Quality of Life Valuations for Traumatic Brain Injury States

Abstract

Background: Recent studies identify the true burden of mild traumatic brain injuries (mTBIs) as significantly higher than previously estimated. One way to measure the impact of mTBIs is using an outcome measure such as the health-related quality of life (HRQoL). Literature suggests that individuals HRQoL improves over time despite ongoing issues as they adapt and adjust, and the HRQoL stabilises around 2 years. Although the trajectory and rationales for the changes in HRQoL after moderate to severe TBIs is well documented, little attention has been paid to the mTBI population. Aim: The aim of this study was to investigate the trajectory of HRQoL after a mTBI and explore the rationales behind the changes in HRQoL in the first 30 months post-mTBI. Methods: In this cross-sectional qualitative study, six semi-structured interviews were conducted with participants that had experienced a mTBI in the last 30 months. The participants completed the EQ-5D 3L questionnaire, followed by standard gamble (SG) valuation tasks using think-aloud for three different time-periods. Reponses to these valuations were followedup by discussions between the researcher and the participant to understand participants’ experiences of HRQoL using interpretive phenomenology. Results: The trajectory of HRQoL after a mTBI is positive as demonstrated by participant’s EQ-5D index values and SG utility scores. The findings indicate whilst mTBI symptoms reduce over time, some remain a persistent issue. In response, individuals described a range of adjustments directed at these persistent issues and reported good HRQoL. A decrease in the usual activities was also found in the current sample. Conclusion: The findings from this study is consistent with previous literature on positive trajectory of HRQoL after a TBI and reflects some of the suggested rationales (e.g. change in values or usual activities) alongside new rationales (e.g. behaviour and environmental adjustments) for the observed changes in HRQoL.