Life satisfaction and disability after severe traumatic brain injury.

OBJECTIVE: To assess the relationships between life satisfaction and disability after a severe traumatic brain injury (TBI). DESIGN: Cross-sectional study, including 75 patients 2 years or more after a severe TBI. METHODS: Life satisfaction was assessed with the Subjective Quality of Life Profile. Impairments, activities and participation were assessed with standardized tests. RESULTS: The satisfaction profile was flat, i.e. the majority of items obtained mean satisfaction scores close to 0, suggesting that participants felt indifferent to these items or in other words that they were neither satisfied nor unsatisfied. Patients were on average slightly dissatisfied with their cognitive functions, physical abilities and self-esteem. A factor analysis revealed three underlying factors. The main finding was that the relationships between life satisfaction and disability were not linear: the lowest satisfaction scores were reported by participants with moderate disability rated by the Glasgow Outcome Scale, while individuals with severe disability did not significantly differ from the good recovery group. CONCLUSION: Life satisfaction is not linearly related to disability after severe TBI.

[Child and adolescent quality of life: study analysis]. / La qualité de vie des enfants et des adolescents: analyse à partir d'enquêtes.

As with adults, the quality of life of children is a multi-dimensional concept, therefore, in theory, evaluations cannot be carried out except by the subject, given the very subjective nature of this procedure. There are obstacles in pediatrics with this postulate, as one would prefer to implement a procedure of evaluation regarding the child's own characteristics in order to determine the cognitive limits of his/her development. We have attempted to summarize this subjective aspect by adapting tools for evaluation suitable for both the child and adolescent. 1) The AUQUEL questionnaire. Targeted to nursery school or primary school children, it consists of a closed scale comprised of thirty-one items: the phases of satisfaction are presented with the use of four aspects which express different emotional conditions. It also includes an open question. 894 French children so far have filled out this questionnaire: 491 from the general population, 403 were evaluated under specific contexts, either organic illnesses, psychological problems, or in the context of social personalities. Differences can be observed, depending on the contexts, in a closed scale or an open question. We will look at the example of a kidney transplant to illustrate our point. 2) The "OKadolescent" questionnaire Similar in structure to an adult questionnaire; it differs, however, by the themes that are adopted to the life and preoccupations of an adolescent. It is made up, as with the questionnaire for children, of a closed scale (26 items), and an open question. Here, 268 adolescents from the general population can be compared with adolescents evaluated in either a somatic or war-zone context. We will take as an example adolescents who have undergone kidney transplants or have suffered from hepatitis, to demonstrate the paradoxical characteristics of the evaluation of the adolescents quality of life. 3) Conclusion Our experience in this domain of the evaluation of a child's quality of life enables us to confirm its feasibility, on the condition of using specific tools, for the clinician (the best representation for the impact of pathology on a child's quality of life), and its relevance as an element for evaluating the needs linked with the health of the given population.

[Concept of quality of life, results of studies of 13,000 subjects]. / Le concept de qualité de vie, résultats d'enquêtes effectuées auprès de 13,000 sujets.

A questionnaire (Subjective Quality of Life Profile, or SQLP) was finalized at the end of the eighties by our team. It was endorsed and tested on more than 13,000 subjects recruited outside of any medical context, or suffering from any somatic or psychological pathologies. On a conceptual framework, the questionnaire takes into account the subject's history independent from the context of his/her personal objectives. It differentiates quality of life from health, and stresses its multi-factorial aspect. The questionnaire is made up of 28 "inevitable" items covering four domains: relational, somatic, contextual and psycho-affective, as well as a list of optional items. Two types of questions pertaining to history are applied to each item, as well as to the anticipated expectations. The results are of interest in the following domains: 1) To specify the demands and complaints of subjects afflicted with various illnesses, and comparing them with healthy subjects. 2) To demonstrate the impact of various factors on the quality of life. 3) To observe patients' development following long-term or difficult therapy. 4) To be able to compare (once the questionnaires are filled out by different contributors), the patient's responses to those of his family or caregiver. 5) To take into account the patients' illness in order to provide the most pertinent results. These illnesses are always higher in psychiatry (and in particular those suffering from addictions): and are an unfavorable prognoses. Once the patient improves clinically, their illness decreases. 6) Regarding associates whose illnesses are at a "normal" level, the illness does not prove to be more serious than in exposed situations (either medical or social). At the moment it seems that the evaluation of a patient's quality of life brings an enriching, clarification to the appreciation of traditional medicine. Avoiding a social "desirability" criteria, we believe the responses relative to the illnesses will provide the best indication of the subjects' quality of life.

Infant, child and adolescent quality of life: surveys performed in a European context.

The authors have validated three quality of life questionnaires designed to assess mostly subjective aspects of quality of life, in infants (QUALIN questionnaire, a parents' report), children (AUQUEI questionnaire, a pictured self-report for children aged 3-11 years old) and in adolescents (OK.ado questionnaire). Psychometric properties being satisfactory, these questionnaires were completed by different samples, in different health states. We were thus able to detect the influence of several factors on children or adolescents' quality of life: illness tends to alter quality of life, but this is also the case for several psychosociological conditions, especially when combined with the child's age. In adolescents, one has to be careful in interpretation of results, since the healthy adolescent tends to complain to adults.