Reference Values for the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) from General Population Samples in the United Kingdom, Italy, and The Netherlands

Abstract

After traumatic brain injury (TBI), individuals may experience short- or long-term health burdens, often referred to as post-concussion symptoms (PCS). The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is one of the commonly used instruments to assess self-reported PCS. To date, no reference values for RPQ have been provided, although they are crucial for clinical practice when evaluating a patient’s health status relative to a comparable healthy population. Therefore, the aim of this study is to provide reference values for the United Kingdom, the Netherlands, and Italy. A total of 11,759 individuals (50.3% women) from representative general population samples participated in an online survey (4646 individuals from the UK, 3564 from the Netherlands, and 3549 from Italy). The factorial structure of the RPQ was examined using confirmatory factor analysis (CFA), and results from the general population samples were compared with those from respective TBI samples recruited within the international CENTER-TBI study using multigroup CFA. Reference values were stratified by sex, health status, age, and education using percentiles. The three-factorial model outperformed the one-factorial structure. The general population samples were largely comparable to the corresponding TBI samples, except for items such as dizziness, vision, and sensory sensitivity, which can be considered more TBI-specific. Because of the significant differences between the general population samples, we provided reference values for the total score and for the somatic, emotional, and cognitive scales for each country separately. The reference values provided can now be used in clinical practice and research. Future studies should obtain stratified reference values for other countries and languages to improve accuracy in the diagnosis and treatment of symptom burden after TBI.

Catastrophizing is associated with excess cognitive symptom reporting after mild traumatic brain injury.

“…To explore the specificity of relationship between catastrophizing and cognitive symptoms, we ran two additional models with catastrophizing as predictor and somatic symptoms and emotional symptoms as outcome variables. The sum of the nine somatic items (i.e., headaches, dizziness, nausea, noise sensitivity, sleep disturbance, fatigue, blurred vision, light sensitivity, and double vision) on the RPQ scale was used to indicate somatic symptoms severity, and the sum of the four emotional items (i.e., irritability, depression, frustration/impatience, and restlessness) on the RPQ scale was used to indicate emotional symptoms severity, consistent with prior factor analytic studies (Smith-Seemiller et al, 2009; Zeldovich et al, 2022). We found that catastrophizing was significantly associated with somatic symptoms (β = 0.58, 95% CI [0.39, 0.77], p < .001) as well as emotional symptoms (β = 0.55, 95% CI [0.36, 0.74], p < .001).…”

Psychometric evaluation and reference values for the German Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8–12 years

“…In our study, 40.2% of the children had at least one chronic health condition, as reported by their parents. It is known from adult research ( 43 ) that general population samples with at least one chronic health condition are more likely to report PC-like symptoms than those without any chronic conditions. Moreover, some studies in adult context suggest that the development of PCS is TBI independent and is rather associated with the general health state [e.g., ( 44 , 45 )].…”

Comparability of the six Rivermead Post-Concussion Symptoms Questionnaire translations: Results from the CENTER-TBI study

“…This information could be considered when establishing reference or norm values for the interpretation of the results of the patients when applying the RPQ. For example, in the recent study [53] which provided reference values for the United Kingdom, the Netherlands, and Italy, one of the strati cations for the reference values was the presence the chronic health conditions which has proved important for the RPQ scores.…”