Quality of life in a population with dizziness and balance problems following mild-moderate traumatic brain injury. 

Kleffelgaard, I.1,2,3, Langhammer, B.2, Soberg, H.L.1,2
1Dept. of Physical Medicine and Rehabilitation, Oslo University Hospital HF, Norway
2Faculty of Health Sciences, Oslo Metropolitan University, Norway
3Faculty of Medicine, University of Oslo, Norway

Objectives: Dizziness and balance problems are common following traumatic brain injury, (prevalence: 30-80%), and might cause functional limitations, psychological distress, and have a negative impact on quality of life. The purpose of this study was to evaluate health-related quality of life (HRQL) in patients with dizziness and balance problems following a mild-moderate traumatic brain injury, and to explore the associations between HRQL and personal, injury related and post-injury functioning factors. 

Methods: Baseline assessments of 64 patients (45 female, mean age 39.4 (13.0) years) included in an RCT evaluating the effect of vestibular rehabilitation for dizziness and balance problems were analyzed.  
Personal factors (age, gender, social status, educational level, sick-leave status, co-morbidities), injury related factors (GCS, PTA, LOS, CT/MRI) and self-reported and performance based outcome measures were used for the assessments: Rivermead Post-concussion symptoms Questionnaire (RPQ), Vertigo Symptom Scale-short form (VSS-sf), Hospital Anxiety and Depression Scale (HADS), Balance Error Scoring System (BESS), High Mobility Assessment Tool for TBI (HiMAT). HRQL was measured with the QOLIBRI - Quality of life after brain injury (0-100 worst-best).
Preliminary univariate regression analyses were performed to explore the associations between HRQL and personal and injury related factors, and self-reported and performance-based functioning after TBI. 

Results: The mean total QOLIBRI score was 53.2 (17.5). Scores on the subscales were: Cognition: 50.1 (21.8); Self: 45.4 (22.7); Daily life and autonomy: 48.5 (22.6); Social relationships 66.7 (22.6); Emotions: 60.4 (21.4); Physical problems: 51.4 (19.2).
Being on sick-leave was significantly associated with HRQL (Beta = -0.281, p = 0.03). No other personal or injury related factors showed significant associations with HRQL. Self-reported outcomes measuring post-concussion symptoms (RPQ) and vertigo symptoms had significant associations with HRQL (Beta = -0.762, p < 0.001 and Beta = 0.569, p < 0.001 respectively). Psychological distress (HADS) also had significant associations with HRQL (-0.766, p < 0.001). Significant associations were also found between HRQL and balance (BESS: Beta -0.243, p = 0.05), and mobility (HiMAT: Beta 0.350, p = 0.005). 

Conclusions: The patients had a total score on the QOLIBRI, indicating reduced HRQL. At baseline it was significantly associated with sick-leave, post-concussion- and dizziness symptoms, psychological distress, and reduced balance and mobility. The results confirm the negative impact dizziness and balance problems have on HRQL following a mild-moderate TBI. 

Trial registration: Clinical Trials # NCT01695577