Is the Rivermead Post-Concussion Symptoms Questionnaire a Reliable and Valid Measure to Assess Long-Term Symptoms in Traumatic Brain Injury and Orthopedic Injury Patients? A Novel Investigation Using Rasch Analysis.

Shivanthi Balalla,Richard Siegert,Chris Krägeloh,Oleg Medvedev

doi:10.1089/neur.2020.0017

Shivanthi Balalla, Richard Siegert + Show 2 more

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https://doi.org/10.1089/neur.2020.0017

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Abstract

Persistent post-concussion syndrome (PCS) symptoms are known to last years after traumatic brain injury (TBI), and similar symptoms are increasingly being documented among those who have not experienced a TBI. There remains however, a dearth of empirical evidence on the structural composition of symptoms beyond the post-acute symptom phase after TBI, and little is known about the potential use of PCS symptom scales to measure PCS-like symptoms in non-TBI individuals. Our objective was therefore to examine the psychometric performance and dimensionality of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) as a measure of long-term PCS symptoms among a TBI and non-TBI sample. A case-control sample of 223 patients with injury, consisting of age- and sex-matched TBI participants (n = 109) and orthopedic participants (n = 114) were recruited from a regional trauma registry in New Zealand (NZ), and assessed at mean 2.5 years post-injury. Results from the Rasch analysis showed that the RPQ achieved fit to the Rasch model, demonstrating very good reliability (Person Separation Index [PSI] = 0.87), thereby indicating that the measure can be used reliably for individual and group assessment of symptoms among both TBI and orthopedic patients. In this study we demonstrated evidence of a unidimensional construct of PCS symptoms in both groups, which helps alleviate previous uncertainty about factor structure, and permits the calculation of a total RPQ score. Conversion of ordinal to interval total scores presented within are recommended for clinicians and researchers, to improve instrument precision, and to facilitate the interpretation of change scores and use of parametric methods in data analysis.

Highlights

Traumatic brain injury (TBI) has myriad consequences that can have lasting effects on cognition, physical and psychological functioning, return to employment, social reintegration, and quality of life.[1,2,3] Among the most commonly persisting difficulties associated with TBI is the onset of post-concussion syndrome (PCS)symptoms, which are a constellation of neurological and neuropsychological symptoms including headache, dizziness, irritability, anxiety, depression, fatigue, and difficulties with memory and concentration.[4]
Further fueling the ongoing debate is the non-specificity of PCS symptoms as a phenomenon solely attributable to the experience of a TBI, given that symptoms arise in various groups including those with chronic pain,[15] psychological disorders,[16] orthopedic injuries,[17] and even within the healthy population.[8]
As validation of PCS symptom scales in non-TBI populations does not currently exist, this study aimed to examine whether the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) can be reliably administered as a measure of PCS-like symptoms, in a control injury sample consisting of participants with orthopedic injuries

Summary

Introduction

Traumatic brain injury (TBI) has myriad consequences that can have lasting effects on cognition, physical and psychological functioning, return to employment, social reintegration, and quality of life.[1,2,3] Among the most commonly persisting difficulties associated with TBI is the onset of post-concussion syndrome (PCS)symptoms, which are a constellation of neurological and neuropsychological symptoms including headache, dizziness, irritability, anxiety, depression, fatigue, and difficulties with memory and concentration.[4]. Traumatic brain injury (TBI) has myriad consequences that can have lasting effects on cognition, physical and psychological functioning, return to employment, social reintegration, and quality of life.[1,2,3] Among the most commonly persisting difficulties associated with TBI is the onset of post-concussion syndrome (PCS). Factors such as cognitive and somatic symptoms immediately after injury, pre-existing depression, past history of TBI, and sleep quality have been found to increase the chronicity of symptoms.[8]. Despite the burgeoning evidence across such diverse samples, the psychometric utility of these PCS symptom scales has not yet been examined in non-TBI populations

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