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Fatigue After Traumatic Brain Injury and Its Impact on Participation and Quality of Life

Cantor, Joshua B. PhD; Ashman, Teresa PhD; Gordon, Wayne PhD; Ginsberg, Annika BA; Engmann, Clara BA; Egan, Matthew BS; Spielman, Lisa PhD; Dijkers, Marcel PhD; Flanagan, Steve MD

Journal of Head Trauma Rehabilitation: January/February 2008 - Volume 23 - Issue 1 - p 41–51
doi: 10.1097/

Objectives: To examine the relationships between post-TBI fatigue (PTBIF) and comorbid conditions, participation in activities, quality of life, and demographic and injury variables.

Participants: 223 community-dwelling individuals with mild to severe TBI and 85 noninjured controls.

Measures: Global Fatigue Index (GFI), Beck Depression Inventory (BDI-II), McGill Pain Questionnaire (MPQ), Pittsburgh Sleep Quality Inventory (PSQI), Participation Objective Participation Subjective (POPS), SF-36, Life-3.

Method: Data were collected through interviews and administration of self-report measures as part of a study of PTBIF.

Results: Fatigue was more severe and prevalent in individuals with TBI, and more severe among women. It was not correlated with other demographic and injury variables. Once overlap in measurement instruments' content was removed, depression, pain, and sleep problems accounted for approximately 23% of the variance in fatigue in those with TBI compared to 58% of the variance in the control group. PTBIF was correlated with health-related quality of life and overall quality of life, but was not generally related to participation in major life activities.

Conclusions: PTBIF has significant impact on well-being and quality of life and cannot be accounted for by comorbid conditions alone, suggesting that it is related to brain injury itself. It appears to be unrelated to demographic and injury variables other than gender. PTBIF does not limit the quantity and frequency of participation. Future research should focus on the relationship between fatigue and the quality of participation.

From the Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York.

Corresponding author: Joshua B. Cantor, PhD, Department of Rehabilitation Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1240, New York, NY 10029.

This research was supported by Grant H133A020501 from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, United States Department of Education. We would like to extend our thanks to David Arvidsson, Janis Breeze, Zhifen Cheng, Alexis Kramer, Renee Morrison, Angie Ortiz, Sarah Schiavetti, Evelyn Segura, and Colette Seter for their contributions to this project.

© 2008 Lippincott Williams & Wilkins, Inc.