Disability and health-related quality-of-life 4 years after a severe traumatic brain injury: A structural equation modelling analysis

Abstract

Objectives: To assess predictors and indicators of disability and quality-of-life 4 years after severe traumatic brain injury (TBI), using structural equation modelling (SEM).

Methods: The PariS-TBI study is a longitudinal multi-centre inception cohort study of 504 patients with severe TBI. Among 245 survivors, 147 patients were evaluated upon 4-year follow-up, and 85 completed the full assessment. Two outcome measures were analysed separately using SEM: the Glasgow Outcome Scale-extended (GOS-E), to measure disability, and the QOLIBRI, to assess quality-of-life. Four groups of variables were entered in the model: demographics; injury severity; mood and cognitive impairments; somatic impairments.

Results: The GOS-E was directly significantly related to mood and cognition, injury severity, and somatic impairments. Age and education had an indirect effect, mediated by mood/cognition or somatic deficiencies. In contrast, the only direct predictor of QOLIBRI was mood and cognition. Age and somatic impairments had an indirect influence on the QOLIBRI.

Conclusion: Although this study should be considered as explorative, it suggests that disability and quality-of-life were directly influenced by different factors. While disability appeared to result from an interaction of a wide range of factors, quality-of-life was solely directly related to psycho-cognitive factors.

Keywords:

• Traumatic brain injury
• outcome
• quality-of-life

Acknowledgements

The authors thank all patients and family participants, and members of the CRFTC Steering Committee (Centre Ressource Francilien des Traumatisés Crâniens) for their valuable help.

Declaration of interest

The authors report no conflicts of interest. This study was funded by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2004), grant number AOM04084, and from the Institut de Recherche en Santé Publique (IRESP). It was supported by AP-HP (Département de la Recherche Clinique et du Développement).