The Relationship of Health Locus of Control and Health-Related Quality of Life in the Chronic Phase After Traumatic Brain Injury

Objective: To study health locus of control (HLC) after moderate to severe traumatic brain injury (TBI) compared with norm values and in relation to health-related quality of life (HR-QoL) over time. Setting: Three level-1 trauma centers. Participants: Individuals with moderate to severe TBI (N = 85). Design: Prospective cohort study. Main Measures: Multidimensional health locus of control scales including internal control (Internal-HLC), control attributed to physicians (Physician-HLC) or to chance (Chance-HLC) and sickness impact profile-68 including physical and psychosocial HR-QoL. Results: One to 3 years after TBI, Internal-HLC, and Chance-HLC significantly declined, whereas Physician-HLC remained stable. Total and psychosocial HR-QoL did not change over time, but physical HR-QoL improved. Three years after TBI, Internal-HLC (P <.001), and Physician-HLC (P <.001) were significantly lower and Chance-HLC (P <.001) significantly higher than norm values. Chance-HLC was independently related to total (beta =.321, P <.001) and psychosocial HR-QoL (beta =.258, P <.001), adjusted for baseline characteristics, functional, and cognitive outcome. Conclusions: After TBI, HLC may change over time and may be different from healthy adults. The external Chance-HLC orientation has a negative relationship with HR-QoL. Future research focused on the effect of rehabilitation programs for improving the balance in internal and external locus of control is needed.