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Prognostic factors of long-term functioning and productivity after traumatic brain injury: a systematic review of prospective cohort studies

Department of Rehabilitation Medicine, Erasmus MC, a.vanson-willemse{at}erasmusmc.nl

Gerard M. Ribbers

Rijndam Rehabilitation Center and Department of Rehabilitation Medicine, Erasmus MC

Arianne P. Verhagen

Department of General Practice, Erasmus

Henk J. Stam

Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands

Objective: To systematically review prospective cohort studies that investigated prognostic factors associated with long-term activity limitations or participation restrictions and productivity after a traumatic brain injury.

Data sources: PubMed and Psychinfo were searched from 1995 to April 2005, and references were checked.

Review methods: Publications were selected if the study assessed prognostic factors for activity limitations or participation restrictions at least one year post injury; outcome was measured with another or additional measure besides the Glasgow Outcome Scale; the design was a prospective cohort study of adult traumatic brain injury patients; the article was a full-text article written in English, French, German or Dutch. Two reviewers independently assessed methodological quality. A study was considered as `high quality' if it satisfied at least half of the maximum available quality score.

Results: Thirty-five articles reporting on 14 cohorts were included. Due to heterogeneity in prognostic factors and outcome measures, a best-evidence synthesis was performed. All cohorts were of high quality. Strong evidence for predicting disability was found for older age, pre-injury unemployment, pre-injury substance abuse, and more disability at rehabilitation discharge. Strong prognostic factors for being non-productive were pre-injury unemployment, longer post-traumatic amnesia, more disability at rehabilitation admission, and pre-injury substance abuse.

Conclusion: Older age, pre-injury unemployment, pre-injury substance abuse and more disability at rehabilitation discharge are important predictors of long-term disability. Pre-injury unemployment, longer post-traumatic amnesia, more disability at rehabilitation admission and pre-injury substance abuse are important predictors of being non-productive.

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