Functional Outcomes and Life Satisfaction After Traumatic Brain Injury: A Systematic Review Through Progress-plus Framework

Objective(s): To synthesize evidence on functional outcomes and life satisfaction after traumatic brain injury (TBI) in adults using the PROGRESS-Plus framework covering social equity parameters.

Data Sources: We searched Cochrane Central Register of Controlled Trials, CINAHL Ultimate, Embase, MEDLINE, PsycINFO, and Web of Science from inception to September 2019. We repeated searches in March 2024 and uploaded citations to Covidence. We selected observational studies published in English that investigated functional outcomes and life satisfaction in adults (18 years or older) with TBI, which considered at least age, gender/sex, and injury severity in data analysis.

Study Selection: Out of 4,546 citations from updated searches, screened by two authors independently, 10 studies met the inclusion criteria. Combined with 19 studies from initial searches, we included 29 studies in data analysis. We used the NIH-recommended assessment tool for observational studies to assess the study quality.

Data Extraction: Two authors independently extracted data using previously published tables, updated with PROGRESS-Plus parameters, and rated the study quality. The senior author assessed the accuracy of the extraction and quality assessment.

Data Synthesis: 29 studies, all of fair quality, included a total of 99,945 adults with TBI (85% male, mean age 37 years old). Functional outcome was the outcome of interest in 27 studies, and quality of life/life satisfaction in four included studies. Each study considered at least one PROGRESS-Plus parameter in data analysis: after gender/sex and age, education was the most frequently considered parameter, reported in 14 (48%) studies. The eight studies (28%) that built multivariate models found that race was associated with life satisfaction, and that race, language, education, and marital status were associated with functional outcomes. Religion was not investigated in any of the studies.

Conclusions: Limited attention to social equity parameters in TBI research on life satisfaction and functional outcomes indicates a gap in knowledge that needs to be filled to inform equitable research, policy, and practice. PROSPERO: CRD42024547456

Author(s) Disclosures: The study received funding from Canadian Institutes of Health Research (Op. Grant: Brain Health and Reduction of Risk for Age-related Cognitive Impairment - KS and Mobilization Grants - Sex and Gender Differences SGD grant # 202306BK5-510306-BKS-ADHD-220229. The authors have declared that no competing interests exist.