Psychosocial adjustment and life satisfaction until 5 years after severe brain damage

The objectives of this study were to describe psychosocial adjustment and outcome over time for severely brain-injured patients and to find suitable outcome measures for clinical practice during the rehabilitation process and for individual rehabilitation planning after discharge from hospital. The methods include a descriptive, prospective, population-based study. The participants were assessed at 6 months and annually until 5 years after traumatic brain injury or nontraumatic subarachnoid haemorrhage. Inclusion criteria were age 16-65 years, severe traumatic brain injury or nontraumatic subarachnoid haemorrhage defined as Glasgow Coma Scale 8 or worse and need for neurointensive care for at least 5 days. The main outcome measures were Head Injury Evaluation Chart, Glasgow Outcome Scale Extended (GOSE) and Life Satisfaction Questionnaire (LiSat)-11 checklist. Change over time for the group and the individuals, as measured with the GOSE, was analyzed by a statistical method that is suitable for small datasets and takes into account the nonmetric properties of the data. Eighteen patients were included. Three died and one was excluded for the long-term follow-up (n=14). The group had a good outcome with no participant remaining in a vegetative state, 93% (12 of 13) went home and 60% (six of 10) returned to work. Eighty percent (eight of 10) of participants rated 'life as a whole' as satisfactory 5 years after the injury. The change at group level was significant (GOSE) until 1 year after the injury. The GOSE and the LiSat-11 were most clinically useful as they were easy to use for the rater/participants.