Rivermead Post-Concussion Symptoms Questionnaire Research Articles

Recovery in the first year after mild head injury: Divergence of symptom status and self-perceived quality of life

To examine self-perceived health status during the first year following mild closed head injury. At 1 week, and at 3, 6 and 12 months post-injury, 37 patients with mild closed head injury completed written versions of the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ), the Rivermead Head-Injury Follow-up Questionnaire (RHIFQ) and the SF-36 Health Survey. Thirty-seven controls provided baselines for the SF-36 and the RPSQ. The 3 questionnaires conveyed differing impressions of recovery. On the RPSQ, the patients exhibited ongoing symptomatic complaints and higher scores compared with controls. The RHIFQ conveyed a better recovery in terms of everyday function. The SF-36 showed the best recovery, with the mild closed head injury group achieving normal scores at 3, 6 and 12 months. Regression analyses indicated an influence of IQ, but not of age, education, or clinical measures of injury severity, on long-term health status. Recovery after mild closed head injury can involve a dichotomy of persistent post-concussional symptoms but relatively normal functionality and quality of life. In addition to indicating an influence of IQ on perception of recovery in mild closed head injury, our findings demonstrate that the nature of self-report questionnaires considerably influences the picture of recovery. This emphasizes the importance of methods unaffected by IQ and self-evaluative accuracy in the assessment of mild closed head injury.

Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury

Primary objective: To investigate the relation between psychosocial functioning (community integration, life satisfaction and social support) and symptoms (post-concussion, post-traumatic stress and depression) in persons with mild traumatic brain injury (MTBI) 3 years after the trauma.Methods: Population-based follow-up study of 163 patients. At follow-up, an assessment of community integration, social support, life satisfaction and symptoms was made.Results: Total score of Community Integration Questionnaire (CIQ) was negatively correlated to total score of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ, r = −0.270, p < 0.001) and to total score of the Beck Depression Inventory (BDI, r = −0.332, p < 0.001). Life satisfaction (LiSat-11) was negatively correlated to the RPQ (r = −0.459, p < 0.001), to total score of the Impact of Event Scale (IES, r = −0.365, p < 0.001) and to the BDI (r = −0.642, p < 0.001). Low levels of life satisfaction were common at follow-up.Conclusions: A large proportion of the individuals with MTBI experienced both psychosocial difficulties, with low levels of life satisfaction in particular and symptoms (post-concussion, post-traumatic stress and depression) 3 years after trauma. Since the possibility of pre-injury factors contributing to the condition at follow-up cannot be ruled out, the study indicates that all these factors should be taken into consideration in the management of persons with MTBI.

The Rivermead Post Concussion Symptoms Questionnaire

To investigate the factor structure of the Rivermead Post Concussion Symptoms Questionnaire (RPQ) among individuals seen as part of routine follow-up following traumatic brain injury. RPQ data from 168 participants was examined (mean age 35.2, SD 14.3; 89% with post traumatic amnesia duration<24 hours) six months after admission to an Accident & Emergency Department following TBI. Structural equation modelling was carried out to evaluate proposed models of the underlying structure of post-concussion symptoms (PCS). The results support the existence of separate cognitive, emotional and somatic factors, although there was a high degree of covariation between the three factors. A two-factor model that collapsed the emotional and somatic factors together showed a similar goodness-of-fit to the data, whilst a one-factor model proved a poor fit. The results support the notion of post-concussion symptoms as a collection of associated but at least partially separable cognitive, emotional and somatic symptoms, although questions persist regarding symptom specificity. The use of the RPQ is discussed, and classification bands for use in clinical practice are suggested.

Examination of postconcussion-like symptoms in healthy university students: Relationships to subjective and objective neuropsychological function performance

This study examined postconcussion-like symptoms in a group of university students and explored their relationships to neuropsychological function performance. A sample of 124 students was recruited. All of the participants received the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and completed a comprehensive set of neuropsychological tests. They reported a relatively high base rate of postconcussion-like symptoms. The most frequently endorsed items were “fatigue” (76.9%), “longer time to think” (60.3%), “poor concentration” (58.7%), “sleep disturbance” (50.4%), and “frustration” (46.3%). There were no significant differences between low symptom reporters and high symptom reporters, except for self-reported dysexecutive problems. A comparison of the healthy high symptom reporters and a convenient sample of traumatic brain injury patients revealed that the patients performed significantly worse on neuropsychological functions than the high symptom reporters, despite non-significant differences between symptom endorsement. Our findings demonstrate that: (a) the base rate of postconcussion-like symptoms in a group of healthy university students is relatively high and (b) postconcussion symptom (PCS) is not related to neuropsychological functions in normal people.

Construct validity and reliability of the Rivermead Post-Concussion Symptoms Questionnaire

To provide further evidence of reliability and internal and external construct validity of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), which measures severity of postconcussion symptoms following head injury. A cross-sectional study of consecutive patients presenting with a head injury in two urban teaching hospitals and a community trust. Three hundred and sixty-nine patients returned a questionnaire from 1689 consecutive adult patients (18 years and above) referred to radiology for a skull X-ray following a head injury, and those who were currently under the care of a community-based multidisciplinary head injury team. Internal construct validity tested by fit to the Rasch Measurement model; external construct validity tested by correlations with Rivermead Head Injury Follow-up Questionnaire (RHFUQ); test-retest reliability tested by correlations at two-week intervals. Rivermead Post-Concussion Symptoms Questionnaire and Rivermead Head Injury Follow-up Questionnaire. RPQ scores ranged from 0 to 64 (17.3% floor, 0.3% ceiling). Overall fit to the Rasch model was poor (item fit mean -0.416, SD = 1.989, chi-squared= 172.486, p<0.01) suggesting a lack of unidimensionality. The items headaches, dizziness and forgetful displayed misfitting residuals and the first two items also displayed significant item trait fit statistics (p < 0.0006). After removing the items headaches, dizziness and subsequently nausea the RPQ demonstrated good fit at overall and individual item levels, both for the remaining 13 items (RPQ-13) and the three items (RPQ-3) which now formed a subsidiary scale. All items functioned consistently across age and gender. The RPQ-13 and RPQ-3 scales showed test-retest reliability coefficients of 0.89 and 0.72 (both p-values < 0.01) and positive correlations with RHFUQ scores (0.83 for RPQ-13, 0.62 for RPQ-3, both p-values < 0.01). As currently used, the RPQ does not meet modern psychometric standards. Its 16 items do not tap into the same underlying construct and should not be summated in a single score. When the RPQ is split into two separate scales, the RPQ-13 and the RPQ-3, each set of items forms a unidimensional construct for people with head injury at three months post injury. These scales show good test-retest reliability and adequate external construct validity.

How severe should symptoms be before someone is said to be suffering from post-concussion syndrome? An exploratory study with self-reported checklist using Rasch analysis

Primary objective: This study aimed to examine the diagnosis of post-concussive symptoms among a group of people with subjective post-concussive symptoms (PCS) complaints using a self-reported checklist.Research design: A cross-sectional design was adopted with a total of 92 patients with PCS and 123 normal controls.Methods and procedures: The Rivermead Post-concussion Symptoms Questionnaire was administered to all participants. Analysis using the Rasch Model was undertaken.Main outcomes and results: The common matrix of symptom profiles indicated significant effects of gender (p < 0.005) and litigation (p < 0.0004). The patient group reported significantly higher symptoms than the healthy group (p < 0.0001) with differential symptom endorsement along the logits unit continuum.Conclusions: The application of Rasch model analysis successfully set up a common matrix to discriminate patients with post-concussive symptoms from healthy people along the logits unit continuum.

Exploring Childrenʼs Self-efficacy Related to Physical Activity Performance After a Mild Traumatic Brain Injury

To evaluate children's self-efficacy related to their practice of physical activities prior to and after a mild traumatic brain injury (mTBI), and compare these to those of noninjured children matched for age, sex, and premorbid level of physical activity. Thirty-four children (mean age: 12 +/- 3 years) in each group. Children with mTBI were assessed 1 day postinjury (to document preinjury status) and at 12 weeks post-mTBI using a self-efficacy questionnaire, the Physical Activity Questionnaire, the Athletic Competence subscale of the Self-Perception Profile for Children or Adolescents, and the Rivermead Post-Concussion Symptoms Questionnaire. Noninjured children underwent the same assessments at a corresponding time interval. At 12 weeks postinjury, self-efficacy scores of children with mTBI were significantly lower than initial (ie, pretraumatic) values and those of noninjured children. The children with mTBI had, however, returned to their preinjury level of participation in physical activities and maintained their athletic competence. After mTBI, children appear to lack confidence in their ability to perform during physical activities as compared to before their injury. Intervention strategies such as information or counseling sessions targeting children and their parents may minimize the impact of the mTBI on children's confidence in their performance in physical activities.

Comparing effects of methylphenidate, sertraline and placebo on neuropsychiatric sequelae in patients with traumatic brain injury

This study aimed to investigate the effects of methylphenidate and sertraline compared with placebo on various neuropsychiatric sequelae associated with traumatic brain injury (TBI). This was a 4 week, double-blind, parallel-group trial. Thirty patients with mild to moderate degrees of TBI were randomly allocated to one of three treatment groups (n = 10 in each group) with matching age, gender and education, i.e. methylphenidate (starting at 5 mg/day and increasing to 20 mg/day in a week), sertraline (starting at 25 mg/day and increasing to 100 mg/day in a week) or placebo. At the baseline and at the 4 week endpoint, the following assessments were administered: subjective (Beck Depression Inventory) and objective (Hamilton Depression Rating Scale) measures of depression; Rivermead Postconcussion Symptoms Questionnaire for postconcussional symptoms; SmithKline Beecham Quality of Life Scale for quality of life; seven performance tests (Critical Flicker Fusion, Choice Reaction Time, Continuous Tracking, Mental Arithmetic, Short-Term memory, Digit Symbol Substitution and Mini-Mental State Examination); subjective measures of sleep (Leeds Sleep Evaluation Questionnaire) and daytime sleepiness (Epworth Sleepiness Scale). All adverse events during the study period were recorded and their relationships to the drugs were assessed. Neuropsychiatric sequelae seemed to take a natural recovery course in patients with traumatic brain injury. Methylphenidate had significant effects on depressive symptoms compared with the placebo, without hindering the natural recovery process of cognitive function. Although sertraline also had significant effects on depressive symptoms compared with the placebo, it did not improve many tests on cognitive performances. Daytime sleepiness was reduced by methylphenidate, while it was not by sertraline. Methylphenidate and sertraline had similar effects on depressive symptoms. However, methylphenidate seemed to be more beneficial in improving cognitive function and maintaining daytime alertness. Methylphenidate also offered a better tolerability than sertraline.

Symptoms and Cognitive Dysfunction in Patients With the Late Whiplash Syndrome

The aim of the study was to record the severity of symptoms in patients with the late whiplash syndrome and to assess how the symptom load affected the performance on a simple psychometric test. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) with an additional question on neck pain, modified RPQ (mRPQ), and the Short Test of Mental Status (STMS) were applied on 40 chronic whiplash patients. Symptoms reported by the whiplash group were compared to those of 50 normal controls. The patients scored significantly higher than the controls on all symptoms listed in the mRPQ. The most frequent symptoms reported by the whiplash group were neck pain, headache, "taking longer to think," forgetfulness, poor concentration, and fatigue. Total score of STMS was significantly lower (p = .0001) in the patients. There was a statistically significant association (p = .0001) between the total scores of mRPQ and STMS indicating that a high symptom load is associated with a poor performance on STMS. The study illustrates that various symptoms, in addition to neck and head pain, may have an impact on cognitive functions when evaluated by an easily administrated test like STMS.

Early predictors of post-concussion symptoms in patients with mild head injury.

A small proportion of patients with mild head injury (MHI) develop post-concussion symptoms (PCSs). We searched simple measures for the early detection of patients who are probable to develop PCSs. We recorded signs and symptoms, history of previous diseases, medications, and lifestyle factors and measured serum protein S-100B on admission in a series of 172 consecutive MHI patients admitted into the emergency room of a general hospital. A modified Rivermead Post-Concussion Symptoms Questionnaire was used to identify the patients with and without PCSs 1 month after the injury. We identified 37 patients with MHI who developed PCSs (22%). Odds ratios (OR) and 95% confidence intervals (CI) after adjustment for possible confounding variables were calculated by logistic regression. Independent early risk factors for PCSs in the MHI patients were skull fracture (OR 8.0, 95% CI 2.6-24.6), serum protein S-100B >/= 0.50 microg/l (OR 5.5, 95% CI 1.6-18.6), dizziness (OR 3.1, 95% CI 1.2-8.0), and headache (OR 2.6, 95% CI 1.0-6.5). Serum protein S-100B proved to be a specific, but not sensitive predictor of PCSs. The presence of skull fracture, elevated serum protein S-100B, dizziness, and headache may help the emergency room physician to identify patients at risk of PCSs and to refer them for further examination and follow-up.

The clinical value of serum S-100 protein measurements in minor head injury: a Scandinavian multicentre study

Purpose: This study of patients with minor head injury was designed to investigate the relation of S-100 protein measurements to computed tomograpy (CT) findings and patients outcomes. Increased serum levels of this protein were hypothetized to predict intracranial pathology and increased frequency of post-concussion symptoms. Methods: One hundred and eighty-two patients were studied with Glasgow Coma Scale scores of 13-15. The study recruited patients from three Scandinavian neurotrauma centres. Serum levels of S-100 protein were measured at admittance and CT scans of the brain were obtained within 24 hours postinjury in all patients. Outcome was evaluated with the Rivermead Postconcussion Symptoms Questionnaire (RPQ) 3 months after the injury. Results: Increased serum level of S-100 protein was detected in 69 (38%) patients, and CT scan demonstrated intracranial pathology in 10 (5%) (brain contusion in seven, epidural haematoma in two, traumatic subarachnoid haemorrhage in one). The proportion of patients with detectable serum level was significantly (p < 0.01) higher among those with intracranial pathology (90%) compared to those without (35%). The negative predictive value of an undetectable S-100 level was 0.99. Sixty-two per cent reported one or more post-concussion symptoms at follow-up. A trend was observed towards an increased frequency of post-concussion symptoms among patients with detectable serum levels. Conclusions: Undetectable serum level of S-100 protein predicts normal intracranial findings on CT scan. Determination of S-100 protein in serum may be used to select patients for CT scanning. Increased S-100 serum levels may be more related to post-concussion symptoms caused by mild traumatic brain injury than to symptoms of psychological origin.

5-46-07 Rivermead post concussion symptom questionnaire adapted to patients with the late whiplash syndrome

5-46-07 Rivermead post concussion symptom questionnaire adapted to patients with the late whiplash syndrome

The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability.

After head injuries, particularly mild or moderate ones, a range of post-concussion symptoms (PCS) are often reported by patients. Such symptoms may significantly affect patients' psychosocial functioning. To date, no measure of the severity of PCS has been developed. This study presents the Rivermead Post Concussion Symptoms Questionnaire (RPQ) as such a measure, derived from published material, and investigates its reliability. The RPQ's reliability was investigated under two experimental conditions. Study 1 examined its test-retest reliability when used as a self-report questionnaire at 7-10 days after injury. Forty-one head-injured patients completed an RPQ at 7-10 days following their head injury and again approximately 24 h later. Study 2 examined the questionnaire's inter-rater reliability when used as a measure administered by two separate investigators. Forty-six head-injured patients had an RPQ administered by an investigator at 6 months after injury. A second investigator readministered the questionnaire approximately 7 days later. Spearman rank correlation coefficients were calculated for ratings on the total symptom scores, and for individual items. High reliability was found for the total PCS scores under both experimental conditions (Rs = + 0.91 in study 1 and Rs = + 0.87 in study 2). Good reliability was also found for individual PCS items generally, although with some variation between different symptoms. The results are discussed in relation to the major difficulties involved when looking for appropriate experimental criteria against which measures of PCS can be validated.