Life satisfaction is regarded as an important indicator of the efficacy of a rehabilitative intervention. Quality of life (QoL) is a subjective measure that takes many factors into account including but not restricted to: health and functioning, psychological and material wellbeing, and social functioning (Mailhan et al. 2005). Other factors such as cognitive functioning, physical functioning sexual functioning, and vocational outcomes have been related to QoL outcomes (Esbjörnsson et al. 2013; Forslund, Roe, et al. 2013; Jacobsson & Lexell 2013a; Sander et al. 2013). Satisfaction with QoL is a complex concept and there does not seem to be consensus on its definition or operationalization.
Following ABI, overall QoL has been shown to decrease (Gregório et al. 2014) but may fluctuate for years after injury (Anke et al. 2015; Forslund, Roe, et al. 2013; Hu et al. 2012). Compared to healthy individuals, those with ABI reported less satisfaction with multiple aspects of life (Atay et al. 2016; Jacobsson & Lexell 2013a), such as sexuality (Downing et al. 2013; Goldin et al. 2014; Strizzi et al. 2015) Several factors were found to be predictors of QoL including recovery outcomes, post-injury symptoms, and levels of depression and anxiety (Anke et al. 2015; Forslund, Roe, et al. 2013; Soberg et al. 2013), as well as self-esteem and self-awareness (Downing et al. 2013; Goverover & Chiaravalloti 2014; Ponsford & Spitz 2015). However, an earlier study by Mailhan et al. (2005) reported that the relationship between life satisfaction and patient disability is not linear. The authors found that life satisfaction as reported by individuals with severe disabilities did not significantly differ from individuals with little or no disability, while individuals with moderate disabilities reported the lowest satisfaction scores. Esbjörnsson et al. (2013) reported that an individual’s perception of their trauma influences health-related QoL. As such, some individuals may have greater awareness of their obstacles and less denial of their limitations based on their level of impairment, which may influence their anxiety, depression, and life satisfaction.
Social relationships are an important component in improving an individual’s life satisfaction after ABI (Atay et al. 2016; Jacobsson & Lexell 2013b; Vandiver & Christofero-Snider 2000 ). Armengol (1999) showed that social support groups focusing on education, coping training and goal setting resulted in positive changes to measures of hopelessness, which can lead to a greater sense of control and empowerment. Vandiver and Christofero-Snider (2000 ) found similar results in individuals who actively participated in a brain injury club. As part of the club, members were responsible for planning, organizing, and implementing club events which resulted in increased self-efficacy and a sense of personal competency (Vandiver & Christofero-Snider 2000 ).
Productive coping mechanisms are also crucial for individuals following ABI. Individuals with TBI were found to have higher levels of non-productive coping styles after injury (Gregório et al. 2014). As well, those who used non-productive coping styles were found to have lower psychosocial functioning and increased anxiety (Gregório et al. 2014). After a coping skills program for individuals with ABI, participants showed significantly greater perceived self-efficacy than waitlisted controls (Backhaus et al. 2010).
After an intensive cognitive rehabilitation program involving cognitive, emotional, interpersonal and functional interventions, Cicerone et al. (2008) found that participants had higher perceived QoL than those receiving standard neurorehabiliation. Similarly, a comprehensive case management program was compared to usual care for individuals struggling with both substance abuse and the effects of a TBI and found that the case management group had significantly higher satisfaction with life scores at nine months despite being similar at baseline (Heinemann et al. 2004). Reassuringly, it appears that through teaching effective coping skills and community-based programs that increase social participation, satisfaction with life can be positively influenced.
There is Level 1b evidence that more intensive and structured rehabilitation therapy improves satisfaction with community integration and perceived quality of life compared to standard multidisciplinary rehabilitation.
There is Level 2 evidence that coping skills training improves perceived self-efficacy and alleviates emotional distress compared to standard care.
There is Level 2 evidence that comprehensive case management improves life satisfaction more than standard care for individuals dealing with substance abuse issues post TBI.
There is Level 4 evidence that community-based support programs improve measures of self-efficacy leading to a greater sense of personal competency.
Following ABI, individuals often experience a decline in their QoL.
Health-related QoL is influenced by an individual’s perception of their trauma.
Lower psychosocial functioning and increased anxiety and depression are more common among individuals who use non-productive coping strategies.
Life satisfaction is influenced by an individual’s disability and recovery; however, the relationship between life satisfaction and patient disability does not appear to be a linear one.
Social support groups, coping skills training, and comprehensive case management give patients a better sense of control.