Adaptation to Mild Traumatic Brain Injury among Thai Adults

Mild traumatic brain injury (MTBI) affects more than 28,000 individuals annually in Thailand; however, little information about outcome after MTBI is known. This investigation aimed to explore adaptation, determine factors associated with adaptation, and identify the predictors of adaptation among Thai adults who experienced MTBI in the previous 3-12 months. Roy’s Adaptation Model was the framework for this study. A descriptive-predictive, cross-sectional design was used. A sample of 135 adults was interviewed. Subjects were typically men, middle aged, and about half were married. All of them finished the compulsory level of education and had low income. Subjects had Glasgow Coma Scores 14 at 30 minutes after injury and 15 (full score) after 3 days. Duration of posttraumatic amnesia was six minutes while the duration of loss of consciousness was two minutes. Subjects reported low postconcussion symptoms scores, few stressful life events and few depressive symptoms. Scores of coping, social support and quality of life (QOL) were high. All subjects worked or studied before the injury and almost of them returned to normal lives at the time of interview. However, 18% did experience moderately severe disability and 1.5% suffered severe disabilities. Social support was positively correlated with QOL whereas none of the other stimuli were significantly associated with QOL and the Extended Glasgow Outcome Scale (GOSE). All stimuli, coping and depressive symptoms significantly explained 15.8% of QOL, with social support as the only significant predictor. The same set of stimuli could not successfully explain the GOSE. Although the mediator effects of coping and depressive symptoms in the original conceptual model were not supported, moderator effects with social support were found. Future studies with longitudinal, comparison, or predictive methodology with reduced but relevant variables are suggested. Developing a middle range theory is recommended to continue investigating QOL conceptually equivalent to adaptation. Measures used in this study demonstrated reliability, supporting their use in Thailand. Providing of health education or printed information about outcomes especially problems after MTBI is recommended. Further study of the small but clinically important percentage of subjects who experience ongoing disability after MTBI is needed.