Rivermead Post-Concussion Symptoms Questionnaire (RPQ)

Overview

The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is a 16-item self-report questionnaire that measures the severity of common physical, cognitive, and emotional symptoms following a head injury, rated relative to how the person felt before the injury occurred. It is one of the most widely used outcome measures in concussion and mild traumatic brain injury (mTBI) research and clinical practice, valued for capturing the breadth of post-concussion symptoms — not just headache and dizziness, but the cognitive and mood-related symptoms that often drive prolonged recovery.

By anchoring every item to a pre-injury baseline, the RPQ is specifically designed to isolate the change attributable to the head injury, rather than symptoms a person may have experienced anyway — an important distinction in a population where fatigue, poor concentration, and irritability are common even without a brain injury.

History

The RPQ was developed by Nicholas King, Steven Crawford, Frances Wenden, Norman Moss, and Derick Wade, and published in 1995 in the Journal of Neurology, based on work carried out at Rivermead Rehabilitation Centre in Oxford, England. It was designed to give clinicians and researchers a standardised, reliable way to track the cluster of symptoms — collectively known as post-concussion syndrome — that can persist for weeks or months after a head injury.

The original validation established good reliability and identified two clusters of items, which led to the later development of the RPQ-3 (early, more physical symptoms: headache, dizziness, nausea) and RPQ-13 (the remaining, often more persistent symptoms) subscales, refined further by Eyres and colleagues in 2005. The RPQ has since become a standard outcome measure in concussion clinics, sports medicine, and mTBI research worldwide, and is frequently used as an inclusion or outcome criterion in clinical trials.

Indications

The RPQ is used wherever post-concussion symptoms need to be screened for, quantified, or tracked over time:

• Sports-related concussion, to document symptom burden and monitor recovery before considering return-to-play or return-to-learn.
• Mild traumatic brain injury (mTBI) in emergency and primary care, as a standardised way to record the symptom profile at presentation and follow-up.
• Persistent post-concussion symptoms, where scores remain elevated well beyond the expected recovery window and may prompt referral for multidisciplinary management.
• Vestibular and oculomotor rehabilitation following head injury, where dizziness, blurred vision, and light sensitivity often guide treatment priorities.
• Medico-legal and insurance assessments, where a standardised, validated measure of symptom severity relative to baseline is often required.
• Monitoring treatment response across a course of concussion rehabilitation, by re-administering at intervals.

How It’s Scored

Each of the 16 symptoms is rated on how much of a problem it has been over the last 24 hours, compared with before the injury, from 0 (not experienced at all) through 1 (no longer a problem) to 4 (severe problem). The simple total is the sum of all 16 items, giving a raw range from 0 to 64, where higher scores indicate greater post-concussion symptom burden.

Many clinics and researchers additionally split the items into two subscales:

• RPQ-3 — the sum of the first three items (headache, dizziness, nausea/vomiting), which tend to resolve earliest after injury.
• RPQ-13 — the sum of the remaining 13 items (fatigue, mood, cognitive, and visual symptoms), which tend to be more persistent and are more strongly associated with prolonged recovery.

In the original scoring convention, a response of “no longer a problem” (1) on the RPQ-13 items is recoded to 0 before the subscale is summed, since it reflects resolution rather than an ongoing symptom. This tool displays the straightforward raw total across all 16 items for simplicity and transparency.

What It Tells the Clinician

• Captures the full post-concussion symptom cluster. Unlike tools focused on a single domain, the RPQ spans physical, cognitive, and emotional symptoms in one brief measure — useful given how often these domains interact after head injury.
• Anchors symptoms to a pre-injury baseline. Asking patients to rate change relative to before the injury helps separate genuinely new or worsened symptoms from pre-existing complaints.
• Distinguishes early from persistent symptom clusters. The RPQ-3/RPQ-13 split helps identify patients whose early physical symptoms have settled but who continue to struggle with fatigue, mood, or cognitive symptoms — a pattern associated with prolonged recovery.
• Supports return-to-play and return-to-learn decisions. Serial RPQ scores give an objective, comparable record of symptom trajectory to inform graded return-to-activity protocols.
• Flags cases warranting multidisciplinary input. Persistently elevated scores, especially on RPQ-13 items, can prompt referral for vestibular rehabilitation, psychological support, or specialist concussion clinic review.

References

1. 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):587-592.
2. Eyres S, Carey A, Gilworth G, Neumann V, Tennant A. Construct validity and reliability of the Rivermead Post-Concussion Symptoms Questionnaire. Clin Rehabil. 2005;19(8):878-887.