Comparison of subjective and objective assessments of outcome after traumatic brain injury using the International Classification of Functioning, Disability and Health (ICF).

PURPOSE: The aim is to examine two aspects of outcome after traumatic brain injury (TBI). Functional outcome was assessed by the Glasgow Outcome Scale - Extended (GOSE) and by clinician ratings, while health-related quality of life (HRQoL) was assessed by the Quality of Life after Brain Injury (QOLIBRI). METHOD: The GOSE and the QOLIBRI were linked to the International Classification of Functioning, Disability and Health (ICF) to analyse their content. Functional outcome on ICF categories was assessed by rehabilitation clinicians in 55 participants with TBI and was compared to the participants' own judgements of their HRQoL. RESULTS: The QOLIBRI was linked to 42 and the GOSE to 57 two-level ICF categories covering 78% of the categories on the ICF brief core set for TBI. The closest agreement in the views of the professionals and the participants was found on the Physical Problems and Cognition scales of the QOLIBRI. CONCLUSIONS: The problems encountered after TBI are well covered by the QOLIBRI and the GOSE. They capture important domains that are not traditionally sufficiently documented, especially in the domains of interpersonal relationships, social and leisure activities, self and the environment. The findings indicate that they are useful and complementary outcome measures for TBI. In rehabilitation, they can serve as tools in assessment, setting meaningful goals and creating therapeutic alliance.

Applicability of the ICF checklist to traumatically brain-injured patients in post-acute rehabilitation settings.

OBJECTIVE: To evaluate the applicability of the International Classification of Functioning, Disability and Health (ICF) checklist in post-acute traumatically brain-injured patients in rehabilitation settings. DESIGN: A cross-sectional study based on the written documents of an interdisciplinary rehabilitation team. SUBJECTS: A sample of 55 patients with traumatic brain injury. METHODS: Two raters extracted information from the patients' medical documents using the ICF checklist. The most common ICF categories were identified and the agreement between the raters was evaluated. RESULTS: Of the 123 checklist categories, 30 reached a prevalence of 30% or more in the ratings of both raters, and 18 further categories reached a prevalence of 30% or more in the ratings of either one rater. Seventy-five categories (61%) did not reach the cut-off point and were thus considered irrelevant. Fourteen ICF categories not included in the checklist were also considered important. Extracting the data from pre-existing documents seems to be reliable: in 86% of the most relevant categories the difference between the raters in the qualifier values was at most 1. CONCLUSION: A checklist is a practical tool in clinical work. However, the current ICF checklist seems not to be adequate in characterizing patients with post-acute traumatic brain injury. Developing an ICF core set for these patients might prove useful.