Patient-Proxy Agreement on the Health-Related Quality of Life One Year after Traumatic Brain Injury

Publication date: Available online 16 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Hei-Fen Hwang, Chih-Yi Chen, Mau-Roung Lin
ObjectiveTo examine the level of agreement between patients and their proxies on a measure of health-related quality of life (HRQL) 1 year after traumatic brain injury (TBI).DesignA cross-sectional study.Participantsand Setting: Eighty-eighty patients with TBI identified from discharge records of four hospitals in Taiwan and 88 family members or friends who could answer questions regarding the patient's health and HRQL 1 year after the injury.Main Outcome MeasuresA health profile of the brief Taiwanese version of the World Health Organization Quality of Life (WHOQOL-BREF) and two health utility measures of the time tradeoff (TTO) and standard gamble (SG).ResultsCompared to proxy responses, patients provided higher ratings of the WHOQOL-BREF's domains and lower ratings of the TTO and SG. Intraclass correlation coefficients between patient and proxy ratings varied among the four WHOQOL-BREF's domains, in which levels of agreement were moderate or good for physical capacity (0.69) and low for psychological well-being (0.45), social relationships (0.24), and the environment (0.32). Levels of agreement were extremely low for the TTO (0.0) and SG (0.10). A profile analysis showed that patients' ratings on the WHOQOL-BREF, on average, were significantly greater than those of their proxies (with a mean difference of 3.07), with a similar distribution of scatter responses (with a mean difference of 0.002) and shape agreement (0.57). Greater variations in the patient-proxy level of agreement appeared in patients who were younger and had more-severe injuries, and also with parent and child proxies.ConclusionsTo assess the HRQL of patients with a TBI, the level of patient-proxy agreement was adequate for the physical domain but was lower for the social and environmental domains, and the agreement was very low for the TTO and SG. Furthermore, a patient's age and injury severity, and patient-proxy' relationship may affect the agreement.



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