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Internal construct validity of the Rivermead Post-Concussion Symptoms Questionnaire
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
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2011 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, no 11, 997-1002 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the internal construct validity of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) by Rasch analysis of data from a national cohort of patients with mild traumatic brain injury.

METHODS: Data collected at 3 months after mild traumatic brain injury from 2,523 patients were analysed using the partial credit model, describing rating scale structure, local dependency, age and gender differential functioning, dimensionality and model fit.

RESULTS: Categories did not work in a consistent manner; however, collapsing of Categories 1 and 2 yielded ordered thresholds. Local dependency of items was present and 2 item pairs were combined. There was no differential item functioning by gender or age. The Rasch factor explained 47.7% of the variance and the first contrast explained 12.4% of the unexplained variance (eigenvalue 1.9). Further analysis indicated 3 or more dimensions. Person measure had a mean of -2.16, showing poor targeting of persons to items. Person reliability was 0.71 and person separation index was 1.56.

CONCLUSION: According to this Rasch analysis of data from a representative sample of mild traumatic brain injury, the RPQ may not be optimal for this population. Even after reducing the number of categories and collapsing items with local dependency, unidimensionality was not reached, which argues against summation of a total score. However, the scale is unbiased for gender and age.

Place, publisher, year, edition, pages
2011. Vol. 43, no 11, 997-1002 p.
National Category
Other Clinical Medicine
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:uu:diva-161396DOI: 10.2340/16501977-0875ISI: 000297658600006PubMedID: 22031345OAI: oai:DiVA.org:uu-161396DiVA: diva2:456047
Available from: 2011-11-11 Created: 2011-11-11 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Mild Traumatic Brain Injury: Studies on outcome and prognostic factors
Open this publication in new window or tab >>Mild Traumatic Brain Injury: Studies on outcome and prognostic factors
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives: To explore the prevalence and structure of self-reported disability after mild traumatic brain injury and the impact of traumatic brain pathology on such outcome.

Material and methods: In study 1-3, symptoms data were collected by use of Rivermead Post-concussion Symptoms Questionnaire (RPQ) and data on global function by use of Glasgow Outcome Scale Extended (GOSE) from 2602 patients at 3 months after MTBI. RPQ data were subject to factor and Rasch-analyses Head CT data from 1262 patients were used in a prediction analysis that also included age and gender. In study 4, MRI and symptoms data were collected at 2-3 days and at 3-7 months follow-up after MTBI in 19 patients. Global function was assessed at follow-up by use of the Rivermead Head Injury Follow-Up Questionnaire (RHIFUQ) and GOSE.

Results: I. Most respondents reported no remaining symptoms but 24% reported ≥3 and 10% ≥7 remaining symptoms. The factor analysis demonstrated that all symptoms are correlated but also identified subgroups of symptoms. II. Rasch-analysis of RPQ showed disordered category function, local dependency of items, poor targeting of persons to items and indications of 3 or more dimensions. There was no differential item functioning. III. Head CT pathology with no need for acute intervention was observed in 52 patients (4%) but was not associated with either frequency of remaining symptoms or global outcome at 3 months post injury. Female gender and age over 30 years were associated with less favourable outcome with respect to symptoms and GOSE. IV. Post-acute MRI indicated trauma-related pathology in one patient and follow-up MRI indicated loss of brain volume in 4 patients.

Conclusions: A substantial proportion of patients with MTBI report remaining problems at three months after MTBI. RPQ is useful but not optimal to assess symptoms outcome after MTBI and calculation of a total sum score is not recommended. Female gender and older age are negative prognostic factors while brain pathology according to CT has no effect on self-reported outcome. Loss of brain volume after MTBI according to MRI may be a sensitive marker of traumatic brain pathology and deserves further studies.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 43 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 810
Keyword
Rehabilitation, Mild Traumatic Brain Injury, Rivermead Post-concussion Symptoms Questionnaire, Rasch-analysis, prediction, outcome, head CT pathology, Magnet Resonance Imaging
National Category
Other Clinical Medicine
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:uu:diva-180326 (URN)978-91-554-8464-4 (ISBN)
Public defence
2012-10-18, Brömssalen, Gävle sjukhus, Gävle, 13:15 (Swedish)
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Supervisors
Available from: 2012-09-27 Created: 2012-09-03 Last updated: 2013-01-23

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