Assessing Quality of Life (QoL) Measures for Elderly Traumatic Brain Injury (TBI) Survivors: A Systematic Review
This project will guide future research on the elderly, as quality of care for elderly traumatic brain injury (TBI) survivors cannot be improved until valid and reliable measures of quality of life (QoL) are used and then combined with better management.
Findings: Our search yielded 3,145 citations. Of these 15 were duplicates and 2,663 were excluded based on the titles and abstracts, leaving 467 full text articles for review. Of these, 72 papers met the inclusion criteria. A total of 27 validated Qol tools were identified predominantly SF-36, EQ-5D, the WHO-QoL, Sickness Impact Profile and the QOLIBRI. Validity of the QoL tools were assessed by locating one publication using the measure in addition to the study included in the review. Seniors, particularly older women and mild TBI (compared to moderate and severe combined) are underrepresented in studies on QoL on traumatic brain injury.
Impact of findings: Seniors are more likely than younger adults to suffer emotional, physical and behavioural consequences and often require a longer period of time for recovery following Traumatic Brain Injury. It is difficult to make inferences on the QoL of elderly patients surviving TBI when the majority of the study populations are younger adults. This also suggests that perhaps many investigators are not taking in account specific QoL issues facing the elderly. More research on QoL after mild traumatic brain injury in the elderly is required to better understand the burden of mild traumatic brain injury. Our Head Injury Clinic is developing a mild TBI clinical data base with patient data on type of injury, symptoms, medical history, family history, community participation and QoL. This systematic review has helped guide our team to select the EQ-5D as our QoL measure. Our data base is establishing common data elements for a larger Ontario Concussion Strategy (public policy development) and as such this systematic review has helped to establish a key parameter QoL for the future provincial data base on common data elements for TBI.
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About the Project
TBI can be most alarming for the elderly and signal the end of independent living. Much of what is currently known about recovery is based on information provided by family or clinician ratings. Recently, there has been increased interest in the patients’ perception of problems post injury.
Nevertheless, there is a significant absence of synthesized evidence on characteristics of measures of QoL following this life-changing injury and it is unclear which tools are best suited for the distinctive elder population. Without this knowledge, the full impact of clinical interventions may go undetected, clinical decision-making may be less informed and comparisons across studies difficult. That's why our objective was to systematically review the literature for QoL measurements for elderly TBI survivors and summarize the evidence on reliability, validity and implementation.
For more details on the project rationale and objectives, click here.
Donna Ouchterlony, MD, CCFP -- St. Michael’s Hospital
Andrew Baker, PhD, MD -- University of Toronto
Shree Bhalerao, MD -- St. Michael’s Hospital
Michael Cusimano, MD -- University of Toronto
Cindy Hunt, BScN, DrPH, MPH -- St. Michael's Hospital/Dalla Lana School of Public Health, University of Toronto
David Lightfoot, PhD -- St. Michael’s Hospital
Cheryl Masanic, MD -- St. Michael’s Hospital
Alicja Michalak, RN -- St. Michael’s Hospital
Jane Toplovec-Vranic, PhD -- University of Toronto
Chantal Vaidyanath, MD -- St. Michael’s Hospital
Knowledge Users and Partners:
Charissa Levy, MHSc, BScOT -- GTA Rehab Network
Shawn Marshall, MD, MSc -- Ottawa Hospital Rehabilitation Centre
Bonny Pietkiewicz -- St. Michael’s Hospital
Camilla Wong, MD -- St. Michael’s Hopsital
Project Contact: Cindy Hunt -- firstname.lastname@example.org
Key words: traumatic brain injury; brain injury; concussion; head injury