Research Reports - Spectrum of outcomes following traumatic brain injury-relationship between functional impairment and health-related quality of life

Acta Neurochir (Wien). 2017 Oct 7. doi: 10.1007/s00701-017-3334-6. [Epub ahead of
print]

Tsyben A(1)(2), Guilfoyle M(3)(4), Timofeev I(3)(4), Anwar F(5), Allanson J(5),
Outtrim J(6), Menon D(6), Hutchinson P(3)(4), Helmy A(3)(4).

BACKGROUND: The outcome following traumatic brain injury (TBI) is heterogeneous
and poorly defined and physical disability scales like the extended Glasgow
Outcome Score (GOSE) while providing valuation information in terms of broad
categorisation of outcome are unlikely to capture the full spectrum of deficits.
Quality of life questionnaires such as SF-36 are emerging as potential tools to
help characterise factors important to patients' recovery. This study assessed
the association between physical disability and subjective health rating. The
relationship is of value as it may help evaluate the impact of TBI on patients'
lives and facilitate the delivery of appropriate neuro-rehabilitation services.
METHODS: A single-centre retrospective study was undertaken to assess the
relationship between physical outcome as measured by GOSE and quality of life
captured by the SF-36 questionnaire. Cronbach's alpha was calculated for each of
the eight SF-36 domains to measure internal consistency of the test. Multivariate
analysis of variance was conducted to look at the association between GOSE and
the physical (PCS) and mental (MCS) component scores on the SF-36. Finally, we
performed a generalised linear mixed model (GLMM) to assess the relative
contribution of GOSE score, age at the time of trauma, sex and TBI duration
towards MCS and PCS rating.
RESULTS: There is a statistically significant difference in the MCS and PCS
scores based on patients' GOSE scores. The mean scores of the eight SF-36 domains
showed significant association with GOSE. GLMM demonstrated that GOSE was the
strongest predictor of PCS and MCS. Age was an important variable in the PCS
score while time following trauma was a significant predictor of MCS rating.
CONCLUSIONS: This study highlights that patients' physical outcome following TBI
is a strong predictor of the subjective mental and physical health. Nevertheless,
there remains tremendous variability in individual SF-36 scores for each GOSE
category, highlighting that additional factors play a role in determining quality
of life. 

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