Abstract
BackgroundThere is growing interest in health related quality of life (HRQoL) as an outcome measure in international trials. However, there might be differences in the conceptualization of HRQoL across different socio-cultural groups. The objectives of current study were: (I) to compare HRQoL, measured with the short form (SF)-36 of Dutch and Chinese traumatic brain injury (TBI) patients 1 year after injury and; (II) to assess whether differences in SF-36 profiles could be explained by cultural differences in HRQoL conceptualization. TBI patients are of particular interest because this is an important cause of diverse impairments and disabilities in functional, physical, emotional, cognitive, and social domains that may drastically reduce HRQoL.MethodsA prospective cohort study on adult TBI patients in the Netherlands (RUBICS) and a retrospective cohort study in China were used to compare HRQoL 1 year post-injury. Differences on subscales were assessed with the Mann-Whitney U-test. The internal consistency, interscale correlations, item-internal consistency and item-discriminate validity of Dutch and Chinese SF-36 profiles were examined. Confirmatory factor analysis was performed to assess whether Dutch and Chinese data fitted the SF-36 two factor-model (physical and mental construct).ResultsFour hundred forty seven Dutch and 173 Chinese TBI patients were included. Dutch patients obtained significantly higher scores on role limitations due to emotional problems (p < .001) and general health (p < .001), while Chinese patients obtained significantly higher scores on physical functioning (p < .001) and bodily pain (p = .001). Scores on these subscales were not explained by cultural differences in conceptualization, since item- and scale statistics were all sufficient. However, differences among Dutch and Chinese patients were found in the conceptualization of the domains vitality, mental health and social functioning.ConclusionsOne year after TBI, Dutch and Chinese patients reported a different pattern of HRQoL. Further, there might be cultural differences in the conceptualization of some of the SF-36 subscales, which has implications for outcome evaluation in multi-national trials.
Highlights
There is growing interest in health related quality of life (HRQoL) as an outcome measure in international trials
This results in 899 eligible patients of whom 447 completed all items of at least one of the short form (SF)-36 subscales after 12month follow-up
Notwithstanding, we found that vitality was strongly associated with mental health but not with physical health in the Dutch population, suggesting that this association could be related to the traumatic brain injury (TBI) rather than to cultural conceptualization
Summary
There is growing interest in health related quality of life (HRQoL) as an outcome measure in international trials. TBI patients are of particular interest because this is an important cause of diverse impairments and disabilities in functional, physical, emotional, cognitive, and social domains that may drastically reduce HRQoL. Health-related quality of life (HRQoL) reflects an individual’s perception of how an illness and its treatment affect physical, mental and social aspects of his/her life [1]. Because it provides well-standardized information on recovery patterns, frequency, nature, and predictors of disabilities, HRQoL has been recognized as an important outcome in many medical fields, including injury [2]. HRQoL has been emerged as an important outcome measurement following TBI [8]
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