Participation, Life Satisfaction, and Psychosocial Health Dissociate with Level of Disability: A Traumatic Brain Injury Model System Study

Research Objectives: Examine the association between global function assessed by the Glasgow Outcome Scale Extended (GOSE) and participation (Participation Assessment of Recombined Tools Objective [PARTO]), life satisfaction (Satisfaction with Life Scale [SWLS]), and psychosocial health (Patient Health Questionnaire-9 [PHQ9]), Generalized Anxiety Disorder-7 [GAD7]), one-year post-traumatic brain injury (TBI).

Design: Retrospective analysis of prospectively collected cross-sectional data.

Setting: TBI Model Systems (TBIMS) inpatients rehabilitation facilities and the community.

Participants: Adults with moderate-severe TBI enrolled in TBIMS who completed the GOSE and at least one additional outcome measure at the one-year follow-up assessment.

Interventions: N/A

Main Outcome Measures: GOSE, PARTO, SWLS, PHQ9, GAD7

Results: In 7,568 participants (median interquartile range [IQR]) age=44(27,61) years, 73% male, 66% white), the median (IQR) 1-year GOSE score was 6(4, 7). Although the total GOSE score was correlated with each outcome measure (p < 0.001), within each GOSE category, there were wide distributions in PARTO, SWLS, PHQ9, and GAD7 scores (e.g., SWLS ranged from the minimum to the maximum score [5-35] in participants with lower severe disability on the GOSE [score=3])). There was no significant difference in PARTO scores for participants with GOSE scores of 7vs8, in SWLS scores for participants with GOSE 3vs4 and 4vs5, in PHQ9 scores for participants with GOSE 3vs4 and 4vs5, and in GAD7 scores for participants with GOSE 3 vs 4, 4 vs 5, and 5 vs 6. Among participants with an “unfavorable” outcome (GOSE ≤ 4), 191 (8%), 601 (44%), 536 (67%), and 602 (75%) participants scored in the normal range on the PARTO, SWLS, PHQ9, and GAD7, respectively. Conversely, among participants with a “favorable” outcome (GOSE > 4), 2789 (57%), 1509 (34%), 456 (17%), and 331 (13%) participants scored below normal range on the PARTO, SWLS, PHQ9, and GAD7, respectively.

Conclusions: Although there was an association between global outcome and participation, life satisfaction, depression, and anxiety, within each GOSE outcome category, there was wide variability in function across these domains. A dichotomized GOSE rating is likely to mischaracterize individuals who may have a lower level of global function but adequate life satisfaction and psychosocial health, or, conversely, a higher level of global function but poor life satisfaction and psychosocial health. Furthermore, our findings suggest that a 1-point change in a GOSE score is not necessarily associated with a change in life satisfaction or psychosocial health. Overreliance on a single measure of global function after TBI disregards critical information about other meaningful outcomes.

Author(s) Disclosures: No disclosures.