Psychometric Properties of the German Version of the Rivermead Post-Concussion Symptoms Questionnaire in Adolescents after Traumatic Brain Injury and Their Proxies

Abstract

The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) assesses post-concussion symptoms (PCS) after traumatic brain injury (TBI). The current study examines the applicability of self-report and proxy versions of the German RPQ in adolescents (13–17 years) after TBI. We investigated reliability and validity on the total and scale score level. Construct validity was investigated by correlations with the Post-Concussion Symptoms Inventory (PCSI-SR13), Generalized Anxiety Disorder Scale 7 (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) and by hypothesis testing regarding individuals’ characteristics. Intraclass correlation coefficients (ICC) assessed adolescent–proxy agreement. In total, 148 adolescents after TBI and 147 proxies completed the RPQ. Cronbach’s α (0.81–0.91) and McDonald’s ω (0.84–0.95) indicated good internal consistency. The three-factor structure outperformed the unidimensional model. The RPQ was strongly correlated with the PCSI-SR13 (self-report: r = 0.80; proxy: r = 0.75) and moderately–strongly with GAD-7 and PHQ-9 (self-report: r = 0.36, r = 0.35; proxy: r = 0.53, r = 0.62). Adolescent–proxy agreement was fair (ICC [2,1] = 0.44, CI95% [0.41, 0.47]). Overall, both self-report and proxy assessment forms of the German RPQ are suitable for application in adolescents after TBI. As proxy ratings tend to underestimate PCS, self-reports are preferable for evaluations. Only if a patient is unable to answer, a proxy should be used as a surrogate.

Applicability and Clinical Utility of the German Rivermead Post-Concussion Symptoms Questionnaire in Proxies of Children after Traumatic Brain Injury: An Instrument Validation Study

“…Our results underline the sensitivity and clinical utility of the RPQ in identifying differences between individuals with respect to TBI severity, functional recovery status, as well as symptoms of depression and anxiety. Furthermore, the RPQ proxy is a valid tool for the assessment of PCS in children where needed just as in adolescents (25). Summarizing the current results…”

“…Analyses of DIF between RPQ proxy ratings for children and adolescents, as investigated previously (25), revealed a signi cant but minimal difference on one item (i.e., 'Forgetfulness, Poor Memory'). More speci cally, proxies of adolescents rated indicated more severe impairment associated with this item compared to proxies of children.…”

“…Results in favor of acceptable psychometric properties would suggest that the RPQ proxy version can be used to evaluate the presence and severity of PCS reliably and validly after pTBI. A secondary aim is the comparison of RPQ ratings provided by children's proxies with the RPQ ratings of adolescents' proxies (25). We expect no signi cant differences in response behavior, indicating that RPQ proxy ratings can be applied for children just as they can be for adolescents, thus underlining the utility of the instrument in clinical context.…”

“…Proxy ratings were sampled from parents and caregivers using paper-pencil questionnaires (8-12 years: n = 146; 13-17 years: n = 147). The psychometric evaluation of the RPQ in the adolescent subsample can be found elsewhere (25). The current study focuses on the proxy assessments of the German RPQ obtained from the parents of children after pTBI aged 8-12 years.…”

“…Proxy ratings are often utilized to evaluate children's mental health problems after pTBI (e.g., 23), offering an additional perspective of the effects of the injury and subsequent therapeutic interventions. Proxy-assessed versions of the RPQ have been evaluated in pediatric samples (4-17 years) in English (24) and, most recently, speci cally in adolescents after pTBI in German (25). With regard to PCS and PC-like symptoms, proxies tend to report lower rates of impairment (26), resulting in an only moderate parent-child concordance (22).…”