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Comparison of long-term outcomes following traumatic injury: what is the unique experience for individuals with brain injury compared with orthopaedic injury?
thesisposted on 21.02.2017, 05:03 by Dahm, Jane
Traumatic brain injury (TBI) is associated with long-term cognitive, behavioural and emotional difficulties that may last for 10 years or more. Less is understood about long-term outcomes following orthopaedic trauma, or how they differ from outcomes following TBI. Most studies comparing these trauma groups have been either short-term or cross-sectional in design, identifying few differences other than the expected cognitive impairment associated with TBI. The ability to draw conclusions and generalise findings from prior trauma research has been further limited by the use of differing measures, definitions and methodology. Given that TBI may be accompanied by comorbid orthopaedic injuries which are frequently not considered in TBI studies, the specific influence of TBI in the context of other injuries has therefore been unclear. There is evidence of orthopaedic recovery stabilising by 2 years post-injury, while TBI sequelae may persist. Outcomes following TBI may consequently become more differentiated over an extended timeframe. The overarching aim of this thesis was to seek greater understanding of the subjective experience following TBI compared with traumatic orthopaedic injury (TOI), and hence identify aspects unique to individuals with TBI. Three prospective, long-term studies were undertaken to achieve this. Study One compared a wide range of self-reported outcomes at 5-10 years for a group with complicated mild to severe TBI, a group with TOI, and an uninjured control group. Long-term disability was reported by both injury groups, specifically, poorer global functioning, greater interference from pain, and more psychological distress than the control group. Self-reported outcomes for individuals with TBI were distinguished from those with TOI by greater cognitive difficulties; greater psychological distress with more symptoms of anxiety and PTSD; and more psychosocial difficulties, including lower rates of employment and relationships. In Study Two, factors associated with two outcomes—global functioning (GOS-E) and employment status— were investigated at 10 years post-injury. Factors differed for the trauma groups, with demographic factors and injury severity contributing to global functioning and employment following TBI, but not TOI. These findings suggest that injuries continue to influence outcomes over an extended timeframe following TBI, while outcomes following TOI are more influenced by other factors. More detailed study of the trajectory and factors related to employment over 10 years following traumatic injury was the focus of Study Three. Factors associated with poorer employment outcomes over the 10 year period were a more severe TBI, older age, pre-injury psychological treatment, and studying or having a blue collar occupation at time of injury. Despite long-term difficulties with employment participation following TBI, the possibility of ongoing improvements was also identified except for the most severely injured. Overall, the findings from this thesis indicate that the post-injury experience for individuals with TBI incorporates unique cognitive and psychosocial characteristics compared with orthopaedic trauma. Given the potential for improving outcomes over an extended period, ongoing access to individualised rehabilitation is warranted, although further investigation is required to develop a substantive basis for evidence-based practice.