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Abstract

Traumatic brain injury (TBI) can cause impairment of functioning, that
disrupts critical aspects of psychosocial functioning such as work, interpersonal
relationships, and participation in recreational activity (Jennett, 1997; Seibert et
al., 2002; Tate, Lulham, Broe, Strettles, & Pfaff, 1989). As such, TBI affects the
quality of life of those who suffer its ongoing effects (Ponsford, Sloane, & Snow,
1996; Tennant, Macdermott, & Neary, 1995). Although many TBI rehabilitation
services state their aims as being to optimize quality of life following injury, there
has been very little research in this area. Reasons for this include ambiguity in
conceptualisation of quality of life and lack of consensus about appropriate
measures. Building on recent international consensus group recommendations
(e.g., Bullinger, 2002; National Institutes of Health [NIH], 1999), this thesis
addressed some fundamental gaps in knowledge in the TBl/QOL field.
This project aimed to provide an understanding of SQOL outcome and
ultimately develop predictive models of SQOL outcome following TBI. The
project utilized outcome data from a large population-based sample, collected
prospectively by the Neurotrauma Register of Tasmania. In summary, Study 1
identified an appropriate measure of subjective quality of life (SQOL), Frisch's
(1994) Quality of Life Inventory (QOLI) and found it was sensitive and
appropriate for adults with TBI. However, no research had been conducted with
the QOLI within the TBI population.
Study 2 confirmed a three-factor structure for the QOLI using both
exploratory and confirmatory factor analysis and identified only subtle
differences between the US-based normative distribution and pre-injury estimates of a sample of 470 people with TBI. Study 3 reported SQOL outcome
over four time-points to 12 months following injury for the QOLI Total and QOLI
Factor scores with a sample of 663 participants. Significant deterioration was
observed in QOLI scores at one and three months following injury, returning to
near pre-injury estimates by six months. Study 4 examined outcomes and
relationships between a large number of potential predictive variables identified
from previous research with QOLI outcomes. A number of important predictive
variables were identified across the five domains suggested by Berger, Leven,
Pirente, Bouillon, & Neugebauer (1999). Study 5 used regression modeling to
confirm predictive models of SQOL outcome at one, three, six and twelve
months following TBI and provided a means of identifying those at risk of poor
outcome.
This fundamental TBl/SQOL research provides clinicians and researchers
with the structure as well as pre and post injury normative distributions of an
appropriate measure of SQOL. The predictive models produced by this analysis
explained more variance than models reported in previous research, correctly
predicting participants' SQOL outcome to within a single point in over 70% of
cases. The predictive models will be valuable for rehabilitation clinicians who
wish to identify people who are at risk of poorer outcome. Building on the results
of this project, there are many avenues for further research. These include
extending the methodology to predict SQOL outcome over two, five or more
years following injury, and developing effective interventions that facilitate
restoration of SQOL following TBI.

Item Type:	Thesis - PhD
Authors/Creators:	Thomas, Matthew David
Keywords:	Brain damage, Brain, Brain injuries
Copyright Holders:	The Author
Copyright Information:	Copyright 2008 the author
Additional Information:	Thesis (PhD)--University of Tasmania, 2008. Includes bibliographical references. Ch. 1. Introduction and thesis overview -- Ch. 2. Measurement of subjective quality of life following traumatic brain injury -- Ch. 3. Predictors of subjective quality of life following traumatic brain injury -- Ch. 4. Study 1 - facilitation of adjustment following TBI: evaluation of a programme approach -- Ch. 5. Study 2 - Estimation of pre-injury subjective quality of life in traumatic brain injury -- Ch. 6. Study 3 - longitudinal subjective quality of life outcomes following traumatic brain injury -- Ch. 7. Study 4 - the relationship of domain variables and subjective quality of life following traumatic brain injury -- Ch. 8. Study 4.1 - the relationship of variables in the demographic and clinical domain and subjective quality of life -- Ch. 9. Study 4.2 - relationship of variables in the physical domain with subjective quality of life -- Ch. 10. Study 4.3 - relationship of variables in the psychological domain with subjective quality of life -- Ch. 11. Study 4.4 - relationship of variables in the social domain with subjective quality of life -- Ch. 12. Study 4.5 - relationship of variables in the cognitive domain with subjective quality of life -- Ch. 13. Summary and integration of findings from study four -- Ch. 14. Study 5 - models of subjective quality of life outcome -- Ch. 15. Discussion
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