A review of health-related quality of life in adult traumatic brain injury survivors in the context of combat veterans.(Report)

ABSTRACT

Health-related quality of life (HRQOL) research in traumatic brain injury (TBI) populations is beginning to emerge in the literature. Because rehabilitation and reintegration issues are complex with TBI, especially with new combat veterans, it is critical that future HRQOL research be designed to consider these issues. Utilizing explicit definitions and a conceptual model of HRQOL can provide researchers with a holistic base on which to build interventions for successful patient outcomes. The conceptual model of HRQOL of C.E. Ferrans, J.J. Zerwic, J.E. Wilbur, and J.L. Larson (2005) is an exemplar model that presents clear definitions and encompasses domains of HRQOL relevant to TBI survivors and their families. This review was organized utilizing the model of HRQOL of Ferrans et al. The objective of this review was to identify gaps in current knowledge of HRQOL and TBI. These findings were then used to develop recommendations for future research with combat veterans who have sustained a TBI.

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In 2006, the Centers for Disease Control and Prevention (CDC) reported that 1.4 million Americans experience a traumatic brain injury (TBI) each year in the United States, resulting in 50,000 deaths, 235,000 hospitalizations, and 1.1 million emergency service evaluations and discharges (CDC, 2006). Traumatic brain injuries most often occur from falls (28%), motor vehicle accidents (20%), struck-by or -against incidents (19%), or assaults (11%). In 2000, direct medical costs and indirect costs of TBI were estimated at $60 billion. Furthermore, the CDC has suggested that approximately 5.3 million Americans with TBI have life-long needs for assistance in performing their activities of daily living postinjury (CDC, 2006; Department of Veterans Affairs, 2004; National Dissemination Center for Children With Disabilities, 2006).

Recently, TBI also has significantly affected the lives of our uniformed service personnel. In March 2007, the Department of Defense acknowledged that more than 24,000 soldiers have been wounded in action since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom (Bascetta, 2007). Improved protective equipment is increasing the survival rate of soldiers with combat injuries that would have been fatal in previous wars (Hoge et al., 2008). However, the Defense and Veterans Brain Injury Center (DVBIC) confirmed that TBI has emerged as a major cause of morbidity among our soldiers during the current conflicts. Military healthcare providers regard brain trauma as the "signature wound of the Iraqi War" (DVBIC, 2006; Zoroya, 2007). At Walter Reed Army Medical Center, nearly 30% of all combat-related injuries treated from 2003 to 2005 included a brain injury (DVBIC, 2006). In fact, this number is probably higher because closed brain injuries are not always diagnosed promptly (Bascetta, 2007; DVBIC, 2006; Kronenberger & Sarkar, 2005).

The results of TBI can be devastating for both soldiers and their family members as the soldiers return from deployment. Cognitively, soldiers may experience difficulties with concentration, learning, memory deficits, and executive control dysfunctions (Sloane, 2006). Soldiers may concurrently have other disorders such as posttraumatic stress disorder, depression, anxiety disorders, and/or adjustment disorder (Hoge et al., 2008). Many U.S. soldiers have also sustained other physical trauma such as amputations and bums. They require periods of extensive recovery with unique rehabilitation challenges and long-term healthcare needs that include pain management, special prosthetics, limited communication, and various points of entry in the Department of Veteran Affairs' healthcare system. Many soldiers' healthcare needs are highly complex, involving multiple systems, and may create adversity in life situations as they reintegrate into society (Sloane, 2006).

Despite the number of troops involved in recent conflicts, there is a lack of knowledge of combat veterans' quality of life subsequent to TBI. The purposes of this review were to (a) identify the gaps in current knowledge regarding quality of life within the context of TBI and (b) apply these findings to developing recommendations for future research with combat veterans with a TBI. The conceptual model of health-related quality of life (HRQOL) of Ferrans, Zerwic, Wilbur, and Larson (2005) was used as a guide for this review.