Perceived changes in quality of life in trauma patients:A focus group study

Quality of life (QoL) following a physical trauma is still insufficiently known from a patient perspective. The aim of this study was to qualitatively report perceived changes in QoL after trauma. Focus groups were conducted. Patients admitted to the hospital were eligible for inclusion if they had a lower extremity trauma, severe injuries, or severe traumatic brain injury (TBI). Patients 75 years or older were invited. To analyze the perceived changes in QoL, open coding was used. Patients ( n = 20, M = 55 years) reported comparable consequences. In the first month posttrauma, physical limitations, independency, pain, and anxiety predominated. Later, patients experienced problems with acceptance. The patients’ feelings of the need to have control over their own situation, their own expectations, and a social network were related to QoL. Compared with the other patient groups, TBI patients reported more psychosocial consequences, and elderly patients reported more difficulties in performing (social) activities. Quality of health care was considered an important aspect in the patients’ perceived QoL, and adequate aftercare was missed according to the patients. The impact of a trauma influences QoL in different health domains. Further improving the quality of aftercare may positively influence trauma patients’ perceived QoL. These results indicated that TBI patients and elderly patients deserve specific attention regarding QoL

Ervaren kwaliteit van leven na een trauma

Dit focusgroeponderzoek (20 deelnemers, gemiddelde leeftijd 55 jaar) toont aan dat de gevolgen van een trauma de KvL op verschillende gezondheidsdomeinen beïnvloeden, en dat dit door de tijd heen kan veranderen. In de eerste maanden na het ongeval overheersen fysieke beperkingen, afhankelijkheid, pijn en angst. Later in het herstelproces hebben patiënten moeite met het accepteren van blijvende gevolgen. Daarnaast speelt het sociale netwerk van de patiënt met een trauma en de kwaliteit van de gezondheidszorg een belangrijke rol in de ervaren KvL. Het ontbreken van passende nazorg heeft een negatieve invloed op de ervaren KvL

Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population

Introduction While the number of trauma patients surviving their injury increase, it is important to measure Quality of Life (QoL). The Abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire can be used to assess QoL. However, its psychometric properties in trauma patients are unknown and therefore, we aimed to investigate the validity and reliability of the WHOQOL-BREF for the hospitalized trauma population. Methods Data were derived from the Brabant Injury Outcome Surveillance. Floor and ceiling effects and missing values of the WHOQOL-BREF were examined. Confirmatory factor analysis (CFA) was performed to examine the underlying 4 dimensions (i.e. physical, psychological, social and environmental) of the questionnaire. Cronbach’s alpha (CA) was calculated to determine internal consistency. In total, 42 hypotheses were formulated to determine construct validity and 6 hypotheses were created to determine discriminant validity. To determine construct validity, Spearman’s correlations were calculated between the WHOQOL-BREF and the EuroQol-five-dimension-3-level questionnaire, the Health Utility Index Mark 2 and 3, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. Discriminant validity between patients with minor injuries (i.e. Injury Severity Score (ISS)≤8) and moderate/severe injuries (i.e. ISS ≥ 9) was examined by conducting Mann-Whitney-U-tests. Results In total, 202 patients (median 63y) participated in this study with a median of 32 days (interquartile range 29–37) post-trauma. The WHOQOL-BREF showed no problematic floor and ceiling effects. The CFA revealed a moderate model fit. The domains showed good internal consistency, with the exception of the social domain. All individual items and domain scores of the WHOQOL-BREF showed nearly symmetrical distributions since mean scores were close to median scores, except of the ‘general health’ item. The highest percentage of missing values was found on the ‘sexual activity’ item (i.e. 19.3%). The WHOQOL-BREF showed moderate construct and discriminant validity since in both cases, 67% of the hypotheses were confirmed. Conclusion The present study provides support for using the WHOQOL-BREF for the hospitalized trauma population since the questionnaire appears to be valid and reliable. The WHOQOL-BREF can be used to assess QoL in a heterogeneous group of hospitalized trauma patients accurately