title: Disability and health-related quality-of-life 4 years after a severe traumatic brain injury: A structural equation modelling analysis.
abstract: OBJECTIVE
  To assess predictors and indicators of disability and quality-of-life 4 years after severe traumatic brain injury (TBI), using structural equation modelling (SEM).
  
  
  METHODS
  The PariS-TBI study is a longitudinal multi-centre inception cohort study of 504 patients with severe TBI. Among 245 survivors, 147 patients were evaluated upon 4-year follow-up, and 85 completed the full assessment. Two outcome measures were analysed separately using SEM: the Glasgow Outcome Scale-extended (GOS-E), to measure disability, and the QOLIBRI, to assess quality-of-life. Four groups of variables were entered in the model: demographics; injury severity; mood and cognitive impairments; somatic impairments.
  
  
  RESULTS
  The GOS-E was directly significantly related to mood and cognition, injury severity, and somatic impairments. Age and education had an indirect effect, mediated by mood/cognition or somatic deficiencies. In contrast, the only direct predictor of QOLIBRI was mood and cognition. Age and somatic impairments had an indirect influence on the QOLIBRI.
  
  
  CONCLUSIONS
  Although this study should be considered as explorative, it suggests that disability and quality-of-life were directly influenced by different factors. While disability appeared to result from an interaction of a wide range of factors, quality-of-life was solely directly related to psycho-cognitive factors.
authors.affiliation: a Assistance Publique-Hôpitaux de Paris , Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation , Garches , France.|b EA 4047 HANDIReSP , Université de Versailles , Saint-Quentin , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Azouvi
authors.affiliation: c Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France.
authors.forename: Idir
authors.initials: I
authors.lastname: Ghout
authors.affiliation: d Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation , Paris, France Université Pierre et Marie Curie , Paris , France.
authors.forename: Eleonore
authors.initials: E
authors.lastname: Bayen
authors.affiliation: c Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France.|e Centre Ressources Francilien du Traumatisme Crânien (CRFTC) , Paris , France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Darnoux
authors.affiliation: c Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Azerad
authors.affiliation: a Assistance Publique-Hôpitaux de Paris , Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation , Garches , France.|b EA 4047 HANDIReSP , Université de Versailles , Saint-Quentin , France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ruet
authors.affiliation: b EA 4047 HANDIReSP , Université de Versailles , Saint-Quentin , France.|f Antenne UEROS-SAMSAH 92-UGECAM IDF , Hôpital Raymond Poincaré , Garches , France.
authors.forename: Claire
authors.initials: C
authors.lastname: Vallat-Azouvi
authors.affiliation: d Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Physique et Réadaptation , Paris, France Université Pierre et Marie Curie , Paris , France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Pradat-Diehl
authors.affiliation: c Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.affiliation: e Centre Ressources Francilien du Traumatisme Crânien (CRFTC) , Paris , France.
authors.forename: James
authors.initials: J
authors.lastname: Charanton
authors.affiliation: a Assistance Publique-Hôpitaux de Paris , Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation , Garches , France.|b EA 4047 HANDIReSP , Université de Versailles , Saint-Quentin , France.
authors.forename: Claire
authors.initials: C
authors.lastname: Jourdan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D019964:Mood Disorders / Q000209:etiology; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000209:etiology; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012678:Sensation Disorders / Q000209:etiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Traumatic brain injury; outcome; quality-of-life