more and a trauma injury score (TRISS) of 0.90 or less. In this descriptive study, telephone interviews were conducted to administer the Sickness Impact Profile (SIP), an analog scale, and a demographic data form. All the survivors were interviewed at least 6 months after discharge from the hospital. The data collected on 64 survivors showed that they experienced a significantly poorer quality of life after the trauma incidents, as indicated by both the SIP scores and the analog scores. Although most of the SIP's 12 behavior categories indicated severe disruption, the behavior categories of work, recreation and pastimes, home management, and sleep and rest were the most negatively affected. Patients and families should be prepared for the physical, emotional, and financial disruptions that occur after severe traumatic injury. Support services, including community resources, are needed to optimize outcomes after discharge.