Citation

Andelic N, Soberg H, Berntsen S, Sigurdardottir S, Roe C. PM R 2014; 6(11): 1013-21; quiz 1021.

Affiliation

Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: e.c.t.roe@medisin.uio.no.

Copyright

(Copyright © 2014, American Academy of Physical Medicine and Rehabilitation, Publisher Elsevier Publishing)

DOI

10.1016/j.pmrj.2014.05.005

PMID

24844444

Abstract

OBJECTIVE: To describe the self-perceived health care needs in patients with moderate-to-severe traumatic brain injury (TBI) and to assess the impact of functional level at 1-year post injury on patients' unmet needs at the 5-year follow-up.

DESIGN: Prospective follow-up study. SETTING: Clinical research. PARTICIPANTS: A total of 93 patients participated in the 5-year follow-up.

METHODS: We registered demographic and injury-related data at the time of admission and scores for the Disability Rating Scale (DRS), Glasgow Outcome Scale-Extended (GOSE) and SF-36 subscales for physical functioning (PF) and mental health (MH) at 1 and 5 years. The patients' self-perceived health care needs and use of health care services at 5 years was main outcome measurement.

RESULTS: At the 5-year follow-up, 70% of patients reported at least one perceived need. The self-perceived health care needs were met in 39% of patients. The patients with unmet needs (n=29, 31%) reported frequent needs in emotional (65%), vocational (62%) and cognitive (58%) domains. These patients were significantly more likely to present a less severe disability on the DRS at the 1-year follow-up (OR, 0.11; 95% CI, 0.02-0.7; p=.02). Worse MH at the 1-year follow-up and a younger age (16-29 years) largely predicted unmet needs at the 5-year follow-up (OR, 3.28; 95% CI, 1.1-10.04; p=.04 and OR, 4.93; 95% CI, 0.16-15.2; p=.005 respectively).

CONCLUSION: Gaps between self-perceived health care needs and health care services received at the 5-year follow-up were found. An important message to clinicians who provide health care services in the late TBI phase is that they should be aware of patients' long-term needs regarding cognitive and emotional difficulties. Of equal importance is an emphasis on long-term vocational rehabilitation services. To ensure the appropriateness of health care service delivery, health care services after TBI should be better targeted at less severe TBI population as well.

Language: en