Explaining quality of life for persons with traumatic brain injuries 2 years after injury

To model the complex effects of demographic, psychosocial, physical, and rehabilitation variables on quality of life 2 years after hospital discharge.

Medical record and longitudinal survey data on traumatic brain injury (TBI) survivors who did or did not receive formal rehabilitation services after being injured were analyzed.

The study sample was selected from a representative sample of hospitals in north-central Alabama.

Criteria for inclusion were: (1) 18 years and older with TBI; (2) discharged after hospital stay of 3 or more days; and (3) resided and injured in Alabama. There were 293 persons eligible for the 24-month follow-up survey, 186 (63%) of whom participated; the focus was on the 116 persons (of 186) who responded to the surveys themselves.

A causal model of hypothesized direct and indirect effects of several variables on quality of life outcomes.

Employment was the strongest contributor of improved quality of life. Persons unable to pay for health care showed less improvement in functional independence 12 to 24 months postinjury and reported a poorer quality of life. The psychosocial variables of self-blame and family support improved quality of life by reducing impairments and increasing the likelihood of employment. Family support also improved quality of life by increasing functional independence. Fewer physical impairments and gains in functional independence directly improved quality of life.

The interrelationships between psychosocial and physical variables are important when examining quality of life. Interventions are recommended targeting psychosocial variables and functional independence in efforts to improve quality of life.