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.
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
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.
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.
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
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
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.
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
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
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.”
The RPQ can be completed:
on paper
digitally
independently
verbally if assistance is required
during reassessment
as part of symptom monitoring
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
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.
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.
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.
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.
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.
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.
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
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.”
For general fitness clients, RPQ scores may help show whether symptoms are affecting exercise, sleep, concentration or daily activity.
For athletes, RPQ can help monitor symptom burden during return-to-training planning, but it should never be used as the only clearance measure.
For workplace clients, RPQ may help monitor symptoms that affect screen time, concentration, fatigue, noise tolerance, light sensitivity and work capacity.
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.
For persistent post-concussion symptoms, RPQ can help monitor symptom patterns over time and support referral-aware management.
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.
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
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 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
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.
The RPQ measures the presence and severity of symptoms commonly reported after concussion or head injury.
The RPQ includes 16 symptoms.
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.
A higher score indicates greater post-concussion symptom burden.
No. RPQ monitors symptoms but does not diagnose concussion on its own.
No. It should not be used as a stand-alone return-to-sport clearance tool.
It should be combined with history, symptom behaviour, activity tolerance, relevant physical findings and appropriate professional guidance.
Worsening symptoms, neurological changes, repeated vomiting, seizure, severe headache or deteriorating condition require appropriate medical escalation.
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.
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
