Rivermead post-concussion symptoms questionnaire

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Rivermead post-concussion symptoms questionnaire
Purposemeasure severity of symptoms of traumatic brain injury

The Rivermead Post-Concussion Symptoms Questionnaire, abbreviated RPQ, is a questionnaire that can be administered to someone who sustains a concussion or other form of traumatic brain injury to measure the severity of symptoms. The RPQ is used to determine the presence and severity of post-concussion syndrome (PCS), a set of somatic, cognitive, and emotional symptoms following traumatic brain injury that may persist anywhere from a week, [1] to months, [2] or even more than six months. [1] [3]

Contents

The RPQ has been cited in over 40 papers. [4] 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. [5]

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 (MTBI). [6] 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). [4] 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. [7]

The questionnaire asks the sufferer to assess the following symptoms: [7]

The first three symptoms are referred to as RPQ-3, also known as RPQh (RPQ head), [8] 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), [8] and are the late symptoms associated with the syndrome. [7] Late symptoms can occur days to weeks after the initial injury, although headaches and dizziness can persist well into the "late stage" as well. [7] 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. [9] [10] 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, [5] administered in person by a second party, [5] or administered over telephone. [11] The questionnaire can feasibly be used as any other neuropsychological test 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. [9]

Relationship to Post-Concussion Syndrome

Inclusion/Exclusion of Known Symptoms

The questionnaire includes a selection of cognitive, somatic, and emotional symptoms associated with post-concussion syndrome. [9] 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. [9]

Fatigue is the most frequently affirmed symptom of PCS included on the questionnaire, while double vision is the least affirmed. [7] 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. [12]

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. [13] 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. [9] 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. [9]

Validity

The RPQ has been shown to fit best to a two-factor model of the syndrome (see Factor analysis), with somatic and emotional symptoms collapsed into one factor and cognitive symptoms in another. This is due to high covariance in reported symptom severity scores between the symptoms classified as "somatic" and "emotional". [4] 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 when scored on a single scale. In doing this, each scale forms a unidimensional construct, demonstrating good test-retest reliability. [7] Further studies are necessary to establish any predictive value of the RPQ, however. [7]

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. [9] 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. [14] Recreational drug use, 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. [9] 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 (specifically DSM-IV-TR). [15]

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. [4] In one study, higher average severity scores were associated with patients involved in litigation at the time the questionnaire was administered. [9] 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. [16]

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. [13]

See also

Related Research Articles

Head injury Serious trauma to the cranium

A head injury is any injury that results in trauma to the skull or brain. The terms traumatic brain injury and head injury are often used interchangeably in the medical literature. Because head injuries cover such a broad scope of injuries, there are many causes—including accidents, falls, physical assault, or traffic accidents—that can cause head injuries.

Brain damage Destruction or degeneration of brain cells

Neurotrauma, brain damage or brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage, while neurotoxicity typically refers to selective, chemically induced neuron damage.

Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance. Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), concussion, and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.

Concussion Type of 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 or balance; nausea; blurred vision; sleep disturbances; and mood changes. Any of these symptoms may begin immediately, or appear days after the injury. Concussion should be suspected if a person indirectly or directly hits their head and experiences any of the symptoms of concussion. It is not unusual for symptoms to last 2 weeks in adults and 4 weeks in children. Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.

Traumatic brain injury Injury of the brain from an external source

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, mechanism, or other features. Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to permanent disability or death.

Closed-head injury is a type of traumatic brain injury in which the skull and dura mater remain intact. Closed-head injuries are the leading cause of death in children under 4 years old and the most common cause of physical disability and cognitive impairment in young people. Overall, closed-head injuries and other forms of mild traumatic brain injury account for about 75% of the estimated 1.7 million brain injuries that occur annually in the United States. Brain injuries such as closed-head injuries may result in lifelong physical, cognitive, or psychological impairment and, thus, are of utmost concern with regards to public health.

Post-concussion syndrome (PCS) is a set of symptoms that may continue for weeks, months, or a year or more after a concussion – a mild form of traumatic brain injury (TBI). About 15% of individuals with a history of a single concussion develop persistent symptoms associated with the injury.

Chronic traumatic encephalopathy Neurodegenerative disease caused by repeated head injuries

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repeated blows to the head. The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. The disease often gets worse over time and can result in dementia. It is unclear if the risk of suicide is altered.

Second-impact syndrome (SIS) occurs when the brain swells rapidly, and catastrophically, after a person suffers a second concussion before symptoms from an earlier one have subsided. This second blow may occur minutes, days or weeks after an initial concussion, and even the mildest grade of concussion can lead to second impact syndrome. The condition is often fatal, and almost everyone who is not killed is severely disabled. The cause of SIS is uncertain, but it is thought that the brain's arterioles lose their ability to regulate their diameter, and therefore lose control over cerebral blood flow, causing massive cerebral edema.

Concussion grading systems are sets of criteria used in sports medicine to determine the severity, or grade, of a concussion, the mildest form of traumatic brain injury. At least 16 such systems exist, and there is little agreement among professionals about which is the best to use. Several of the systems use loss of consciousness and amnesia as the primary determinants of the severity of the concussion.

Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.

Traumatic brain injury can cause a variety of complications, health effects that are not TBI themselves but that result from it. The risk of complications increases with the severity of the trauma; however even mild traumatic brain injury can result in disabilities that interfere with social interactions, employment, and everyday living. TBI can cause a variety of problems including physical, cognitive, emotional, and behavioral complications.

The British Columbia Postconcussion Symptom Inventory (BC-PSI), is a 16 item self-report inventory designed to measure both the frequency, and intensity of the ICD-10 criteria for Post concussion syndrome, which is a common occurrence in cases of mild traumatic brain injury. The (BC-PSI) asks the respondent to rate the severity of 13 symptoms rated on a six-point Likert-type rating scale that measures the frequency and intensity of each symptom in the past two weeks.

Automated Neuropsychological Assessment Metrics (ANAM), is a library of computer-based assessments of cognitive domains including attention, concentration, reaction time, memory, processing speed, and decision-making. ANAM has been administered nearly two million times in a variety of applications and settings. ANAM provides clinicians and researchers with tests to evaluate changes in an individual’s cognitive status over time.

Prevention of concussions

Prevention of mild traumatic brain injury involves taking general measures to prevent traumatic brain injury, such as wearing seat belts and using airbags in cars. Older people are encouraged to try to prevent falls, for example by keeping floors free of clutter and wearing thin, flat, shoes with hard soles that do not interfere with balance.

Concussions and other types of repetitive play-related head blows in American football have been shown to be the cause of chronic traumatic encephalopathy (CTE), which has led to player deaths and other debilitating symptoms after retirement, including memory loss, depression, anxiety, headaches, stress, and sleep disturbances.

Concussions, a type of mild traumatic brain injury, are a frequent concern for those playing sports, from children and teenagers to professional athletes. Repeated concussions are a known cause of various neurological disorders, most notably chronic traumatic encephalopathy (CTE), which in professional athletes has led to premature retirement, erratic behavior and even suicide. In the context of sports-related concussions (SRC), an SRC is currently defined as a "complex pathophysiological process affecting the brain, induced by biomechanical forces". Because concussions cannot be seen on X-rays or CT scans, attempts to prevent concussions have been difficult.

A sports-related traumatic brain injury is a serious accident which may lead to significant morbidity or mortality. Traumatic brain injury (TBI) in sports are usually a result of physical contact with another person or stationary object, these sports may include boxing, gridiron football, field/ice hockey, lacrosse, martial arts, rugby, soccer, wrestling, auto racing, cycling, equestrian, roller blading, skateboarding, skiing or snowboarding.

Concussions in rugby union

Concussions in England's professional rugby union are the most common injury received. Concussion can occur where an individual experiences an impact to the head, and commonly occurs in high-contact sporting activities, including American football, boxing, MMA and the rugby codes. It can also occur in recreational activities like horse riding, jumping, cycling, and skiing. The reason being that it doesn't have to be something to strike you in the proximity of your brain, but can also be caused by rapid change of movement, giving the skull not enough time to move with your body, causing your brain to press against your skull. With rugby being such a contact and fast moving sport, it is no wonder why there is concussion and other head injuries occurring. With the development of equipment and training methods, these will help benefit the players on the field know what could happen and how they can help with preventing it.

Sleep disorder is a common repercussion of traumatic brain injury (TBI). It occurs in 30%-70% of the patients suffering from TBI. TBI can be distinguished into two categories, primary and secondary damage. Primary damage includes injuries of white matter, focal contusion, cerebral edema and hematomas, mostly occurring at the moment of the trauma. Secondary damage involves the damage of neurotransmitter release, inflammatory responses, mitochondrial dysfunctions and gene activation, occurring minutes to days following the trauma. Patients with sleeping disorders following TBI suffer specifically from insomnia, sleep apnea, narcolepsy, periodic limb movement disorder and hypersomnia. Furthermore, circadian sleep-wake disorders can occur after TBI.

References

  1. 1 2 Legome E. 2006. Postconcussive syndrome. eMedicine.com. Retrieved 14 November 2012.
  2. ↑ McHugh T, Laforce R, Gallagher P, Quinn S, Diggle P, Buchanan L (2006). "Natural history of the long-term cognitive, affective, and physical sequelae of mild traumatic brain injury". Brain and Cognition. 60 (2): 209–11. doi:10.1016/j.bandc.2004.09.018. PMID   16646125.
  3. ↑ Evans RW (2004). "Post-traumatic headaches". Neurological Clinics. 22 (1): 237–249. doi:10.1016/S0733-8619(03)00097-5. PMID   15062537.
  4. 1 2 3 4 Potter S, Leigh E, Wade D, Fleminger S (December 2006). "The Rivermead Post Concussion Symptoms Questionnaire: A confirmatory factor analysis". J. Neurol. 253 (12): 1603–14. doi:10.1007/s00415-006-0275-z. PMID   17063314.
  5. 1 2 3 King NS, Crawford S, Wenden FJ, Moss NE, Wade DT (September 1995). "The Rivermead Post Concussion Symptoms Questionnaire: A measure of symptoms commonly experienced after head injury and its reliability". J. Neurol. 242 (9): 587–92. doi:10.1007/BF00868811. PMID   8551320.
  6. ↑ Mittenberg W, Strauman S (2000). "Diagnosis of mild head injury and the postconcussion syndrome". Journal of Head Trauma Rehabilitation. 15 (2): 783–791. doi:10.1097/00001199-200004000-00003. PMID   10739967.
  7. 1 2 3 4 5 6 7 Eyres S, Carey A, Gilworth G, Neumann V, Tennant A (2005). "Construct validity and reliability of the Rivermead Post Concussion Symptoms Questionnaire". Clinical Rehabilitation. 19 (8): 878–87. doi:10.1191/0269215505cr905oa. PMID   16323387.
  8. 1 2 Sveen U, Bautz-Holter E, Sandvik L, Alvsaker K, Roe C (2010). "Relationship between competency in activities, injury severity, and post-concussion symptoms after traumatic brain injury". Scandinavian Journal of Occupational Therapy. 17 (3): 225–32. doi:10.3109/11038120903171295. hdl: 10642/518 . PMID   20302448.
  9. 1 2 3 4 5 6 7 8 9 Smith-Seemiller L, Fow N, Kant R, Franzen M (2003). "Presence of Post-Concussion Symptoms in Patients With Chronic Pain vs Mild Traumatic Brain Injury". Brain Injury. 17 (3): 199–206. doi:10.1080/0269905021000030823. PMID   12623496.
  10. ↑ Draper K, Ponsford J, Schonberger M (2007). "Psychosocial and emotional outcomes 10 years following traumatic brain injury". Journal of Head Trauma Rehabilitation. 22 (5): 278–87. doi:10.1097/01.htr.0000290972.63753.a7. PMID   17878769.
  11. ↑ King N (1996). "Emotional, neuropsychological and organic factors: Their use in prediction of persisting post concussive symptoms after moderate or mild head injury". Journal of Neurology, Neurosurgery, and Psychiatry. 61 (1): 75–81. doi:10.1136/jnnp.61.1.75. PMC   486463 . PMID   8676166.
  12. ↑ Stulemeijer M, van der WS, Bleijenberg G, Biert J, Brauer J, Vos PE (2006). "Recovery from mild traumatic brain injury: A focus on fatigue". Journal of Neurology. 253: 1041–7. doi:10.1007/s00415-006-0156-5.
  13. 1 2 McMillan T, Davies R (2005). "Opinion About Post-Concussion Syndrome in Health Professionals". Brain Injury. 19 (11): 941–7. doi:10.1080/02699050400000565.
  14. ↑ Foy K, Murphy K (2009). "Post-concussion syndrome". British Journal of Hospital Medicine. 70 (8): 440–3. doi:10.12968/hmed.2009.70.8.43536.
  15. ↑ Faux S, Sheedy J, Delaney R, Riopelle R (2011). "Emergency department prediction of post-concussive syndrome following mild traumatic brain injury—an international cross-validation study". Brain Injury. 25 (1): 14–22. doi:10.3109/02699052.2010.531686.
  16. ↑ Lange R, Iverson G, Brooks B, Rennison V (2010). "Influence of Poor Effort on Self-Reported Symptoms and Neurocognitive Test Performance Following Mild Traumatic Brain Injury". Journal of Clinical and Experimental Neuropsychology. 32 (9): 961–72. doi:10.1080/13803391003645657.
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