Clinimetrics and functional outcome one year after traumatic brain injury
Klinimetrie en functionele uitkomst één jaar na traumatisch hersenletsel
This thesis is based on the findings of the FuPro-TBI (Functional Prognosis in Traumatic Brain Injury) study, which was part of the national FuPro research programme which investigated the functional prognosis of four neurological disorders: multiple sclerosis (MS), stroke, amyotrofic lateral sclerosis (ALS), and TBI. Frequently used measurement instruments were tested at different moments on their reliability and sensitivity to change. At the moment of discharge from hospital a reliable minimum set is the FIM, the FAM, and the Coop. At follow-up the data set can be extended with the NRS, the FAI, and the SIP-68 which are most sensitive to change, thereby covering all relevant domains of functioning and participation after TBI. A high level of agreement was found between patient and proxy on rating the patientâ€™s functioning, and quality of life. Unlike results from earlier reports, in the present study no underestimation or overestimation of the patientâ€™s limitations by the proxies was found. Few rehabilitation studies include patients from acute care hospitals. In this study 46% of the patients was discharged home and would not be taken into account in the usual prognostic studies on TBI in rehabilitation medicine. The risk of being admitted to an institution was significantly higher only for those with severe TBI [adjusted odds ratio (OR) = 14], and lowered cognitive status at the time of being discharged from hospital [adjusted OR = 12]. Our results show that patients with a caregiver with a preference for a passive coping style are more restricted in participation than patients with a caregiver with another preference for coping. One year post injury, 13% of the patients reported problems in physical functioning, 35% in cognitive functioning, and 26% in their emotional functioning. In addition, 76% of the patients were limited in psychosocial activities, 72% experienced work restrictions, and 91% of all patients reported a reduced QoL. Being a woman, having sustained a moderate TBI, and having a low physical or a low cognitive status at discharge from hospital are important predictor variables in poor functional prognosis and QoL one year after TBI.