Functional recovery and domain-specific quality of life after moderate-to-severe traumatic brain injury: a mixed-effects analysis

Introduction The purpose of this study is to investigate how functional recovery, measured by the Glasgow Outcome Scale-Extended (GOSE), is associated with quality of life (QOL) as measured by the Quality of Life after Brain Injury (QOLIBRI) survey in adults with moderate-to-severe TBI (msTBI). We aim to better understand this nuanced relationship to guide more individualized and effective rehabilitation planning. Methods This study enrolled 138 adults aged 18 to 65 years with a history of msTBI one-year post-injury. Functional recovery was assessed using the GOSE score, administered face-to-face by a single trained investigator. Health-related QOL was evaluated using the QOLIBRI across six domains: Emotion, Feeling, Independence, Physical, Social, and Thinking. A mixed effects model using participant as the primary random effect and estimated marginal trends were calculated to examine the relationship between GOSE scores and QOLIBRI outcomes. Results GOSE score alone is not significantly associated with QOL. Estimated marginal trends showed that higher GOSE scores were strongly associated with better QOL in the Independence ( p < 0.001), Thinking ( p < 0.001), and Physical ( p = 0.019) domains. A weak, non-significant association was observed with the Feelings domain. No significant association was found between GOSE scores and the Social domain. Conclusion Functional recovery after TBI is most closely related to independence, cognitive, and physical QOL but does not adequately reflect social or emotional well-being. These psychosocial domains may require targeted intervention and further emphasizes the importance of incorporating patient-reported QOL measures to more holistically assess recovery.