The Rivermead Post-Concussion Symptoms Questionnaire, abbreviated RPQ, is a questionnaire that can be administered to someone who sustains a

concussion A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness (LOC); memory loss; headaches; difficulty with thinking, concentration, ...

or other form of

traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic b ...

to measure the severity of

symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an disease, illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormali ...

. The RPQ is used to determine the presence and severity of

post-concussion syndrome Post-concussion syndrome (PCS) is a set of symptoms that may continue for weeks, months, or a year or more after a concussion – medically classified as a so-called mild traumatic brain injury (TBI). About 34 to 35% of people with concussi ...

(PCS), a set of somatic, cognitive, and emotional symptoms following traumatic brain injury that may persist anywhere from a week,Legome E. 2006
Postconcussive syndrome.
eMedicine.com. Retrieved 14 November 2012. to months, or even more than six months. The RPQ has been cited in over 40 papers. The test was presented in 1995 by a group led by N.S. King. At the time of its design, no measure of PCS severity had been developed.

Questionnaire contents

The test, which can be self-administered or given by an interviewer, asks patients to rate the severity of 16 different symptoms commonly found after a

mild traumatic brain injury A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness (LOC); memory loss; headaches; difficulty with thinking, concentration, ...

(MTBI). Patients are asked to rate how severe each of the 16 symptoms has been over the past 24 hours. In each case, the symptom is compared with how severe it was before the injury occurred (

premorbid Premorbidity refers to the state of functionality prior to the onset of a disease or illness. It is most often used in relation to psychological function (e.g. premorbid personality or premorbid intelligence), but can also be used in relation to ot ...

). These symptoms are reported by severity on a scale from 0 to 4: not experienced, no more of a problem, mild problem, moderate problem, and severe problem. The questionnaire asks the sufferer to assess the following symptoms: *

Headaches Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result of m ...

* Feelings of

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a common medical c ...

Nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...

and/or

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the Human nose, nose. Vomiting can be the result of ailments like Food-poisoning, foo ...

Hyperacusis Hyperacusis is the increased sensitivity to sound and a low tolerance for environmental noise. Definitions of hyperacusis can vary significantly; it can refer to normal noises being perceived as: loud, annoying, painful, fear-inducing, or a combina ...

(noise sensitivity) * Sleep disturbance *

Fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...

, tiring more easily * Being irritable, easily angered * Feeling depressed or tearful * Feeling frustrated or impatient * Forgetfulness, poor memory * Poor concentration * Taking longer to think * Blurred vision *

Light sensitivity Photosensitivity is the amount to which an object reacts upon receiving photons, especially visible light. In medicine, the term is principally used for abnormal reactions of the skin, and two types are distinguished, photoallergy and phototoxicity ...

(easily upset by bright light) *

Double vision Diplopia is the simultaneous perception of two images of a single object that may be displaced horizontally or vertically in relation to each other. Also called double vision, it is a loss of visual focus under regular conditions, and is often v ...

* Restlessness The first three symptoms are referred to as RPQ-3, also known as RPQh (RPQ head), and are the early (immediately following injury) symptoms associated with post-concussion syndrome. The other thirteen are referred to as RPQ-13, also known as RPQgen (RPQ general), and are the late symptoms associated with the syndrome. Late symptoms can occur days to weeks after the initial injury, although headaches and dizziness can persist well into the "late stage" as well. RPQ-3 symptoms are regarded as the more "physical" symptoms, whereas the RPQ-13 set of symptoms are considered to have a more significant impact on psychic and social function. The questionnaire also includes a space for the test-taker to report any additional symptoms they may be experiencing since the onset of the injury.

Questionnaire Administration

The questionnaire may be self-administered, administered in person by a second party, or administered over telephone. The questionnaire can feasibly be used as any other

neuropsychological test Neuropsychological tests are specifically designed tasks that are used to measure a psychological function known to be linked to a particular brain structure or pathway. Tests are used for research into brain function and in a clinical setting f ...

for assessment of concussions would, including following MTBI following accidents or sports-related injury. The questionnaire can also be used for the assessment of conditions that show symptoms similar to PCS, such as

chronic pain Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between Acute (medicine), acute and Chronic condition, chronic pain is sometimes determined by the amount of time since onset. Two commonly ...

Relationship to Post-Concussion Syndrome

Inclusion/Exclusion of Known Symptoms

The questionnaire includes a selection of

cognitive Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...

somatic Somatic may refer to: * Somatic (biology), referring to the cells of the body in contrast to the germ line cells ** Somatic cell, a non-gametic cell in a multicellular organism * Somatic nervous system, the portion of the vertebrate nervous sys ...

, and

emotional Emotions are mental states brought on by neurophysiological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or displeasure. There is currently no scientific consensus on a definition. E ...

symptoms associated with post-concussion syndrome. These symptoms were analyzed separately as individual clusters to determine frequency among PCS sufferers, although these clusters are not formally associated with the development and intentions of the questionnaire itself. Fatigue is the most frequently affirmed symptom of PCS included on the questionnaire, while double vision is the least affirmed. Some other neuropsychological tests do not include fatigue as a symptom of PCS, giving the Rivermead Post-Concussion Symptoms Questionnaire an advantage in an "accurate" assessment of the condition. Severe fatigue has been reported in at least a third of a representative cohort of MTBI sufferers, and this symptom was associated with a significant limitation of the ability of sufferers to function normally in daily activities. Post-concussion syndrome is believed to be able to arise for reasons aside from sustaining a (mild) traumatic brain injury. In one study, health professionals cited organic causes in general as being most responsible for the development of PCS; however, emotional and compensatory causes have also been implicated as factors. For example, depression may contribute to the development or severity of PCS, whether triggered by a physical injury or not. PCS symptoms also overlap with symptoms associated with other conditions, such as chronic pain. Because of this, the Rivermead Post-Concussion Symptoms Questionnaire is useful in the assessment of other conditions besides MTBI-induced PCS. The questionnaire has been used in studies with a slightly altered wording in order to remove references to head injuries, so that test-takers don't assume their symptoms are (or are not) derived solely from a head injury and so the questionnaire can be more broadly utilized.

Validity

The RPQ has been shown to fit best to a two-factor model of the syndrome ''(see

Factor analysis Factor analysis is a statistical method used to describe variability among observed, correlated variables in terms of a potentially lower number of unobserved variables called factors. For example, it is possible that variations in six observed ...

)'', with somatic and emotional symptoms collapsed into one factor and cognitive symptoms in another. This is due to high

covariance In probability theory and statistics, covariance is a measure of the joint variability of two random variables. If the greater values of one variable mainly correspond with the greater values of the other variable, and the same holds for the les ...

in reported symptom severity scores between the symptoms classified as "somatic" and "emotional". RPQ-3 and RPQ-13 symptoms (not corresponding to somatic and emotional scales) are also scored separately, as they have shown to fit poorly to the

Rasch model The Rasch model, named after Georg Rasch, is a psychometric model for analyzing categorical data, such as answers to questions on a reading assessment or questionnaire responses, as a function of the trade-off between the respondent's abilities, at ...

when scored on a single scale. In doing this, each scale forms a unidimensional construct, demonstrating good

test-retest reliability Repeatability or test–retest reliability is the closeness of the agreement between the results of successive measurements of the same measure, when carried out under the same conditions of measurement. In other words, the measurements are taken ...

. Further studies are necessary to establish any

predictive value Predictive value of tests is the probability of a target condition given by the result of a test, often in regard to medical tests. *In cases where binary classification can be applied to the test results, such yes versus no, test target (such as a ...

of the RPQ, however. The questionnaire has displayed several flaws in implementation and its ability to accurately reflect test-taker experience. While the questionnaire includes symptoms non-specific to PCS, which allows for a broader range of diagnosis (i.e. of other conditions such as chronic pain), this is at the expense of precision. The questionnaire is a useful tool for assessing progress or regression of symptom severity, but it is not ideal for actual diagnosis as there is no standard criteria for what constitutes post-concussion syndrome. The only feature characteristic of PCS that is generally agreed upon among health professionals is a significant impairment of the ability to function socially.

Recreational drug use Recreational drug use indicates the use of one or more psychoactive drugs to induce an altered state of consciousness either for pleasure or for some other casual purpose or pastime by modifying the perceptions and emotions of the user. When a ...

, for instance, can often result in symptoms similar to those associated with PCS, making it difficult to determine the severity of a head injury if the victim is a habitual drug user. Despite this, studies have used the RPQ as a way of meeting criteria that may not be universally agreed upon, such as those found in the

Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

(specifically

DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

). Self-administration is commonly used for the RPQ, raising several issues of concern. Interpretation and accuracy of the RPQ can vary widely due to self-administration and the various confounding variables involved. In one study, higher average severity scores were associated with patients involved in

litigation - A lawsuit is a proceeding by a party or parties against another in the civil court of law. The archaic term "suit in law" is found in only a small number of laws still in effect today. The term "lawsuit" is used in reference to a civil actio ...

at the time the questionnaire was administered. Studies using other neuropsychological assessments for post-concussion syndrome or general cognitive performance have also shown poor test-taker effort to affect the reported severity of symptoms. Opinions on the questionnaire itself are also mixed amongst health professionals, with a small percentage believing that the questionnaire and in fact no treatment efforts at all were useful for post-concussion syndrome.

References

External links

The Rivermead Post-Concussion Symptoms Questionnaire, version from N.S. King et al, 1995

Post Concussion Syndrome
{{Neuropsychology tests Cognitive tests Neuropsychological tests Neurotrauma