- Quality of life comprises physical, emotional, cognitive, social, & general health
- Left hemisphere injured patients are less satisfied with their cognitive function
- Right hemisphere patients are less satisfied with their physical function
- Age, education, and lesion size influence perceived quality of life after injury
- Lesion location may mediate which aspects of quality of life are adversely impacted
To test the hypothesis that quality of life (QOL) is made up of different components and each of these has different anatomic and demographic contributors.
Questionnaire-based study ;
Center for Cognitive Neuroscience, University of Pennsylvania
52 people with chronic brain injury volunteered for the study. After excluding patients with severe communication deficits, bilateral lesions, and incomplete data, 42 patients with focal lesions were included in the final study: 22 patients with left hemisphere injury, LHI (9 females and 13 males; mean age 60.6 years (SD=11.2; Range: 36-83) mean chronicity 11.5 years (SD=4.2)) and 20 patients with right hemisphere injury, RHI (16 females and 4 males; mean age 62.7 years (SD= 12.8; Range: 31-79); mean chronicity 10.1 years (SD=4.3)).
Main Outcome Measures
We administered the RAND36-Item Health Survey (RAND-Version-1.0), Stroke Impact Scale (SIS-Version 3.0), Positive Affect and Negative Affect Scale (PANAS) and Distress Thermometer (DT) to measure QOL in LHI and RHI patients. Exploratory Factor Analysis (EFA) with principal component method reduced these measures to five factors, roughly categorized as— 1. Physical functioning, 2.General health, 3. Emotional health, 4. Social functioning, and 5. Cognitive functioning. Exploratory analyses attempted to relate these factor scores to demographic variables, neuroanatomical data, and neuropsychological measures.
Physical functioning was the biggest contributor to reduced QOL, explaining 32.5%, of the variance. Older age, less education, and larger lesion size predicted poorer physical functioning (p < .001). Age also affected emotional health. (p=.019). Younger patients reported poorer emotional health than older patients. LHI patients reported less satisfaction with their cognitive functioning (p=.009) and RHI patients with their physical functioning (p=.06). Exploratory neuroanatomical analyses hinted at brain areas that may be associated with the perception of disability in each QOL component.
QOL is comprised of five components. Clinical and demographic factors appear to differentially impact these aspects of patients’ perceived quality of life, providing hypotheses for further testing and suggesting potential relationships for therapeutic interventions to consider.