Motivations for testing and linkage to HIV services following HIV self-testing among fishermen in Kenya: a qualitative analysis.

Traumatic brain injury (TBI) is defined as an injury affecting how the brain works. Annually, 2.8 million U.S. people sustain a TBI, with low rates of immediate medical care. Annually, approximately 275,000 require hospitalization for at least 2 days, with 50-75% discharging home, less than 20% to an inpatient rehabilitation facility, and 15% to a skilled nursing facility. Among those discharged home, some have high levels of physical functioning, while others endure chronic cognitive and physical functioning impairments or decline. Heterogenous TBI impairments can impact patient coping, emphasizing the need to address patients’ quality of life (QOL). QOL is defined as patients’ self-reported contentment in life, including physical and mental well-being, which is a critical outcome of interest. Recommendations suggest addressing how patients with TBI cope with chronic impairments, using QOL as a critical indicator of TBI recovery, recognizing people with limitations in functioning can still enjoy good health and QOL. QOL is often comingled with conceptualization and measurement of related constructs, including functional outcomes and health related quality of life (HRQOL), used in assessment of valued domains of an individual’s health. HRQOL, measuring self-perceived health status, has variations in measurement instruments and timepoints across recovery trajectories in patients with TBI, including: Short Form-36 (SF-36) or Short-Form-12 (SF-12, a derivative of SF-36), Euro-QOL-5D, Glascow Outcomes Scale-Extended, Sickness Impact Profile, Quality of Life after Brain Injury instrument (QOLIBRI), European Brain Injury Questionnaire (EBIQ), and World Health Organization Quality of Life short version. Existing measures have been criticized for floor/ceiling effects, lack of sensitivity and specificity, lack of insight from patients with TBI to answer self-assessments in patient reported outcomes, and variations in inter-rater reliability. Desire to capture individuals’ own perspective on HRQOL points to use of general patient reported outcomes measures like SF-36, and TBI specific measures like EBIQ and QOLIBRI. Although validity of several HRQOL measures among patients with TBI is lacking, for the SF-36, evidence suggests strong internal consistency and reliability for patients with TBI, and thus a more commonly used HRQOL measure in this population. SF-12 limits participant burden for data collection to 12 items, compared to 36 items for SF-36, 37 for QOLIBRI, and 63 for EBIQ. HRQOL measurement timepoints vary widely for TBI, including days to years after injury, with chronic TBI studies measuring at 6-12 months to years after injury. Several studies assessed HRQOL among adults with TBI within 1 to 3 months after injury.