Functional Prognosis of Long-term Outcome: a prospective Cohort study after Traumatic Brain Injury: A prospective Follow-up Study

The rationale of this thesis was to investigate the prognosis, course, and determinants of long-term activities and participation following moderate to severe Traumatic Brain Injury (TBI). Further, we investigated whether there was equity in health care utilization and whether patients experienced unmet needs for participation restrictions. The literature showed strong evidence for the prognostic vaJue in predicting long-term Disability for: older age, pre-injury unemployment, substance abuse, and disability at rehabilitation discharge. In contrast to previous studies, we found a protective effect for presence of the aJlete Apolipoprotein e:4 (APOE-e:4): Patients carrying the APOE-e:4 allele had a better global functional outcome than patients without the APOE-e:4 atleie, especiaUy at the long-term. The course on community integration af ter TBI, showed that most improvement was found in the first year af ter injury. However, mean levels of community integration, social integration, and productivity remained below mean preinjury levels. The BartheiIndex, age, and pre-injury community integration were the major determinants for community integration af ter 3 years. Health-related needs, like participation restrictions and co-morbidity, contributed mostly to healthcare use. This suggests that most patients that need care, do actually rec~ive care. However, health beliefs, such as external and internallocus of control also played a role. Therefore, we could not rule out inequity in the utilisation of medical specialists and supportive care. At 3-5 years post-injury, 17% of the patients, reported unmet needs on one or more domains. Most unmet needs concerned complex participation. Patients with clinical depression were more likely to experience unmet needs.

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