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Peer-reviewedCC BY 4.0Frontiers in Neurology

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

  • Ramzi Badra1
  • Brooke Scardina1
  • Mason Nelson1
  • Varun Mishra2
  • Taylor P. van Doren3
  • Melissa Martinez4
  • Justin L. Weppner1,2,4
4 affiliations
  1. 1Edward Via College of Osteopathic Medicine
  2. 2Virginia Tech-Carilion School of Medicine
  3. 3High Point University
  4. 4Carilion Clinic Brain Injury Center
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{badra2026functional,
  title = {{Functional recovery and domain-specific quality of life after moderate-to-severe traumatic brain injury: a mixed-effects analysis}},
  author = {Ramzi Badra and Brooke Scardina and Mason Nelson and Varun Mishra and Taylor P. van Doren and Melissa Martinez and Justin L. Weppner},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1871168},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1871168/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Functional recovery and domain-specific quality of life after moderate-to-severe traumatic brain injury: a mixed-effects analysis
AU  - Ramzi Badra
AU  - Brooke Scardina
AU  - Mason Nelson
AU  - Varun Mishra
AU  - Taylor P. van Doren
AU  - Melissa Martinez
AU  - Justin L. Weppner
PY  - 2026
DA  - 2026/10/27
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1871168
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1871168/full
AB  - 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.
SN  - 1664-2295
ER  -