A history of unemployment or sick leave influences long-term functioning and health-related quality-of-life after severe traumatic brain injury.
ABSTRACT Abstract Primary objective: The consequences of pre-morbid factors in adults with severe traumatic brain injury have not been widely addressed. This study aimed to determine whether being unemployed or on sick leave before injury influences long-term health-related quality-of-life (HRQoL) and functioning in patients with severe traumatic brain injury. Subjects: Fifty-one consecutive patients were studied; aged 16-65 years, with severe traumatic brain injury who were admitted to Sahlgrenska University Hospital, Gothenburg, from 1999-2002. Methods: The patients were assessed once, 2-11 years after trauma. Data from the time of injury were combined into a validated prognostic model to adjust for injury severity. Data on sick leave and unemployment before injury were gathered from the Swedish social insurance agency. Outcomes were measured with the Short Form-36 Health Survey, the Glasgow Outcome Scale-Extended, and a self-report questionnaire specifically designed for this study to measure functioning. Results: In a multivariate analysis, a history of sick leave/unemployment predicted a worse long-term global outcome, more problems with personal activities of daily living and worse HRQoL. Conclusion: These results should be considered when refining outcome predictions and optimizing rehabilitation interventions for patients with severe traumatic brain injury.
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ABSTRACT: To examine the long-term global clinical outcomes of TBI patients from 1 week to 10 years post-injury. A retrospective study was conducted at a level I trauma centre. A total of 327 TBI patients were recruited retrospectively in this longitudinal study and the score of Glasgow Outcome Scale Extended (GOSE) was then documented as an indicator of the clinical outcomes. The results presented that less than one-in-three patients recovered well within 2 weeks after trauma. Around 40% of patients were evaluated as favourable outcomes within 6 months post-injury. Less than 30% of TBI patients could gain favourable outcomes at 3 years post-injury and over half of patients still could not recover well at 6 years. Five patients' outcomes were continuously followed until 10 years and the results indicated that they started to have good outcomes after 3 years post-injury. This study might be the first one to longitudinally evaluate the outcomes of patients from 1 week to 10 years post-injury and revealed that patients still may have difficulties in social interactions and family relationships until 6 years post-injury, even though they could live and work independently. Hence, professionals should pay attention to the underlying factors causing their difficulties within the long-term recovery process.Brain Injury 10/2010; 24(13-14):1606-15. DOI:10.3109/02699052.2010.523056 · 1.86 Impact Factor
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ABSTRACT: Traumatic brain injury (TBI) can cause lasting functional changes and lead to unemployment. The purpose of this study was to create and test a structural equation model (SEM) of the prediction of functional and employment outcome after TBI. Participants were 949 individuals with predominantly moderate to severe TBI (74% males, median age 25.7 years) who attended a follow-up interview 1 year post-injury. Outcome (employment and mood, cognitive and behavioural changes) was measured using the Structured Outcome Questionnaire. An SEM, based on existing research, was developed, tested and modified. A comparative fit index of 0.99 and a root mean square error of approximation of 0.03 supported the fit of the final model. Age, education, pre-injury employment, injury severity and limb injuries were direct predictors of employment outcome. Gender, pre-injury psychiatric disorders and limb injuries were related to employment outcome by their association with mood, cognitive and behavioural changes. The results demonstrate the complex interplay between various factors predicting outcome after TBI and provide evidence for the importance of tailoring rehabilitation to the individual's needs. Further research, including other conditions, can build on this model and include additional predictor and outcome measures.Journal of neurology, neurosurgery, and psychiatry 07/2011; 82(8):936-41. DOI:10.1136/jnnp.2010.210021 · 5.58 Impact Factor
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ABSTRACT: The International Mission on Prognosis and Analysis of Clinical Trials and Corticoid Randomisation After Significant Head injury prognostic models predict outcome after traumatic brain injury but have not been compared in large datasets. The objective of this is study is to validate externally and compare the International Mission on Prognosis and Analysis of Clinical Trials and Corticoid Randomisation after Significant Head injury prognostic models for prediction of outcome after moderate or severe traumatic brain injury. External validation study. We considered five new datasets with a total of 9,036 patients, comprising three randomized trials and two observational series, containing prospectively collected individual traumatic brain injury patient data. Outcomes were mortality and unfavorable outcome, based on the Glasgow Outcome Score at 6 months after injury. To assess performance, we studied the discrimination of the models (by area under the receiver operating characteristic curves), and calibration (by comparison of the mean observed to predicted outcomes and calibration slopes). The highest discrimination was found in the Trauma Audit and Research Network trauma registry (area under the receiver operating characteristic curves between 0.83 and 0.87), and the lowest discrimination in the Pharmos trial (area under the receiver operating characteristic curves between 0.65 and 0.71). Although differences in predictor effects between development and validation populations were found (calibration slopes varying between 0.58 and 1.53), the differences in discrimination were largely explained by differences in case mix in the validation studies. Calibration was good, the fraction of observed outcomes generally agreed well with the mean predicted outcome. No meaningful differences were noted in performance between the International Mission on Prognosis and Analysis of Clinical Trials and Corticoid Randomisation After Significant Head injury models. More complex models discriminated slightly better than simpler variants. Since both the International Mission on Prognosis and Analysis of Clinical Trials and the Corticoid Randomisation After Significant Head injury prognostic models show good generalizability to more recent data, they are valid instruments to quantify prognosis in traumatic brain injury.Critical care medicine 05/2012; 40(5):1609-17. DOI:10.1097/CCM.0b013e31824519ce · 6.15 Impact Factor