Communication and Psychosocial Outcomes 2-Years After Severe Traumatic Brain Injury: Development of a Prognostic Model

Leanne Togher; Elise Elbourn; Belinda Kenny; Cynthia Honan; Emma Power; Robyn Tate; Skye McDonald; Brian MacWhinney

doi:10.1016/j.apmr.2023.04.010

Communication and Psychosocial Outcomes 2-Years After Severe Traumatic Brain Injury: Development of a Prognostic Model

Arch Phys Med Rehabil. 2023 Nov;104(11):1840-1849. doi: 10.1016/j.apmr.2023.04.010. Epub 2023 May 3.

Authors

Leanne Togher¹, Elise Elbourn², Belinda Kenny³, Cynthia Honan⁴, Emma Power⁵, Robyn Tate⁶, Skye McDonald⁷, Brian MacWhinney⁸

Affiliations

¹ Faculty of Medicine & Health, Susan Wakil Health Building, The University of Sydney, Sydney, Australia.
² Faculty of Medicine & Health, Susan Wakil Health Building, The University of Sydney, Sydney, Australia. Electronic address: elise.elbourn@sydney.edu.au.
³ Western Sydney University, Penrith, Australia.
⁴ School of Medicine, University of Tasmania, Hobart, Australia.
⁵ The University of Technology, Sydney, Australia.
⁶ Faculty of Medicine & Health, Northern Clinical School, The University of Sydney, Sydney, Australia.
⁷ School of Psychology, University of New South Wales, Sydney, Australia.
⁸ Department of Psychology, Carnegie Mellon University, Pittsburgh, PA.

PMID: 37146957
DOI: 10.1016/j.apmr.2023.04.010

Abstract

Objective: To examine predictive factors underlying communication and psychosocial outcomes at 2 years post-injury. Prognosis of communication and psychosocial outcomes after severe traumatic brain injury (TBI) is largely unknown yet is relevant for clinical service provision, resource allocation, and managing patient and family expectations for recovery.

Design: A prospective longitudinal inception design was employed with assessments at 3 months, 6 months, and 2 years.

Participants: The cohort included 57 participants with severe TBI (N=57).

Setting: Subacute and post-acute rehabilitation.

Main outcome measures: Preinjury/injury measures included age, sex, education years, Glasgow Coma Scale, and PTA. The 3-month and 6-month data points included speech, language, and communication measures across the ICF domains and measures of cognition. The 2-year outcome measures included conversation, perceived communication skills, and psychosocial functioning. Predictors were examined using multiple regression.

Interventions: Not applicable.

Results: The cognitive and communication measures at 6 months significantly predicted conversation measures at 2 years and psychosocial functioning as reported by others at 2 years. At 6 months, 69% of participants presented with a cognitive-communication disorder (Functional Assessment of Verbal Reasoning and Executive Strategies [FAVRES]). The unique variance accounted for by the FAVRES measure was 7% for conversation measures and 9% for psychosocial functioning. Psychosocial functioning at 2 years was also predicted by pre-injury/injury factors and 3-month communication measures. Pre-injury education level was a unique predictor, accounting for 17% of the variance, and processing speed/memory at 3 months uniquely accounted for 14% of the variance.

Conclusion: Cognitive-communication skills at 6 months are a potent predictor of persisting communication challenges and poor psychosocial outcomes up to 2 years after a severe TBI. Findings emphasize the importance of addressing modifiable cognitive and communication outcomes variables during the first 2 years after severe TBI to maximize functional patient outcomes.

Keywords: Cognition; Communication; Outcomes; Prognosis; Rehabilitation; Traumatic brain injury.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Injuries* / rehabilitation
Brain Injuries, Traumatic* / psychology
Communication
Humans
Prognosis
Prospective Studies