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Appears in Collections:Psychology Journal Articles
Peer Review Status: Refereed
Title: Discrepancy between disability and reported well-being after traumatic brain injury
Author(s): Retel Helmrich, Isabel Rosalie Arianne
van Klaveren, David
Andelic, Nada
Lingsma, Hester
Maas, Andrew
Menon, David
Polinder, Suzanne
Røe, Cecilie
Steyerberg, Ewout W
Van Veen, Ernest
Wilson, Lindsay
Keywords: Psychiatry and Mental health
Neurology (clinical)
Issue Date: 10-May-2022
Date Deposited: 24-May-2022
Citation: Retel Helmrich IRA, van Klaveren D, Andelic N, Lingsma H, Maas A, Menon D, Polinder S, Røe C, Steyerberg EW, Van Veen E & Wilson L (2022) Discrepancy between disability and reported well-being after traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry.
Abstract: Background Following traumatic brain injury (TBI), the clinical focus is often on disability. However, patients’ perceptions of well-being can be discordant with their disability level, referred to as the ‘disability paradox’. We aimed to examine the relationship between disability and health-related quality of life (HRQoL) following TBI, while taking variation in personal, injury-related and environment factors into account. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. Disability was assessed 6 months post-injury by the Glasgow Outcome Scale-Extended (GOSE). HRQoL was assessed by the SF-12v2 physical and mental component summary scores and the Quality of Life after Traumatic Brain Injury overall scale. We examined mean total and domain HRQoL scores by GOSE. We quantified variance in HRQoL explained by GOSE, personal, injury-related and environment factors with multivariable regression. Results Six-month outcome assessments were completed in 2075 patients, of whom 78% had mild TBI (Glasgow Coma Scale 13–15). Patients with severe disability had higher HRQoL than expected on the basis of GOSE alone, particularly after mild TBI. Up to 50% of patients with severe disability reported HRQoL scores within the normative range. GOSE, personal, injury-related and environment factors explained a limited amount of variance in HRQoL (up to 29%). Conclusion Contrary to the idea that discrepancies are unusual, many patients with poor functional outcomes reported well-being that was at or above the boundary considered satisfactory for the normative sample. These findings challenge the idea that satisfactory HRQoL in patients with disability should be described as ‘paradoxical’ and question common views of what constitutes ‘unfavourable’ outcome.
DOI Link: 10.1136/jnnp-2021-326615
Rights: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:
Notes: Output Status: Forthcoming/Available Online
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