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

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 postacute 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.

Enhancing the Assessment of Gratitude in Mindfulness Research: a Rasch Analysis of the 6-Item Gratitude Questionnaire

“…1, representative of the disordering patterns for all other items, where categories 1, 3, and 4 are never modal in item 1, and categories 2 and 3 are never modal for item 2. Item 6 "Long amounts of time can go by before I feel grateful to something or someone" displayed significant uniform DIF by age (F(2, 641) = 27.22, p < 0.001), with older people scoring lower on this item compared to younger people which was also confirmed by visual examination of the plot and subsequent sign test (Balalla et al, 2020). Items 2, 4, 5, and 6 showed significant uniform DIF by sample, with Indian participants scoring higher on item 2 (F(1, 641) = 138.85, p < 0.001), 4 (F(1, 641) = 487.47, p < 0.001), and 6 (F(1, 641) = 610.22, p < 0.001), and lower on item 5 (F(1, 641) = 184.42, p < 0.001).…”

Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury

“…These questionnaires evaluate between 10 and 25 symptoms and use a 5- to 7-point Likert scale to score each symptom. 28 Some questionnaires like the Rivermead Post-Concussion Symptoms Questionnaire and the 21-Item ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) have been studied for their reliability and validity 2,28,33 but not for their responsiveness. Future studies should therefore look at the responsiveness of these questionnaires.…”

Memory perfectionism is associated with persistent memory complaints after concussion

“…Our primary outcome was a single ordinal rating of how much participants' experienced problems with forgetfulness now compared to before their injury. This item has demonstrated test-retest stability 39 and strong discrimination between concussion and orthopedic injury control groups 40 , however, it may not have comparable reliability and validity to longer patient-reported outcomes assessing subjective memory functioning. Still, we believe that the presence vs. absence of severe memory complaints is a clinically relevant outcome.…”