Predictors of Long-Term Outcomes after Severe Brain Injury

Neuro OT Article Review

Early rehabilitation interventions appear to be essential for how well an individual recovers after a severe brain injury. It might even increase the chances for long-term survival, according to researchers at the University of Gothenburg. In a series of studies, Doctoral Student, Trandur Ulfarsson has explored the long-term effects of traumatic brain injuries caused for example by accidents or violence.

280 Swedish and Icelandic participants were followed up 1-11 years post brain injury, the study has shown a clear association between how quickly individuals get access to rehabilitation and how well they recover. Outcomes were measured once, 2 -11 years after trauma, and included;

• Hormonal testing
• The Short Form-36 Health Survey
• The Glasgow Outcome Scale – Extended (GOSE)
• A self-report questionnaire specifically designed for these studies.

Brain injury - Premorbid Functional Status and Health Complications

The studies found that the functional activity, for example how independent the individuals were in their daily activities and how fast they can return to work, is substantially improved among those who are admitted to inpatient rehabilitation early. The studies also show that severe brain injury often leads to an impaired pituitary function, most often lack of growth hormone, which in turn may cause obesity.

Individuals who were unemployed or on sick leave prior to the injury also seems to be associated with worse functional performance and reduced quality of life several years after the injury. Moreover, the Gothenburg studies show that men who suffer a severe traumatic brain injury have a five times higher risk of dying ten years after the injury. For women, the risk is eight times higher. These findings also confirm similar recent research results. The increased risk can be attributed to illnesses and disabilities lingering on for several years after the injury. The participants reported lasting disability, and low quality of life, with a complex range of physical, cognitive, behavioural and emotional disturbance.

Ulfarsson stated:

‘The studies provide important information for brain injury victims, their families and friends, and the healthcare sector.’

One conclusion is that:

‘Severe traumatic brain injury should be considered a chronic medical condition that requires professional care and support for a very long time. The study provides valuable information that will help us improve outcome predictions, optimise the rehabilitation process and evaluate treatment effects for these patients.’

Management of brain injury - conclusions

These studies highlight the concrete factors that could increase long-term survival including admission to rehabilitation support at the right time, special interventions for individuals who were unemployed or on sick leave prior to the injury, and assessment of pituitary function in overweight individuals. It is important that we, as rehabilitation clinicians, consider these types of research and findings when refining long-term outcome predictions and optimising rehabilitation interventions.

The full article is available here

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