The Rivermead Post-Concussion Questionnaire as a risk indicator for prolonged recovery from concussion

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McGarry, Penelope
Author ORCID Profiles (clickable)
Master of Health Science
Eastern Institute of Technology
Marshall, Bob
Forrest, Rachel
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
New Zealand
concussion clients
concussion services
mild traumatic brain injury
post-concussion syndrome
recovery times
Rivermead Post-Concussion Questionnaire
ANZSRC Field of Research Code (2020)
McGarry, P. J. (2016). The Rivermead Post-Concussion Questionnaire as a risk indicator for prolonged recovery from concussion. (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Health Science). Eastern Institute of Technology (EIT), New Zealand.
BACKGROUND Brain injury is a major health issue with an estimated 36,000 New Zealanders and an estimated 54 to 60 million people sustaining a brain injury worldwide each year. Approximately five percent of brain injuries sustained are deemed to be moderate or severe, with the remaining 95 percent classified as mild TBI, also known as concussion (Feigin et al., 2013). While many quickly return to pre-injury functioning, up to one third of people with a concussion will have symptoms which persist for more than three months and some develop Post-Concussion Syndrome (PCS). This has been the subject of much research, however there is still no conclusive way to identify those who are at risk of slower recovery (Bunnage, 2013). This research aims to determine if the Rivermead Post-Concussion Questionnaire (RPQ) can be useful in identifying people who may be at risk of a slower recovery. AIM OF RESEARCH Are any of the symptoms, or clusters of symptoms (physical, psychological or cognitive), assessed using the RPQ, associated with a slowed recovery from concussion? Are there any demographic factors associated with a slower recovery time? METHOD A retrospective, medical record review was undertaken to gather data from clients discharged from Concussion Service over a six-month period in 2014. The final study sample was comprised of 107 people – 53 were female and 54 were male. All participants were aged between 16 and 65 years of age, had completed an RPQ during the triage assessment and had been diagnosed with a concussion or post-concussion syndrome by a medical doctor. Data extracted from files included RPQ scores at initial assessment, client demographics, injury details including severity, duration of services, status at discharge and other services required. Duration of services provided was calculated from the date of triage until the date of discharge - when clients were free of symptoms, or able to self-manage these and return to their pre-injury level of functioning and lifestyle. Statistical analysis was then performed on the data collected. Descriptive statistics were used to describe the sample population. Differences between means were ascertained using one-way ANOVA while differences in proportions were assessed using z-tests (Bonferroni corrected). Associations between the variables and the duration of time in the concussion service were explored using a General Linear Mixed-effects Model (GLMM); Pearson’s correlations; and forward and stepwise linear regressions. FINDINGS There were no statistical differences related to gender, ethnicity or accident type and duration of services. Headache was the most frequently reported symptom, reported by 94.4% of clients. The proportion this symptom contributed to the overall RPQ score was negatively correlated with service duration. Fatigue, forgetfulness/poor memory, taking longer to think and poor concentration were the next highest reported symptoms on RPQ. A significant association was found between the symptoms of sensitivity to noise, feeling depressed and feeling frustrated, along with the psychological cluster and a longer duration of services. As the proportion each of these symptoms, or psychological symptom cluster, contributed to the overall RPQ score increased, so too did service duration. In addition, when correlated with duration of services the total RPQ score shows a moderate correlation (R=0.425, P<0.001) as did 13 of the 16 individual RPQ symptom scores. This suggests that the total RPQ score is a useful indicator in determining risk of a slower recovery. CONCLUSION The findings of this study indicate that certain individual symptom scores, and notably the scores associated with the individual variables of sensitivity to noise, feeling depressed or tearful and feeling frustrated or impatient, as well as the psychological cluster score and the total summed score on the RPQ, are all correlated with length of stay in the service. This indicated that the RPQ is an effective tool to assist in identifying increased risk of a slower recovery.
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