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Rehabilitation Measures Instrument

Rivermead Post-Concussion Symptom Questionnaire

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Purpose

The Rivermead Post-Concussion Symptom Questionnaire (RPQ) is a self-report scale to measure the severity of post-concussive symptoms following a Traumatic Brain Injury (TBI). 

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Instrument Details

Acronym RPQ

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Key Descriptions

  • 16 items
  • Self-administered questionnaire or completed by interview (in-person or telephonically). Can be completed by mail correspondence.
  • Three categories of physical, cognitive, and behavioral symptoms.
  • Individuals are asked to rate the degree to which they experience 16 post-concussion symptoms within the last 24 hours compared to their pre-injury symptoms.
  • Each item is rated on a 5-point ordinal scale: 0 = not experienced at all, 1 = no more of a problem, 2 = a mild problem, 3 = a moderate problem, and 4 = a severe problem.
  • The total score ranges from 0 to 64 from (best to worst).
  • The total score is the sum of all items, excluding 1 because it indicates “no longer a problem”, and corresponds to resolution of prior symptoms.
  • Two variations: RPQ (King, Crawford, Wenden, Moss, & Wade, 1995) and RPQ Modified Scoring System (RPQ-3/RPQ-13) (Eyres, Carey, Gilworth, Neumann, & Tennant, 2005)

Number of Items

16

Equipment Required

  • The self-report measure questionnaire
  • A writing utensil

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jamie Basch, MOTR/L, CBIS and Pam Cornwell, PT, MHS, NCS in 2018. 

Body Part

Head

ICF Domain

Body Function
Body Structure

Measurement Domain

Cognition

Considerations

Recommendations for not administering RPQ or BDI-II in isolation for diagnostic purposes due to significant difference (higher scores) found between depressed and nondepressed TBI patients on self-reported mood, cognitive, somatic, and visual postconcussion symptoms (Hermann et al., 2009) and high correlation found between RPQ and BDI-II in non-clinical sample by Sullivan et al. (2011).

Recently emerging disagreement regarding factor structure and validity of this measure:

  • Poor item fit for unidimensionality of RPQ (single factor scale) 3-6 months post-head injury; lacks invariance across construct (χ2 = 172.486, p < 0.001).  (Eyres et al., 2005)

A variation of the RPQ, the Rivermead Head Injury Follow Up Questionnaire (RHFUQ), exists and is comprised of 10 brief questions for use with minor brain injury (Crawford et al., 1996).

Predictive validity with use of HADS and PTA appears to decrease after 3 months (King et al., 1999).

Brain Injury

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Cut-Off Scores

  • > 3 symptoms listed in the RPQ present at 3 months following mild head injury indicates diagnostic criteria for Post- Concussion Syndrome (PCS). (Ingebrigsten, Waterloo, Marup-Jensen, Attner, & Romner, 1998; n = 100; mean age 30, range 10-66; 3 months post injury; 66% men, 34% women; Scandinavian)
  • > 35 predictive of moderate to severe limitations in abilities, adjustment, and participation of daily activities within the first three months following mTBI (sensitivity = 90%, specificity = 60%) (de Guise et al., 2016; n = 47; mean age 39.3 (17.6), range 18 – 84 years; mean time post mTBI = 7 days (4.2), range 2-12; 51.1% women)

Normative Data

Mild Traumatic Brain Injury: (Lundin, De Boussard, Edman, & Borg, 2006; n = 122; mean age = 37.3, range 15-65 at 3 months post mTBI; 58% men and 42% women; Swedish version of RPQ.)

  • Mean intensity of symptoms 6.5 (11.28)

Mild Traumatic Brain Injury: (Medvedev, Theadom, Barker-Collo, Feigin, & BIONIC Research Group, 2018; n = 146; mean age 39.7 (18.0), 58.9% men and 41.1% women)

  • Mean (SD) RPQ total scores within 1, at 6, and at 12 months, post mTBI)
    • Baseline/within 1-month post injury mean (SD) = 19.5 (13.6)
    • 6-months post injury mean (SD) = 14.4 (12.5)
    • 12-months post injury mean (SD) = 12.9 (12.2)

Mild Traumatic Brain Injury with Post Concussion Syndrome (PCS): (Ingebrigtsen et al., 1998)

  • Mean (SD) RPQ total score 19.1 (11.9), range 6 - 48.

Test/Retest Reliability

Head Injury: (King, Crawford, Wenden, Moss, & Wade, 1995, n = 41 for test-retest reliability portion of study; mean age 31 (14.3), range 16 – 64; time post head injury for first administration 7 days and second administration at 8 days; 54% men and 46% women)

  • Total PCS Score:  Excellent test-retest reliability (Spearman rank correlation coefficient Rs = .90)
  • Individual PCS items: Adequate to Excellent test-retest reliability (Rs = .50 to .91 with r > .80 for 8/15 items)

Mild Traumatic Brain Injury: (Medvedev et al., 2018)

  • RPQ: Adequate test-retest reliability (ICC = .63, CI +/- .08) for RPQ total scores at 1, 6, and 12 months

 

Interrater/Intrarater Reliability

Mild or Moderate Head Injury: (King et al., 1995, n = 46 for interrater reliability portion of study; mean age = 34 (13.2), range 17 – 64; time post Head Injury mean 6 months and 6 days (10.6 days) for first administration and mean of 9 days (5.3, range 3-34) later for second administration; 67% men and 33% women)

  • Clinician-administered:
    • Total PCS score: Excellent inter-rater reliability (Rs = .87, p < .001)
    • Individual items score: Adequate to Excellent inter-rater reliability (Rs = .47 to 1.00 with r > .75 for 6/16 items, p < .001)

Internal Consistency

Mild Traumatic Brain Injury: (Medvedev et al., 2018)

  • Excellent internal consistency (Cronbach’s alpha 0.94 to 0.95) within 1 month of injury, 6, and 12 months

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Mild to moderate head injury: (King, Crawford, Wenden, Caldwell, & Wade, 1999; n = 66; mean age = 33 (13.0) years, range 17 – 65; time post head injury = 7 – 10 days; 65% men and 35% women)

  • Excellent concurrent validity with Hospital Anxiety and Depression Scale (HADS) Anxiety Score at 7-10 days (r = .61, p < .005)
  • Excellent concurrent validity with HADS Depression Score at 7-10 days (r = .61, p < .005)
  • Adequate concurrent validity with Impact of Event Scale (IES) Intrusions Score at 7-10 days (r = .33, p < .05)
  • Adequate concurrent validity with IES Avoidance Score at 7-10 days (r = .50, p < .005)
  • Adequate concurrent validity with RPQ (7-10 days) (r = .37, p < .05) with RPQ at 6 months

Closed Head Injury: (King, 1996, n = 50, mean age = 33 (12.7) range 17-65; time post head injury = 7 – 10 days; time post CHI = 7 – 10 days; 46% men and 54% women)

  • Concurrent validity with Hospital Anxiety and Depression Scale (HADS) Anxiety Score
    • Excellent 7-10 days (r = .60, p < .01)
    • Adequate 3 months post (r = .57, p < .01)
  • Concurrent validity with HADS Depression Score
    • Excellent 7-10 days (r = .65, p < .01)
    • Adequate 3 months post (r = .54, p < .01)
  • Concurrent validity with Impact of Event Scale (IES) Intrusions Score
    • Excellent 7-10 days (r = .69, p < .01)
    • Excellent 3 months post (r = .64, p < .01)
  • Concurrent validity with IES Avoidance Score
    • Excellent 7-10 days (r = .60, p < .01)
    • Adequate 3 months post (r = .53, p < .01)
  • Concurrent validity with RPQ at 3 months
    • Adequate 7-10 days (r = .48, p < .01)

Mild to Moderate Head Injury: (King et al., 1999)

  • Adequate predictive validity with HADS Anxiety (R = .45, p < .05), RPQ (7-10 days) (R = .47, p < .05), and Post-Traumatic Amnesia (R = .48, p < .05) and accounting for 23% of variance in RPQ scores at 6 months.
  • Adequate predictive validity with Hospital Anxiety and Depression Scale (HADS) Anxiety Score at 6 months post (r = .45, p < .05)
  • Adequate predictive validity with HADS Depression Score at 6 months post (r = .32, p < .05)
  • Adequate predictive validity with Impact of Event Scale (IES) Intrusions Score at 6 months post (r = .33, p < .05)
  • Adequate predictive validity with IES Avoidance Score at 6 months post (r = .37, p < .05)

Mild Traumatic Brain Injury: (de Guise et al., 2016)

  • Adequate predictive validity with Mayo-Portland Adaptability Inventory - 4 (MPAI-4) (Receiver Operating Characteristic (ROC) analysis area under the curve = .777)

Construct Validity

Convergent Validity:

Mild Traumatic Brain Injury: (de Guise et al., 2016)

  • Excellent correlation (r = .612; p < .001) with the MPAI - 4
  • Excellent correlation (r = .692, p < .001) with the MPAI - 4 Ability subscale
  • Adequate correlation (r = .508, p = .002) with the MPAI - 4 Adaptation subscale
  • Adequate correlation (r = .516, p = .001) with the MPAI - 4 Participation subscale


Minor to severe head injury: (Crawford, Wenden, & Wade, 1996, n = 43; mean age 32 (15), range 17 – 64; 2 = very severe head injury, 2 = severe head injury, 20 = moderate, and 19 = mild head injury; 30 men and 13 women)

  • Excellent correlation (Spearman rho = .67, p < .001) between the RPQ and RHFUQ at 3 months post injury
  • Adequate correlation (Spearman rho = .56, p < .001) between RPQ and RHFUQ at 6 months post injury

Floor/Ceiling Effects

Head Injury: (Eyres et al., 2005)

  • Adequate: 17.3% floor effect
  • Adequate: 0.3% ceiling with RPQ scores ranging from 0 to 64

Non-Specific Patient Population

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Normative Data

Non-clinical Sample: (Sullivan & Garden, 2011; n = 96; age range 18 – 78, 70% aged between 18- 29; 73% men)

  • Mean 3.35 (SD 3.58) Rivermead Post Concussion Symptoms (RPQ) score

Internal Consistency

Nonclinical sample: (Sullivan & Garden, 2011)

  • Excellent internal consistency (Cronbach’s alpha = .92)
  • Excellent split-half reliability (Cronbach’s alpha = .85)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Nonclinical sample: (Sullivan & Garden, 2011)

  • Excellent correlation with Beck Depression Inventory II (BDI-II) (r = .66, p = .01)

Construct Validity

Convergent Validity:

Nonclinical sample: (Sullivan & Garden, 2011)

  • Adequate correlation with Post-concussion Syndrome Symptom Scale (PCSC) (r = .59, p = .01)
  • Excellent correlation with British Columbia Post-concussion Symptom Inventory (BC-PSI) (r = .78, p = .01)

Divergent Validity:

Nonclinical sample: (Sullivan & Garden, 2011)

  • Excellent correlation (r = .66, p = .01) with the Beck Depression Inventory II (BDI-II)

Bibliography

Crawford S, Wenden FJ, Wade DT. The Rivermead head injury follow up questionnaire: a study of a new rating scale and other measures to evaluate outcome after head injury. Journal of Neurology, Neurosurgery, and Psychiatry. 1996;60(5): 510-514. doi:10.1136/jnnp.60.5.510. Find it on PubMed.

de Guise E, Bélanger S, Tinawi S, et al. Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury. Applied Neuropsychology Adult. 2016;23(3):213-222. doi:10.1080/23279095.2015.1038747. Find it on PubMed.

Eyres S, Carey A, Gilworth G, Neumann V, Tennant A. Construct validity and reliability of the Rivermead Post-Concussion Symptoms Questionnaire. Clinical Rehabilitation. 2005;19(8):878-887. Find it on PubMed.

 

Hermann N, Rapoport M, et al. Factor Analysis of the Rivermead Post-Concussion Symptoms Questionnaire in Mild-to-Moderate Traumatic Brain Injury patients. J Neuropsychiatry Clin Neurosci. 2009 Spring;21(2):181-8. doi: 10.1176/appi.neuropsych.21.2.181 

Ingrebrigsten T, Waterloo K, Marup-Jensen S., Attner E. Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients. Journal of Neurology 1998;245(9):609-612. Find it on PubMed.

King NS, Crawford S, Wenden FJ, Moss NEG, Wade DT. The Rivermead Post Concussion Symptoms Questionnaire: A measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology. 1995;242(9):587-592. doi:10.1007/BF00868811. Find it on PubMed.

King NS. Emotional, neuropsychological, and organic factors: their use in the prediction of persisting postconcussion symptoms after moderate and mild head injuries. Journal of Neurology, Neurosurgery, and Psychiatry. 1996;61(1):75-81. Find it on PubMed.

King NS, Crawford S, Wenden FJ, Caldwell FE, Wade DT. Early prediction of persisting post-concussion symptoms following mild and moderate head injuries. The British Journal of Clinical Psychology. 1999;38 (Pt 1):15-25. Find it on PubMed.

Lundin, A., de Boussard, C., Edman, G., & Borg, J. Symptoms and disability until 3 months after mild TBI. Brain Injury. 2006; 20(8): 799-806. doi: 10.1080/0269905060074432

Medvedev ON, Theadom A, Barker-Collo S, Feigin V, BIONIC Research Group. Distinguishing between enduring and dynamic concussion symptoms: applying Generalisability Theory to the Rivermead Post Concussion Symptoms Questionnaire (RPQ). PeerJ, Vol 6, p e5676 (2018). doi:10.7717/peerj.5676. Find it on PubMed.

Sullivan K, Garden N. A comparison of the psychometric properties of 4 postconcussion syndrome measures in a nonclinical sample. The Journal of Head Trauma Rehabilitation. 2011;26(2):170-176. doi:10.1097/HTR.0b013e3181e47f95. Find it on PubMed.

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