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Rehabilitation Measures Instrument

Rivermead Post Concussion Symptoms Questionnaire: Modified Scoring System

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Purpose

The Rivermead Post Concussion Symptoms Questionnaire with modified scoring (RPQ-3 and RPQ-13) 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-3 and RPQ-13

Area of Assessment

Cognition

Assessment Type

Patient Reported Outcomes

Cost

Free

Actual Cost

$0.00

Cost Description

Cost of equipment only.

Diagnosis/Conditions

  • Brain Injury

Populations

Key Descriptions

  • Two variations: RPQ (King, Crawford, Wenden, Moss, & Wade, 1995) and RPQ Modified Scoring System (RPQ-3/RPQ-13) (Eyres, Carey, Gilworth, Neumann, & Tennant, 2005)
  • 16 item questionnaire with first three items (RPQ-3) scored separately from remaining 13 items (RPQ-13)
  • 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.
  • RPQ-3 = “early” symptom cluster
  • RPQ-13 = “late” symptom cluster
  • 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.
  • RPQ-3: range = 0-12 (best to worst) and RPQ-13: range 0-52 (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.

Number of Items

RPQ-13 = 13 items

RPQ-3 = 3 items

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

Body Part

Head

ICF Domain

Body Function

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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Normative Data

  • 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)

Test/Retest Reliability

Head Injury: (Eyres, Carey, Gilworth, Neumann, & Tennant, 2005; n = 369; mean age = 34.64, median 34 years, range 18 – 62; time post head injury = 3-6 months; 60.4% men and 39.5% women)

  • RPQ-13:
    • Total PCS Score: Excellent test-retest reliability (Rs = 0.89)
    • Individual PCS items: Adequate to Excellent test-retest reliability (Rs = 0.62 - 0.85)

 

  • RPQ-3:
    • Total PCS Score:  Adequate test-retest reliability (Rs = 0.72)
    • Individual PCS items:  Adequate test-retest reliability (Rs = 0.59 - 0.69)

Construct Validity

Convergent validity:

Head Injury: (Eyres et al., 2005)

  • RPQ-13:
    • Excellent (r = 0.83, p < .01) with Rivermead Head Injury Follow-up Questionnaire (RHFUQ) at 3-6 months post injury
  • RPQ-3:
    • Excellent (r = 0.62, p < .01) for RPQ-3 with RHFUQ at 3-6 months post injury

Floor/Ceiling Effects

Head Injury: (Eyres et al., 2005)

  • RPQ-3:
    • Poor: 34.3% floor effect
    • Adequate: 1.8% ceiling effect
  • RPQ-13:
    • Adequate: 20% floor effect

Adequate: 0.3% ceiling effect

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.

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

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.

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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