IMPACT OF STRUCTURED REHABILITATION ON QUALITY OF LIFE IN TRAUMATIC BRAIN INJURY PATIENTS AT TERTIARY CARE HOSPITALS IN PESHAWAR
DOI:
https://doi.org/10.71000/cqdj4x78Keywords:
Quality of Life, Rehabilitation, Brain Injuries, Cognitive Dysfunction, , Developing Countries, Social Adjustment, Trauma Severity IndicesAbstract
Background: Traumatic brain injury (TBI) remains a major public health burden worldwide, contributing significantly to long-term disability and mortality. In low- and middle-income countries such as Pakistan, the impact of TBI is further aggravated by frequent road traffic accidents, limited emergency care, and underdeveloped rehabilitation systems. Conventional assessments like the Glasgow Coma Scale often fail to capture the broader functional and psychosocial consequences faced by survivors. Addressing these gaps through structured rehabilitation may improve recovery outcomes.
Objective: To evaluate the effect of a structured rehabilitation program on cognitive, emotional, functional, and social domains of quality of life (QoL) in post-TBI patients attending tertiary care outpatient departments in Pakistan.
Methods: A descriptive cross-sectional study was conducted from June to December 2024 across three tertiary care hospitals in Peshawar. A total of 169 TBI patients aged 18–60 years were enrolled via convenience sampling. Participants underwent a standardized rehabilitation protocol comprising daily physical therapy (30 minutes, 5 days/week) and weekly psychological counseling (1 hour/session) over two months. QoL was assessed pre- and post-intervention using the QOLIBRI scale. A score <54 indicated poor QoL, while >84 indicated good QoL. Statistical analysis was performed using the Wilcoxon signed-rank test.
Results: Among the 169 patients, 78 (46.15%) were aged 18–30 years, and 105 (62.13%) were male. Post-rehabilitation, Mini-Mental Scale stupor ratings dropped from 59.1% to 14.2%, and cognitive impairments reduced from 47.93% to 11.83% (p < 0.001). Emotional difficulties declined from 33.73% to 15.38%, and impaired social relationships from 42.6% to 14.79% (p < 0.001). Total QOLIBRI scores showed significant improvement across all age and gender groups (p < 0.001).
Conclusion: Structured rehabilitation significantly improves cognitive, emotional, and functional outcomes in TBI patients. These findings advocate for the routine inclusion of multidisciplinary rehabilitation programs in outpatient care, particularly within resource-limited healthcare systems.
References
Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022;21(11):1004-60.
Zhong H, Feng Y, Shen J, Rao T, Dai H, Zhong W, et al. Global Burden of Traumatic Brain Injury in 204 Countries and Territories From 1990 to 2021. Am J Prev Med. 2025;68(4):754-63.
Yan J, Wang C, Sun B. Global, regional, and national burdens of traumatic brain injury from 1990 to 2021. Front Public Health. 2025;13:1556147.
Rahman U, Hamid M, Shan Dasti M, Nouman T, Vedovelli L, Javid A. Traumatic Brain Injuries: A Cross-Sectional Study of Traumatic Brain Injuries at a Tertiary Care Trauma Center in the Punjab, Pakistan. Disaster Med Public Health Prep. 2022;17:e89.
Bodien YG, Barra A, Temkin NR, Barber J, Foreman B, Vassar M, et al. Diagnosing Level of Consciousness: The Limits of the Glasgow Coma Scale Total Score. J Neurotrauma. 2021;38(23):3295-305.
Rauen K, Reichelt L, Probst P, Schäpers B, Müller F, Jahn K, et al. Quality of life up to 10 years after traumatic brain injury: a cross-sectional analysis. Health and Quality of Life Outcomes. 2020;18(1):166.
Ur Rehman MA, Emerson K, Merker VL, Young M, Lin DJ, Zafar SF. A patient-centric approach to neuro-recovery after acute brain injuries. Journal of Clinical Neuroscience. 2025;135:111158.
Samira Mercaldi R. Quality of Life and Occupational Performance after Traumatic Brain Injury. Global Journal of Human-Social Science. 2023;23(H7):1-5.
Ishfaque Ahmed Simair N-U-SAAGMZASDKLCD. Discrepency between Disability and Reported Well-being after Traumatic Brain Injury in Developing Countries. Pakistan Journal of Medical & Health Sciences. 2023;16(12):191.
Gilmore N, Bergquist TF, Bogner J, Corrigan JD, Dams-O’Connor K, Dreer LE, et al. Cognitive Performance is Associated With 1-Year Participation and Life Satisfaction Outcomes: A Traumatic Brain Injury Model Systems Study. The Journal of Head Trauma Rehabilitation. 2025;40(3):E226-E39.
Danial A, Fatima L, Bosan MF. The impact of cognitive impairment resulting from traumatic brain injury on health-related quality of life (HRQOL) in Pakistan. JPMA: Journal of the Pakistan Medical Association. 2023;73(7):e1559-e
Kreitzer N, Jain S, Young JS, Sun X, Stein MB, McCrea MA, et al. Comparing the Quality of Life after Brain Injury-Overall Scale and Satisfaction with Life Scale as Outcome Measures for Traumatic Brain Injury Research. J Neurotrauma. 2021;38(23):3352-63.
Prieto-Palomino MA, Delange-VanDerKroft M, Rodríguez-Rubio D, Lafuente-Baraza J, Aguilar-Alonso E, Rivera-López R, et al. Improvement of quality of life (QOL) between 1 and 3–4 years after traumatic brain injury (TBI) in ICU patients. Acta Neurochirurgica. 2020;162(7):1619-28.10.
Mamman R, Grewal J, Garrone JN, Schmidt J. Biopsychosocial factors of quality of life in individuals with moderate to severe traumatic brain injury: a scoping review. Qual Life Res. 2024;33(4):877-901.
Forslund MV, Perrin PB, Sigurdardottir S, Howe EI, van Walsem MR, Arango-Lasprilla JC, et al. Health-Related Quality of Life Trajectories across 10 Years after Moderate to Severe Traumatic Brain Injury in Norway. Journal of Clinical Medicine. 2021;10(1):157.
Mohanty M, Randhawa TS, Gupta SK, Sahoo SK, Zakhmi T. 6 A Study to Assess the Impact of Injury Severity on Disease Specific Quality of Life After Traumatic Brain Injury (TBI). Journal of the International Neuropsychological Society. 2023;29(s1):118-9.10.1017.
Mulyadi M, Harianto S, Tonapa SI, Lee BO. Early Quality-of-Life Changes in Mild Traumatic Brain Injury: A Prospective Study. J Trauma Nurs. 2023;30(2):75-82.10.1097.
Guan DX, Peters ME, Pike GB, Ballard C, Creese B, Corbett A, et al. Cognitive, Behavioral, and Functional Outcomes of Suspected Mild Traumatic Brain Injury in Community-Dwelling Older Persons Without Mild Cognitive Impairment or Dementia. J Acad Consult Liaison Psychiatry. 2025;66(2):118-29.
Silveira K, Smart CM. Cognitive, physical, and psychological benefits of yoga for acquired brain injuries: A systematic review of recent findings. Neuropsychol Rehabil. 2020;30(7):1388-407.
Ryttersgaard TO, Riis J, Johnsen SP, Mogensen PH, Bjarkam CR. Depression and cognitive sequelae registered within the first year among young Danish TBI survivors. Scand J Psychol. 2020;61(5):663-70.
Pettemeridou E, Lofitou K, Solomou I, Charalambous M, Ioannou M, Lori A, et al. Improving Self-Awareness in Chronic Moderate-Severe Acquired Brain Injury: The Social Cognitive Communication Intervention Combined With Transcranial Direct Current Stimulation. Am J Speech Lang Pathol. 2025;34(4):2228-43.
Venkatesan UM, Lancaster K, Lengenfelder J, Genova HM. Independent contributions of social cognition and depression to functional status after moderate or severe traumatic brain injury. Neuropsychol Rehabil. 2021;31(6):954-70.
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