Quality of life up to 10 years after traumatic brain injury: a cross-sectional analysis

Abstract

Background: Traumatic brain injury (TBI) is the leading cause of death and disability among children and young adults in industrialized countries, but strikingly little is known how patients cope with the long-term consequences of TBI. Thus, the aim of the current study was to elucidate health-related quality of life (HRQoL) and outcome predictors in chronic TBI adults.

Methods: In this cross-sectional study, 439 former patients were invited to report HRQoL up to 10 years after mild, moderate or severe TBI using the QOLIBRI (Quality of Life after Brain Injury) questionnaire. The QOLIBRI total score has a maximum score of 100. A score below 60 indicates an unfavorable outcome with an increased risk of an affective and/or anxiety disorder. Results were correlated with demographics and basic characteristics received from medical records (TBI severity, etiology, age at TBI, age at survey, time elapsed since TBI, and sex) using regression models. Differences were considered significant at p < 0.05.

Results: From the 439 invited patients, 135 out of 150 in principle eligible patients (90%) completed the questionnaire; 76% were male, and most patients experienced severe TBI due to a traffic-related accident (49%) or a fall (44%). The mean QOLIBRI total score was 65.5 (± 22.6), indicating good HRQoL. Factors for higher level of satisfaction (p = 0.03; adjusted R² = 0.1) were autonomy in daily life (p = 0.03; adjusted R² = 0.09) and cognition (p = 0.05; adjusted R² = 0.05). HRQoL was weakly correlated with initial TBI severity (p = 0.04; adjusted R² = 0.02). 36% of patients reported unfavorable HRQoL with increased risk of one (20%) or two (16%) psychiatric disorders.

Conclusions: The majority of chronic TBI patients reported good HRQoL and the initial TBI severity is a slight contributor but not a strong predictor of HRQoL. Autonomy and cognition are decisive factors for satisfied outcome and should be clearly addressed in neurorehabilitation. One third of patients, however, suffer from unsatisfactory outcome with psychiatric sequelae. Thus, an early neuropsychiatric assessment after TBI is necessary and need to be installed in future TBI guidelines.

Keywords: Adaptation and resilience; Anxiety; Autonomy and cognition as decisive outcome factors for satisfaction; Depressive disorder; Health-related quality of life after brain injury; Long-term outcome; Psychiatric disorders after brain injury; QOLIBRI; TBI guidelines; Traumatic brain injury.

Fig. 1

Flow-chart depicting the survey cohort of patients with chronic TBI. In this cross-sectional study, 135 out of the 150 survey participants—representing a net response rate of 90%—reported on their health-related quality of life (HRQoL) up to 10 years following neurorehabilitation due to traumatic brain injury using the QOLIBRI (Quality of Life after Brain Injury) questionnaire

Fig. 2

TBI severity is not a strong predictor of health-related quality of life. a TBI severity was weakly correlated with the QOLIBRI total score (p = 0.04; adjusted R² = 0.02). b The QOLIBRI questionnaire can be used to distinguish two major key aspects in life, satisfaction (obtained by merging the scales cognition, self, daily life & autonomy, and social relationships) and restrictions (obtained by merging the scales emotions and physical problems). TBI was weakly correlated with satisfaction (p = 0.03, adjusted R² = 0.1), daily life & autonomy (p = 0.03; adjusted R² = 0.09), and cognition (p = 0.05; adjusted R² = 0.05). In contrast, TBI severity was not correlated with restrictions (p = 0.31; adjusted R² = 0.08). TBI severity was poorly documented in the medical records of 51 patients (38%); thus, TBI severity was not classified in these 51 patients. GCS: Glasgow Coma Scale

Fig. 3

Time effects on health-related quality of life following TBI. The first year following TBI seems to be crucial for patient’s rehabilitation and adaption, as 13% of patients (n = 17) reported having insufficient HRQoL with a median QOLIBRI total score of 54. Thus, psychiatric evaluation and support should be provided as early as possible after traumatic brain injury

Fig. 4

Health-related quality of life and risk of psychiatric sequels after TBI. Health-related quality of life was assessed in 135 patients with mild, moderate, or severe TBI up to 10 years after neurorehabilitation. The QOLIBRI total score ranges from 0 to 100, representing the lowest and highest quality of life, respectively. Based on the QOLIBRI total scores, 64% of chronic TBI patients indicated good quality of life, 20% of patients had either an increased risk of anxiety or depressive disorder, and 16% of patients an increased risk of both psychiatric disorders