Quality of life after traumatic brain injury: Finnish experience of the QOLIBRI in residential rehabilitation

Objective: To evaluate health-related quality of life of traumatic brain injury patients who have received intensive multidisciplinary residential rehabilitation. To examine the psychometric characteristics of the Finnish Quality of Life after Brain Injury (QOLIBRI) questionnaire. Subjects: A total of 157 adults with TBI, up to 15 years post-injury, who had been treated in the Käpylä Rehabilitation Centre, Helsinki, Finland. Methods: Functional status was assessed using the Extended Glasgow Outcome Scale. Emotional state was evaluated using the Hospital Anxiety and Depression Scale. Health-related quality of life was measured using a generic measure (Short Form-36) and the QOLIBRI. Results: Quality of life was related to depression, amount of help needed, anxiety, education level and age at injury. Quality of life was not associated with time since injury, but a paradoxical relationship was found with injury severity. Internal consistency (alpha = 0.79-0.95) and test-retest reliability (rtt = 0.75-0.87) of the Finnish QOLIBRI met standard psychometric criteria. Conclusion: Quality of life remained relatively stable in the long term. Milder injuries were associated with lower life satisfaction, and careful follow-up is recommended to target patients in special need. This study confirms the reliability and validity of the Finnish QOLIBRI

Health-related Quality of Life 12 months after severe traumatic brain injury: A prospective nationwide cohort study

OBJECTIVE: To assess health-related quality of life in individuals with severe traumatic brain injury at 12 months post-injury, applying the Quality of Life after Brain Injury (QOLIBRI) instrument, and to study the relationship between injury-related factors, post-injury functioning and health-related quality of life. Design/subjects: The study is part of a prospective, Norwegian multicentre study of adults (≥ 16 years old) with severe traumatic brain injury, as defined by a Glasgow Coma Scale score of 3–8 during the first 24 h post-injury. A total of 126 patients were included. METHODS: Socio-demographic data and injury severity variables were collected. Functioning at 3 and 12 months was assessed with the Glasgow Outcome Scale Extended (GOSE), the Functional Independence Measure (FIM), the Rivermead Post-concussion Questionnaire (RPQ), and the Hospital Anxiety and Depression Scale (HADS). Hierarchical regression analysis was applied. RESULTS: Mean QOLIBRI score was 68.5 (standard deviation = 18.8). Predictors of the QOLIBRI in the final regression model were: employment status (p = 0.05), GOSE (p = 0.05), RPQ (p < 0.001) and HADS (p < 0.001). The adjusted R2 showed that the model explained 64.0% of the variance in the QOLIBRI score. CONCLUSION: Symptom pressure and global functioning in the sub-acute phase of traumatic brain injury and psychological distress in the post-acute phase are important for health-related quality of life at 12 months post-injury. These domains should be the focus in rehabilitation aiming to improve health-related quality of life in patients with severe traumatic brain injury

Interpreting Quality of Life after Brain Injury (QOLIBRI) scores: Cross-walk with the Short Form-36

The Quality of Life after Brain Injury (QOLIBRI) instruments are traumatic brain injury-specific assessments of health-related quality of life (HRQoL), with established validity and reliability. The purpose of the study is to help improve the interpretability of the two QOLIBRI summary scores (the QOLIBRI Total score and the QOLBRI Overall Scale score). An analysis was conducted of 761 patients with traumatic brain injury (TBI) that took part in the QOLIBRI validation studies. A cross-walk between QOLIBRI scores and the SF-36 Mental Component Summary norm-based scoring system was performed using geometric mean regression analysis. The exercise supports a previous suggestion that QOLIBRI Total scores &lt; 60 indicate low or impaired HRQoL, and indicate that the corresponding score on the QOLIBRI-OS is &lt;52. The percentage of cases in the sample that fell into the &lsquo;impaired HRQoL&rsquo; category were 36% for the Mental Component Summary, 38% for the QOLIBRI Total, and 39% for the QOLIBRI-OS. Relationships between the QOLIBRI scales and the Glasgow Outcome Scale &ndash; Extended (GOSE), as a measure of global function, are presented in the form of means and standard deviations that allow comparison with other studies, and data on age and gender are presented for the QOLIBRI-OS. While bearing in mind the potential imprecision of the comparison, the findings provide a framework for evaluating QOLIBRI summary scores in relation to generic HRQoL that improves their interpretability

A Rasch Analysis of the QOLIBRI Six-Item Overall Scale

Objective: The Quality Of Life after BRain Injury (QOLIBRI) consortium has developed a short six-item scale (QOLIBRI-OS) to screen health-related quality of life after traumatic brain injury. The goal of the current study is to examine further psychometric qualities of the Quality Of Life after BRain Injury-Overall Scale (QOLIBRI-OS) at the item level using Rasch analysis with particular emphasis on the operating characteristics of the items. Method: A total of 921 participants with traumatic brain injury were recruited. The analysis sample was restricted to 795 participants with Glasgow Coma Score and Glasgow Outcome Score&ndash;Extended available in order to ensure a well-characterized sample. Results: Overall fit statistics indicate sufficient reliability of the QOLIBRI-OS. The assumption of unidimensionality could be confirmed with reservation. The range of item locations is small, whereas item thresholds cover a wide range of the latent trait. The majority of parameter estimations for all class intervals of the respective test are in accordance with the model assumptions. Conclusion: The results show that, despite marginal misfits to the model, the six items representing the QOLIBRI-OS could establish a Rasch scale

Comparison of subjective and objective assessments of outcome after traumatic brain injury using the International Classification of Functioning, Disability and Health (ICF)

Purpose. The aim is to examine two aspects of outcome after traumatic brain injury (TBI). Functional outcome was assessed by the Glasgow Outcome Scale - Extended (GOSE) and by clinician ratings, while health-related quality of life (HRQoL) was assessed by the Quality of Life after Brain Injury (QOLIBRI). Method. The GOSE and the QOLIBRI were linked to the International Classification of Functioning, Disability and Health (ICF) to analyse their content. Functional outcome on ICF categories was assessed by rehabilitation clinicians in 55 participants with TBI and was compared to the participants' own judgements of their HRQoL. Results. The QOLIBRI was linked to 42 and the GOSE to 57 two-level ICF categories covering 78%% of the categories on the ICF brief core set for TBI. The closest agreement in the views of the professionals and the participants was found on the Physical Problems and Cognition scales of the QOLIBRI. Conclusions. The problems encountered after TBI are well covered by the QOLIBRI and the GOSE. They capture important domains that are not traditionally sufficiently documented, especially in the domains of interpersonal relationships, social and leisure activities, self and the environment. The findings indicate that they are useful and complementary outcome measures for TBI. In rehabilitation, they can serve as tools in assessment, setting meaningful goals and creating therapeutic allianceRead More: http://informahealthcare.com/doi/abs/10.3109/09638288.2011.574776?journalCode=dr

Self-awareness and health-related quality of life after traumatic brain injury

Objective: To investigate the relations among self-awareness (SA), impaired SA, and health-related quality of life (HRQOL) after traumatic brain injury (TBI). Participants: One hundred forty-one adults hospitalized with TBI and their significant others from a cross-sectional multicenter study. Using Glasgow Coma Scale classification, 32 participants had severe injuries, 29 moderate, 44 mild, and 25 complicated mild TBI. Measures: Patient Competency Rating Scale for Neurorehabilitation; Short Form-36 Health Survey; Cognitive Quality of Life; Quality Of Life after Brain Injury; Hospital Anxiety and Depression Scale; Profile of Mood States; Glasgow Outcome Scale Extended. Method: Patient Competency Rating Scale for Neurorehabilitation ratings made by participants and their significant others were used to assess SA and discrepancies between the 2 ratings were used to define impaired SA. Results: Significant associations were identified between SA and HRQOL, anxiety, depression, and severity of injury. Participants with and without impaired SA differed in cognitive HRQOL and leisure activities. Using multiple regression, no direct predictors of SA were identified, although interaction effects were observed. Conclusion: After TBI, lower SA is associated with higher estimates of HRQOL, particularly in the cognitive domain. Although the associations are modest, the assessment of SA should play a role in the interpretation of reported HRQOL after TBI

Health-related Quality of Life 12 months after severe traumatic brain injury: A prospective nationwide cohort study

OBJECTIVE: To assess health-related quality of life in individuals with severe traumatic brain injury at 12 months post-injury, applying the Quality of Life after Brain Injury (QOLIBRI) instrument, and to study the relationship between injury-related factors, post-injury functioning and health-related quality of life. Design/subjects: The study is part of a prospective, Norwegian multicentre study of adults (≥ 16 years old) with severe traumatic brain injury, as defined by a Glasgow Coma Scale score of 3–8 during the first 24 h post-injury. A total of 126 patients were included. METHODS: Socio-demographic data and injury severity variables were collected. Functioning at 3 and 12 months was assessed with the Glasgow Outcome Scale Extended (GOSE), the Functional Independence Measure (FIM), the Rivermead Post-concussion Questionnaire (RPQ), and the Hospital Anxiety and Depression Scale (HADS). Hierarchical regression analysis was applied. RESULTS: Mean QOLIBRI score was 68.5 (standard deviation = 18.8). Predictors of the QOLIBRI in the final regression model were: employment status (p = 0.05), GOSE (p = 0.05), RPQ (p < 0.001) and HADS (p < 0.001). The adjusted R2 showed that the model explained 64.0% of the variance in the QOLIBRI score. CONCLUSION: Symptom pressure and global functioning in the sub-acute phase of traumatic brain injury and psychological distress in the post-acute phase are important for health-related quality of life at 12 months post-injury. These domains should be the focus in rehabilitation aiming to improve health-related quality of life in patients with severe traumatic brain injury

Quality of life in persons after traumatic brain injury as self-perceived and as perceived by the caregivers

The primary aim of the study was to adopt QOLIBRI (quality of life after brain injury) questionnaire in a proxy version (Q-Pro), i.e., to use caregivers for comparison and to evaluate whether TBI patients’ judgment corresponds to that of their caregivers since the possible self-awareness deficit of the persons with TBI. A preliminary sample of 19 outpatients with TBI and their proxies was first evaluated with the Patient Competency Rating Scale to assess patients’ self-awareness; then they were evaluated with the QOLIBRI Patient version (Q-Pt) and a patient-centered version of the Q-Pro. Subsequently, 55 patients and their caregivers were evaluated using the patient-centered and the caregiver-centered Q-Pro versions. Q-Pt for assessing Quality of Life (QoL) after TBI, as patients’ subjective perspective and Q-Pro to assess the QoL of patients as perceived by the caregivers. The majority of patients (62.2%) showed better self-perception of QoL than their proxies; however, patients with low self-awareness were less satisfied than patients with adequate self-awareness. Low self-awareness does not impair the ability of patients with TBI to report on satisfaction with QoL as self-perceived