General Outcome Measurements: Rivermead Post-Concussion Symptoms Questionnaire

Post-concussion symptoms can affect daily life, work, study, sport, sleep, mood, concentration, balance, vision and confidence with activity.

The RPQ was developed to measure symptoms commonly experienced after head injury. It asks the client to compare their current symptoms with how they were before the injury or accident.

It may be useful for clients reporting:

• headaches
• dizziness
• nausea
• noise sensitivity
• sleep disturbance
• fatigue
• irritability
• low mood
• frustration
• forgetfulness
• poor concentration
• slowed thinking
• blurred vision
• light sensitivity
• double vision
• restlessness

The RPQ should support monitoring and referral-aware assessment. It should not be used as a stand-alone diagnostic tool.

Quick Summary

• Outcome measure: Rivermead Post-Concussion Symptoms Questionnaire
• Abbreviation: RPQ
• Category: Post-concussion symptom questionnaire
• Type: Client-reported outcome measure
• Number of symptoms: 16
• Response scale: 0–4 per symptom
• Common total score range: 0–64, depending on scoring method
• Higher score means: Greater post-concussion symptom burden
• Lower score means: Lower symptom burden
• Best used for: Monitoring post-concussion symptoms over time
• Key limitation: RPQ does not diagnose concussion or determine clearance readiness

What Is the RPQ?

The RPQ is a 16-item questionnaire that asks the client to rate symptoms compared with how they were before the head injury or accident.

Each symptom is rated using a 0–4 scale:

• 0 = Not experienced at all
• 1 = No more of a problem
• 2 = A mild problem
• 3 = A moderate problem
• 4 = A severe problem

Some scoring approaches treat a score of 1 as 0 when calculating the total symptom score because it means the symptom is no more of a problem than before the injury.

The RPQ may also be considered in subgroups, often separating early symptoms such as headache, dizziness and nausea from the remaining symptom set.

Why It Is Used

The RPQ is used because post-concussion symptoms can be broad and change over time.

A client may report:

• headache after activity
• dizziness with movement
• difficulty concentrating
• fatigue after work or study
• sensitivity to light or noise
• sleep changes
• irritability or low mood
• slowed thinking
• visual symptoms
• difficulty returning to training

The RPQ may help professionals:

• establish a baseline symptom profile
• monitor symptom severity over time
• identify which symptoms are most limiting
• track change across recovery phases
• support referral conversations where appropriate
• compare symptoms with physical, cognitive and activity findings
• improve documentation of post-concussion symptom burden

The RPQ should be interpreted alongside history, mechanism of injury, symptom behaviour, neurological screening, vestibular/ocular findings where appropriate, sleep, workload, sport exposure and professional judgement.

What It Measures

The RPQ measures post-concussion symptom burden.

It may provide insight into:

• headache severity
• dizziness
• nausea
• fatigue
• sleep disturbance
• sensory sensitivity
• cognitive symptoms
• emotional symptoms
• visual symptoms
• restlessness
• change over time

It does not directly measure:

• concussion diagnosis
• brain recovery status
• neurological safety
• vestibular function
• ocular motor function
• cognitive performance with certainty
• imaging findings
• sport readiness
• work readiness
• driving readiness

Who It Is Useful For

The RPQ may be useful for:

• rehabilitation practitioners
• allied health support teams
• exercise professionals working within scope
• sport and performance professionals
• concussion-informed support teams
• movement assessment professionals
• students learning outcome measures

It may be relevant for clients with:

• concussion history
• mild traumatic brain injury history
• persistent post-concussion symptoms
• sport-related concussion
• workplace or accident-related head injury
• symptoms affecting return to activity
• symptoms affecting work, study or daily function

When to Use This Outcome Measure

Use the RPQ when you want to monitor symptom burden after concussion or head injury.

It may be useful at:

• initial post-injury assessment where appropriate
• baseline symptom monitoring
• reassessment
• return-to-learn monitoring
• return-to-work monitoring
• return-to-training monitoring
• persistent symptom review
• progress review
• referral-support documentation

The RPQ is especially useful when symptoms are broad and include cognitive, physical, emotional and sensory domains.

When Not to Use or When to Be Cautious

Use caution when:

• the client has red flags after head injury
• symptoms are worsening or severe
• neurological symptoms are present
• the client has repeated vomiting, deteriorating consciousness or worsening headache
• the client has seizure, neck trauma concern or significant confusion
• the score is being used to clear return to sport or work
• the result is interpreted without medical or neurological context

The RPQ should not be used to:

• diagnose concussion on its own
• rule out serious head injury
• determine brain recovery
• clear someone for sport
• clear someone for work
• clear someone for driving
• replace medical assessment
• replace concussion protocols
• replace professional judgement

Equipment or Resources Required

You need:

• RPQ questionnaire
• scoring instructions
• baseline and retest dates
• symptom notes
• injury history
• activity, work, study and sport exposure notes

Optional related information may include:

• headache intensity rating
• dizziness rating
• sleep notes
• visual symptom notes
• exertion tolerance notes
• vestibular or ocular screening findings where appropriate
• referral or medical notes where available

Administration Protocol / Practice

Setup

Explain the purpose of the questionnaire before the client completes it.

Example wording:

“This questionnaire helps us understand which symptoms have been a problem since the head injury or accident. It does not diagnose concussion or clear you for activity, but it helps us monitor symptoms over time.”

Format

The RPQ can be completed:

• on paper
• digitally
• independently
• verbally if assistance is required
• during reassessment
• as part of symptom monitoring

Client Instructions

Ask the client to:

• compare symptoms with how they were before the injury or accident
• rate each symptom honestly
• answer every item where possible
• avoid overthinking each response
• report any new or worsening symptoms
• complete the same version at retest

Scoring Process

Each of the 16 symptoms is rated from 0 to 4.

Common scoring direction:

• higher scores indicate greater symptom burden
• lower scores indicate lower symptom burden

If using the common modified scoring approach, responses of 1 are treated as 0 because they indicate the symptom is no more of a problem than before the injury.

Make sure the scoring method is consistent across retests.

Retesting Considerations

Retest at meaningful time points, such as:

• baseline
• symptom review
• after changes in work, study or training load
• after symptom flare-up
• during graduated return-to-activity planning
• progress review
• follow-up

For consistency, record current activity exposure, sleep, screen time, work or study demands, exercise load and symptom flare-ups.

Safety Notes

The RPQ is a self-report questionnaire, so it does not create physical testing risk.

However, worsening symptoms, neurological changes, severe headache, repeated vomiting, seizure, major confusion or deteriorating condition require appropriate medical escalation.

Scoring and Interpretation

The RPQ score reflects symptom burden compared with the client’s pre-injury state.

Higher scores indicate greater post-concussion symptom burden.

Lower scores indicate fewer or less severe symptoms.

What a High Score May Suggest

A higher RPQ score may suggest:

• greater symptom burden
• more persistent symptoms
• greater effect on work, study or activity
• higher need for monitoring
• possible need for medical or multidisciplinary review
• need to review load, sleep, screen exposure and symptom triggers

A high score does not prove concussion severity or recovery status.

What a Low Score May Suggest

A lower RPQ score may suggest:

• fewer current symptoms
• lower symptom severity
• improved symptom burden compared with baseline

A low score does not automatically clear the client for sport, work or high-risk activity.

What the Score Does Not Prove

An RPQ score does not prove:

• concussion diagnosis
• brain recovery
• neurological safety
• return-to-sport readiness
• return-to-work readiness
• driving readiness
• cause of symptoms
• whether one intervention caused the change

How to Explain the Result Safely

Example wording:

“Your RPQ score gives us a structured view of your current symptom burden compared with before the injury. We will use it alongside your history, symptoms, activity tolerance and relevant professional guidance.”

What the Score May Mean in Different Client Populations

General Fitness Clients

For general fitness clients, RPQ scores may help show whether symptoms are affecting exercise, sleep, concentration or daily activity.

Sport and Performance Clients

For athletes, RPQ can help monitor symptom burden during return-to-training planning, but it should never be used as the only clearance measure.

Workplace Clients

For workplace clients, RPQ may help monitor symptoms that affect screen time, concentration, fatigue, noise tolerance, light sensitivity and work capacity.

Youth Clients

For youth clients, use age-appropriate guidance and consider parent or guardian involvement. Return-to-learn should usually be considered before return-to-sport progression.

Clients With Persistent Symptoms

For persistent post-concussion symptoms, RPQ can help monitor symptom patterns over time and support referral-aware management.

Meaningful Change, MCID, MDC and Responsiveness

Meaningful change helps determine whether a score change is likely to matter.

High-quality, universally applicable MCID or MDC values for every RPQ population are limited.

RPQ change should be interpreted with:

• baseline comparison
• repeated measurement
• symptom pattern
• work, study and activity exposure
• sleep and fatigue context
• physical, vestibular or ocular findings where relevant
• client goals
• professional judgement

Small changes should not be over-interpreted unless they are consistent with the broader clinical picture.

Normative Data, Reference Values or Comparative Data

RPQ values vary depending on injury severity, time since injury, age, symptom history, mental health context, sleep, workload, pre-existing symptoms and setting.

Because some RPQ symptoms can occur in people without concussion, interpretation should focus on change from pre-injury status and symptom impact over time.

Practical comparison guidance:

• compare the client with their own baseline
• use the same scoring method at retest
• consider time since injury
• interpret symptoms alongside exposure and function
• avoid using one score as a clearance threshold
• escalate when symptoms worsen or red flags appear

Reliability and Validity

The RPQ was developed to measure symptoms commonly experienced after head injury and has been used widely in concussion and traumatic brain injury research.

Evidence supports the RPQ as a practical self-report measure of post-concussion symptom burden, though questions remain around symptom specificity and dimensional structure.

Reliability and validity are strongest when:

• the correct version is used
• the same scoring method is repeated
• the client understands the pre-injury comparison
• all items are completed
• results are interpreted in a concussion-relevant context
• the score is combined with history and broader assessment

Interpret cautiously when:

• symptoms existed before the injury
• the client has multiple overlapping conditions
• mental health, sleep or stress factors strongly influence symptoms
• symptoms are being used for clearance decisions
• red flags or neurological changes are present

Common Errors and Limitations

Common errors include:

• treating RPQ as a concussion diagnosis
• using RPQ alone for clearance
• ignoring red flags
• ignoring pre-injury symptoms
• changing scoring method between tests
• over-interpreting small score changes
• failing to consider sleep, stress or workload
• not combining RPQ with broader assessment

Limitations include:

• symptoms are not specific to concussion
• self-report can be influenced by sleep, mood, stress and context
• total score may hide different symptom patterns
• scoring methods can vary
• it does not directly measure neurological recovery
• it should not replace medical or concussion-specific assessment where needed

Practical Applications

The RPQ may help professionals:

• document baseline post-concussion symptom burden
• monitor symptom change over time
• identify dominant symptom areas
• support return-to-learn, return-to-work or return-to-activity discussions
• improve communication between support team members
• support referral decisions where appropriate
• compare symptoms with sleep, workload and activity exposure

For active clients, the RPQ can help monitor whether symptoms change with exercise, screen time, work, study or sport exposure.

FAQs

What does the RPQ measure?

The RPQ measures the presence and severity of symptoms commonly reported after concussion or head injury.

How many symptoms are in the RPQ?

The RPQ includes 16 symptoms.

How is the RPQ scored?

Each symptom is rated from 0 to 4. Some scoring methods treat a response of 1 as 0 because it means the symptom is no more of a problem than before injury.

What does a higher RPQ score mean?

A higher score indicates greater post-concussion symptom burden.

Does RPQ diagnose concussion?

No. RPQ monitors symptoms but does not diagnose concussion on its own.

Can RPQ clear someone for sport?

No. It should not be used as a stand-alone return-to-sport clearance tool.

What should RPQ be combined with?

It should be combined with history, symptom behaviour, activity tolerance, relevant physical findings and appropriate professional guidance.

When should symptoms be escalated?

Worsening symptoms, neurological changes, repeated vomiting, seizure, severe headache or deteriorating condition require appropriate medical escalation.

Key Takeaways

• RPQ is a 16-item post-concussion symptom questionnaire.
• It compares current symptoms with pre-injury status.
• Higher scores indicate greater symptom burden.
• RPQ does not diagnose concussion or determine recovery.
• It should not be used alone for sport, work or driving clearance.
• Symptoms are not specific to concussion, so context matters.
• Interpretation is strongest when combined with history, exposure, symptoms and professional judgement.

References

King, N. S., Crawford, S., Wenden, F. J., Moss, N. E. G., & Wade, D. T. (1995). The Rivermead Post Concussion Symptoms Questionnaire: A measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology, 242(9), 587–592. https://doi.org/10.1007/BF00868811

Potter, S., Leigh, E., Wade, D., & Fleminger, S. (2006). The Rivermead Post Concussion Symptoms Questionnaire: A confirmatory factor analysis. Journal of Neurology, 253, 1603–1614. https://doi.org/10.1007/s00415-006-0275-z

Ettenhofer, M. L., & Barry, D. M. (2012). A comparison of long-term postconcussive symptoms between university students with and without a history of mild traumatic brain injury or orthopaedic injury. Journal of the International Neuropsychological Society, 18(3), 451–460. https://doi.org/10.1017/S1355617711001895

Bockhop, F., Greving, S., Zeldovich, M., Krenz, U., Cunitz, K., Timmermann, D., et al. (2024). Applicability and clinical utility of the German Rivermead Post-Concussion Symptoms Questionnaire in proxies of children after traumatic brain injury: An instrument validation study. BMC Neurology, 24, 154. https://doi.org/10.1186/s12883-024-03587-2