Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2024

Open Access 01-12-2024 | Central Nervous System Trauma | Research

Applicability and clinical utility of the German rivermead post-concussion symptoms questionnaire in proxies of children after traumatic brain injury: an instrument validation study

Authors: Fabian Bockhop, Sven Greving, Marina Zeldovich, Ugne Krenz, Katrin Cunitz, Dagmar Timmermann, Matthias Kieslich, Nada Andelic, Anna Buchheim, Inga K. Koerte, Maike Roediger, Knut Brockmann, Michaela V. Bonfert, Steffen Berweck, Michael Lendt, Michael Staebler, Nicole von Steinbuechel

Published in: BMC Neurology | Issue 1/2024

Login to get access

Abstract

Background

The German Rivermead Post-Concussion Symptoms Questionnaire (RPQ) can be used to assess post-concussion symptoms (PCS) after traumatic brain injury (TBI) in adults, adolescents, and children.

Methods

In this study, we examined the psychometric properties of the German RPQ proxy version (N = 146) for children (8—12 years) after TBI at the item, total and scale score level. Construct validity was analyzed using rank correlations with the proxy-assessed Post-Concussion Symptoms Inventory (PCSI-P), the Patient Health Questionnaire 9 (PHQ-9), and the Generalized Anxiety Disorder Scale 7 (GAD-7). Furthermore, sensitivity testing was performed concerning subjects’ sociodemographic and injury-related characteristics. Differential item functioning (DIF) was analyzed to assess the comparability of RPQ proxy ratings for children with those for adolescents.

Results

Good internal consistency was demonstrated regarding Cronbach’s α (0.81—0.90) and McDonald’s ω (0.84—0.92). The factorial validity of a three-factor model was superior to the original one-factor model. Proxy ratings of the RPQ total and scale scores were strongly correlated with the PCSI-P (ϱ = 0.50—0.69), as well as moderately to strongly correlated with the PHQ-9 (ϱ = 0.49—0.65) and the GAD-7 (ϱ = 0.44—0.64). The DIF analysis revealed no relevant differences between the child and adolescent proxy versions.

Conclusions

The German RPQ proxy is a psychometrically reliable and valid instrument for assessing PCS in children after TBI. Therefore, RPQ self- and proxy-ratings can be used to assess PCS in childhood as well as along the lifespan of an individual after TBI.
Appendix
Available only for authorised users
Literature
1.
Keenan HT, Bratton SL. Epidemiology and outcomes of Pediatric Traumatic Brain Injury. Dev Neurosci. 2006;28(4–5):256–63.PubMedCrossRef
2.
Dewan MC, Mummareddy N, Wellons JC, Bonfield CM. Epidemiology of global Pediatric Traumatic Brain Injury: qualitative review. World Neurosurg. 2016;91:497–509e1.PubMedCrossRef
3.
Thurman DJ. The epidemiology of traumatic brain Injury in Children and youths: a review of Research since 1990. J Child Neurol. 2016;31(1):20–7.PubMedCrossRef
4.
5.
Hunt AW, Paniccia M, Reed N, Keightley M. Concussion-like symptoms in child and youth athletes at baseline: what is typical? J Athl Train. 2016;51(10):749–57.PubMedPubMedCentralCrossRef
6.
Taylor HG, Dietrich A, Nuss K, Wright M, Rusin J, Bangert B, et al. Post-concussive symptoms in children with mild traumatic brain injury. Neuropsychology. 2010;24(2):148–59.PubMedPubMedCentralCrossRef
7.
Barlow KM, Crawford S, Stevenson A, Sandhu SS, Belanger F, Dewey D. Epidemiology of Postconcussion Syndrome in Pediatric mild traumatic brain Injury. Pediatrics. 2010;126(2):e374–81.PubMedCrossRef
8.
Ledoux AA, Tang K, Yeates KO, Pusic MV, Boutis K, Craig WR, et al. Natural progression of Symptom Change and Recovery from Concussion in a Pediatric Population. JAMA Pediatr. 2019;173(1):e183820.PubMedCrossRef
9.
10.
McNally KA, Bangert B, Dietrich A, Nuss K, Rusin J, Wright M, et al. Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children. Neuropsychology. 2013;27(1):1.PubMedPubMedCentralCrossRef
11.
Fay TB, Yeates KO, Taylor HG, Bangert B, Dietrich A, Nuss KE, et al. Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury. J Int Neuropsychol Soc. 2010;16(1):94–105.PubMedCrossRef
12.
Zemek RL, Farion KJ, Sampson M, McGahern C. Prognosticators of persistent symptoms following Pediatric Concussion: a systematic review. JAMA Pediatr. 2013;167(3):259.PubMedCrossRef
13.
King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The Rivermead Post concussion symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. 1995;242(9):587–92.PubMedCrossRef
14.
von Steinbuechel N, Rauen K, Bockhop F, Covic A, Krenz U, Plass A, et al. Psychometric characteristics of the patient-reported outcome measures Applied in the CENTER-TBI Study. J Clin Med. 2021;10(11):2396.PubMedCrossRef
15.
Plass AM, Van Praag D, Covic A, Gorbunova A, Real R, Von Steinbüchel N. The psychometric validation of the Dutch version of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) after Traumatic Brain Injury (TBI) [Internet]. Scientific Communication and Education; 2018 Dec [cited 2019 Nov 12]. https://​doi.​org/​10.​1101/​502534.
16.
Gioia GA, Schneider JC, Vaughan CG, Isquith PK. Which symptom assessments and approaches are uniquely appropriate for paediatric concussion? Br J Sports Med. 2009;43(Suppl1):i13–22.PubMedCrossRef
17.
Gagnon I, Swaine B, Friedman D, Forget R. Exploring Childrenʼs self-efficacy related to physical activity performance after a mild traumatic brain Injury. J Head Trauma Rehabil. 2005;20(5):436–49.PubMedCrossRef
18.
von Steinbuechel N, Rauen K, Covic A, Krenz U, Bockhop F, Mueller I et al. J Ai editor 2023 Sensitivity of outcome instruments in a priori selected patient groups after traumatic brain injury: results from the CENTER-TBI study. PLoS ONE 18 4 e0280796.PubMedPubMedCentralCrossRef
19.
20.
Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ. Predicting Postconcussion Syndrome after mild traumatic brain Injury in Children and adolescents who Present to the Emergency Department. JAMA Pediatr. 2013;167(2):156.PubMedPubMedCentralCrossRef
21.
Barlow KM, Crawford S, Brooks BL, Turley B, Mikrogianakis A. The incidence of postconcussion syndrome remains stable following mild traumatic brain injury in children. Pediatr Neurol. 2015;53(6):491–7.PubMedCrossRef
22.
Lovell MR, Iverson GL, Collins MW, Podell K, Johnston KM, Pardini D, et al. Measurement of symptoms following sports-related concussion: reliability and normative data for the Post-concussion Scale. Appl Neuropsychol. 2006;13(3):166–74.PubMedCrossRef
23.
Sady MD, Vaughan CG, Gioia GA. Psychometric characteristics of the Postconcussion Symptom Inventory in Children and adolescents. Arch Clin Neuropsychol. 2014;29(4):348–63.PubMedPubMedCentralCrossRef
24.
Preiss-Farzanegan SJ, Chapman B, Wong TM, Wu J, Bazarian JJ. The relationship between gender and postconcussion symptoms after Sport-related mild traumatic brain Injury. PM&R. 2009;1(3):245–53.CrossRef
25.
Bockhop F, Zeldovich M, Greving S, Krenz U, Cunitz K, Timmermann D, et al. Psychometric properties of the German version of the rivermead post-concussion symptoms Questionnaire in adolescents after Traumatic Brain Injury and their proxies. J Clin Med. 2022;12(1):319.PubMedPubMedCentralCrossRef
26.
Miller M, Leathem J. An examination of Concussion Symptom Base Rates for Children aged 5–18 years. J Pediatr Neuropsychol. 2016;2(3–4):99–107.CrossRef
27.
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737–45.PubMedCrossRef
28.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet Lond Engl. 1974;2(7872):81–4.CrossRef
29.
Mundfrom DJ, Shaw DG, Tian Lu Ke. Minimum sample size recommendations for conducting factor analyses. Int J Test. 2005;5(2):159–68.CrossRef
30.
Zeldovich M, Bockhop F, Covic A, Mueller I, Polinder S, Mikolic A, et al. Factorial validity and comparability of the six translations of the rivermead post-concussion symptoms questionnaire translations: results from the CENTER-TBI study. J Patient-Rep Outcomes. 2023;7(1):90.PubMedPubMedCentralCrossRef
31.
Rivera D, Greving S, Arango-Lasprilla JC, Von Steinbuechel N, Zeldovich M. Participants and investigators. Comparability of (Post-Concussion) symptoms across Time in individuals after traumatic Brain Injury: results from the CENTER-TBI Study. J Clin Med. 2022;11(14):4090.PubMedPubMedCentralCrossRef
32.
Zeldovich M, Wu YJ, Gorbunova A, Mikolic A, Polinder S, Plass A, et al. Influence of Sociodemographic, Premorbid, and Injury-related factors on post-concussion symptoms after traumatic brain Injury. J Clin Med. 2020;9(6):1931.PubMedPubMedCentralCrossRef
33.
Sigurdardottir S, Andelic N, Roe C, Jerstad T, Schanke AK. Post-concussion symptoms after traumatic brain injury at 3 and 12 months post-injury: a prospective study. Brain Inj. 2009;23(6):489–97.PubMedCrossRef
34.
35.
Potter S, Leigh E, Wade D, Fleminger S. The Rivermead Post concussion symptoms Questionnaire: a confirmatory factor analysis. J Neurol. 2006;253(12):1603–14.PubMedCrossRef
36.
Zeldovich M, Krol L, Timmermann D, Krenz U, Arango-Lasprilla JC, Gioia G et al. Psychometric evaluation and reference values for the German postconcussion Symptom Inventory (PCSI-SR8) in children aged 8–12 years. Front Neurol. 2023;14(1266828).
37.
Kroenke K, Spitzer RL. The PHQ-9: a New Depression Diagnostic and Severity measure. Psychiatr Ann. 2002;32(9):509–15.CrossRef
38.
39.
Johnson AM, McCarty CA, Marcynyszyn LA, Zatzick DF, Chrisman SP, Rivara FP. Child- compared with parent-report ratings on psychosocial measures following a mild traumatic brain injury among youth with persistent post-concussion symptoms. Brain Inj. 2021;35(5):574–86.PubMedPubMedCentralCrossRef
40.
41.
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.PubMedCrossRef
42.
Yau Y, Orr R, Fyffe A, Cassimatis M, Browne G. Mental Health symptoms following concussion in children and adolescents. J Sci Med Sport. 2022;25:61.CrossRef
43.
Bulmer MG. Principles of statistics. New York: Dover; 1979. p. 252.
44.
Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.PubMedCrossRef
45.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, N.J: L. Erlbaum Associates; 1988. p. 567.
46.
Brown TA. Confirmatory factor analysis for applied research. Second edition. New York; London: The Guilford Press; 2015. 462 p. (Methodology in the social sciences).
47.
Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J. 1999;6(1):1–55.CrossRef
48.
Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online. 2003;8(2):23–7.
49.
Savalei V. On the computation of the RMSEA and CFI from the Mean-and-Variance Corrected Test Statistic with Nonnormal Data in SEM. Multivar Behav Res. 2018;53(3):419–29.CrossRef
50.
Tanveer S, Zecavati N, Delasobera EB, Oyegbile TO. Gender differences in Concussion and Postinjury Cognitive findings in an older and younger Pediatric Population. Pediatr Neurol. 2017;70:44–9.PubMedCrossRef
51.
Moran LM, Taylor HG, Rusin J, Bangert B, Dietrich A, Nuss KE, et al. Do postconcussive symptoms discriminate Injury Severity in Pediatric mild traumatic brain Injury? J Head Trauma Rehabil. 2011;26(5):348–54.PubMedPubMedCentralCrossRef
52.
Pickering A, Grundy K, Clarke A, Townend W. A cohort study of outcomes following head injury among children and young adults in full-time education. Emerg Med J. 2012;29(6):451–4.PubMedCrossRef
53.
Brooks BL, Plourde V, Beauchamp MH, Tang K, Yeates KO, Keightley M, et al. Predicting Psychological Distress after Pediatric Concussion. J Neurotrauma. 2019;36(5):679–85.PubMedCrossRef
54.
Vargha A, Delaney HD. A critique and improvement of the CL common language effect size statistics of McGraw and Wong. J Educ Behav Stat. 2000;25(2):101–32.
55.
Zumbo B. A handbook on the theory and methods of differential item functioning (DIF): logistic regression modeling as a unitary framework for binary and likert-type (ordinal) item scores. Ottawa, ON: Directorate of Human Resources Research and Evaluation, Department of National Defense; 1999. p. 57.
56.
Kirk RE. Practical significance: a concept whose time has come. Educ Psychol Meas. 1996;56(5):746–59.CrossRef
57.
58.
59.
60.
Choi S, Gibbons L, Crane P. Lordif: an R package for detecting differential item functioning using iterative hybrid ordinal logistic regression/item response theory and Monte Carlo simulations. J Stat Softw. 2011;39:1–30.PubMedPubMedCentralCrossRef
61.
Barker-Collo S, Theadom A, Starkey NJ, Kahan M, Jones K, Feigin V. Long-term factor structure of the Rivermead Post-concussion Symptom Questionnaire in mild traumatic brain injury and normative sample. Brain Inj. 2019;33(5):618–22.PubMedCrossRef
62.
Caplan B, Bogner J, Brenner L, Cifu DX, Wares JR, Hoke KW, et al. Differential eye movements in mild traumatic brain injury versus normal controls. J Head Trauma Rehabil. 2015;30(1):21–8.CrossRef
63.
Lundin A, de Boussard C, Edman G, Borg J. Symptoms and disability until 3 months after mild TBI. Brain Inj. 2006;20(8):799–806.PubMedCrossRef
64.
McNeish D, An J, Hancock GR. The thorny relation between measurement quality and fit index cutoffs in latent variable models. J Pers Assess. 2018;100(1):43–52.PubMedCrossRef
65.
Sivo SA, Fan X, Witta EL, Willse JT. The search for optimal cutoff properties: fit index criteria in structural equation modeling. J Exp Educ. 2006;74(3):267–88.CrossRef
66.
Plourde V, Yeates KO, Brooks BL. Predictors of long-term psychosocial functioning and health-related quality of life in children and adolescents with prior concussions. J Int Neuropsychol Soc. 2018;24(6):540–8.PubMedCrossRef
67.
Yumul JN, McKinlay A, Than M, Anderson V, Catroppa C. Concussive symptoms following Pediatric mild traumatic brain Injury. J Head Trauma Rehabil. 2020;35(4):279–87.PubMedCrossRef
68.
Callahan ML, Lim MM. Sensory sensitivity in TBI: implications for chronic disability. Curr Neurol Neurosci Rep. 2018;18(9):56.PubMedCrossRef
69.
Barker-Collo S, Jones K, Theadom A, Starkey N, Dowell A, McPherson K, et al. Neuropsychological outcome and its correlates in the first year after adult mild traumatic brain injury: a population-based New Zealand study. Brain Inj. 2015;29(13–14):1604–16.PubMedCrossRef
70.
Ouellet V, Boucher V, Beauchamp F, Neveu X, Archambault P, Berthelot S, et al. Influence of concomitant injuries on post-concussion symptoms after a mild traumatic brain injury – a prospective multicentre cohort study. Brain Inj. 2021;35(9):1028–34.PubMedCrossRef
71.
Bazarian JJ, Blyth B, Mookerjee S, He H, McDermott MP. Sex differences in outcome after mild traumatic brain Injury. J Neurotrauma. 2010;27(3):527–39.PubMedPubMedCentralCrossRef
72.
Ma C, Wu X, Shen X, Yang Y, Chen Z, Sun X, et al. Sex differences in traumatic brain injury: a multi-dimensional exploration in genes, hormones, cells, individuals, and society. Chin Neurosurg J. 2019;5:1–9.CrossRef
73.
Barry AE, Chaney B, Piazza-Gardner AK, Chavarria EA. Validity and Reliability Reporting Practices in the Field of Health Education and Behavior: a review of seven journals. Health Educ Behav. 2014;41(1):12–8.PubMedCrossRef
74.
Douglas JM, Bracy CA, Snow PC. Exploring the factor structure of the La Trobe Communication Questionnaire: insights into the nature of communication deficits following traumatic brain injury. Aphasiology. 2007;21(12):1181–94.CrossRef
75.
Upton P, Lawford J, Eiser C. Parent–child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res. 2008;17(6):895–913.PubMedCrossRef
76.
Moon EC, Chambers CT, Larochette AC, Hayton K, Craig KD, McGrath PJ. Sex differences in parent and child pain ratings during an experimental child pain task. Pain Res Manag. 2008;13(3):225–30.PubMedPubMedCentralCrossRef
77.
Beauchamp MH, Landry-Roy C, Gravel J, Beaudoin C, Bernier A. Should young children with traumatic brain injury be compared with community or orthopedic control participants? J Neurotrauma. 2017;34(17):2545–52.PubMedCrossRef
78.
Cnossen MC, Winkler EA, Yue JK, Okonkwo DO, Valadka AB, Steyerberg EW, et al. Development of a prediction model for post-concussive symptoms following mild traumatic brain Injury: a TRACK-TBI pilot study. J Neurotrauma. 2017;34(16):2396–409.PubMedPubMedCentralCrossRef
Metadata
Title
Applicability and clinical utility of the German rivermead post-concussion symptoms questionnaire in proxies of children after traumatic brain injury: an instrument validation study
Authors
Fabian Bockhop
Sven Greving
Marina Zeldovich
Ugne Krenz
Katrin Cunitz
Dagmar Timmermann
Matthias Kieslich
Nada Andelic
Anna Buchheim
Inga K. Koerte
Maike Roediger
Knut Brockmann
Michaela V. Bonfert
Steffen Berweck
Michael Lendt
Michael Staebler
Nicole von Steinbuechel
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2024
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-024-03587-2

Other articles of this Issue 1/2024

BMC Neurology 1/2024 Go to the issue

Study Protocol

Study on prognosis of acutely ruptured intracranial aneurysms (SPARTA): a protocol for a multicentre prospective cohort study

Research

Computer-aided cognitive training combined with tDCS can improve post-stroke cognitive impairment and cerebral vasomotor function: a randomized controlled trial

Research

Efficacy of differential reinforcement of other behaviors therapy for tic disorder: a meta-analysis

Research

Designing and validating of a questionnaire measuring perceived self-care ability (PSCA) in chronic stroke patients at home

Case Report

Guillain–Barre syndrome following scrub typhus: a case report and literature review

Research

Drug resistant epilepsy and associated factors among children with epilepsies in tanzania: a cross-sectional study