Evaluating Current Outcome Measures for Persistent Post-Concussion Syndrome (PPCS)
Alayna Dakers, OTS, Rachel Dickerson, OTS, Jenna Lemon, OTS, & Clare Visscher, OTS; Carla
Floyd-Slabaugh, DrOT, OTRL, CBIS, Erika Chapman, MS, OTRL, CBIS, Stephanie Moon, MS, OTRL,
CBIS, Madison Valentine, MS, OTRL, & Betsy Williams, Health Professions Liaison Librarian
KEY CONCEPTS OF PPCS
Concussion:
• A concussion is caused by an indirect or direct
physical injury to an individual’s head (Chong, 2008).
• Symptoms that an individual may experience are brief
memory loss, headaches, dizziness, poor
concentration, and confusion (Anderson et al., 2006;
Chong, 2008).
• An individual is expected to fully recover from a concussion within two to
three weeks (Anderson et al., 2006).
Persistent Post-Concussion Syndrome:
• Persistent Post-Concussion Syndrome, or PPCS, is a persistent experience
of concussive symptoms (Anderson et al., 2006).
• Approximately 30 to 80% of individuals who have a concussion will
experience PPCS symptoms for 3 months following their injury. Of these
individuals, 15% will continue to experience concussive symptoms for a
year following their injury (Preiss-Farzanegan et al., 2009).
PICO QUESTION
What reliable and valid PPCS outcome measures are currently available for
adults and how well do they assess an individual’s ability to engage in
occupations?
P: Adults with PPCS I: Outcome Measures O: Reliability, Validity, &
Overall Fit S: Systematic Review
SIGNIFICANCE TO OT
• Practitioners need a reliable, valid, and occupation-based PPCS outcome
measure to accurately assess the range of occupations clients engage in
and the overall effect PPCS has on one’s engagement
Grand Valley State University, Grand Rapids, Michigan
LITERATURE REVIEW OUTCOMES
Themes found in the literature review:
13 Outcome Measures Found in 7
Articles
• Many outcome measures are designed for individuals who have traumatic ● Neurobehavioral Symptom Inventory
brain injuries (TBIs) instead of PPCS. This may be a result of uncertainty (NSI), NSI Validity 10, Posttraumatic
of the cause, treatment, and definition of PPCS (Willer & Leddy, 2006). Checklist (PCL), Rivermead
• Many research studies fail to report the reliability and validity of outcome Postconcussion Symptoms
measures that are needed to evaluate their effectiveness (Shukla et al., Questionnaire (RPQ), the
2011). Postconcussion Syndrome Symptom
• Many outcome measures use a self-report method to assess symptoms. This Scale (PCSSS), Postconcussion
Syndrome Checklist (PCSC), British
may lead an individual to under- or over-report their symptoms (Voormolen
Columbia Postconcussion Symptom
et al., 2018). Inventory (BC-PSI), Rivermead Head
• Many outcome measures place an emphasis on symptoms rather than how
Injury Follow-up Questionnaire
the symptoms impact an individual’s ability to engage in meaningful (RHFUQ), Paced Auditory Serial
occupations (Belanger et al., 2017; Sullivan & Garden, 2011). Addition Test (PASAT), The Continuous Performance Test of Attention (CPTA), and
Attention Monitoring and Rating Scale (ARMS), World Health Organization Disability
Assessment Schedule 2.0 (WHODAS 2.0), and Postconcussive Symptom Questionnaire
(PCSQ-19)
METHODS Reliability and Validity
● All outcome measures reported different measures of reliability or validity
○ Only 2 that can be compared are Neurobehavioral Symptom Inventory (NSI) and
• This systematic review was conducted using the PRISMA guidelines
Rivermead Postconcussion Symptoms Questionnaire (RPQ) with test-retest
reliability
■ NSI = .78
■ RPQ-13 = 0.89
■ RPQ-3 = 0.72
Occupation-Based Outcome Measures
• The databases used to conduct our search were PubMed, CINAHL Complete, ● Rivermead Head Injury Follow-up Questionnaire
PsychINFO, Web of Science, OTSeeker, and SPORTDiscus. ○ External construct validity of 0.83
• Articles were exported to a secure Excel spreadsheet for review of their title ● World Health Organization Disability Assessment Schedule 2.0
and abstract. The excel sheet began with 2491 articles. Duplicates were ○ Internal consistency of 0.92
removed and left a remaining 1534.
• Articles were divided into four groups and reviewed to determine if they fit the
inclusion and exclusion criteria. SUMMARY
• Articles 1-383 were reviewed by researchers A and J, 384-766 were reviewed
by J and R, 767-1149 were reviewed by R and C, and 1150-1534 by C and A.
• A third researcher resolved any disagreements between researchers reviewing • There is limited, high-quality research available
the same articles. • WHODAS 2.0 and the RHFUQ are occupation-based measures, but lack the full
• We reviewed the full text of 25 articles. Eligibility was determined using the occupational domain of OT
same procedure stated in the last slide. This process yielded seven articles in • Many of the reliability and validity measures could not be compared
total that met all the inclusion and exclusion criteria. • More research is needed to create a relaible, valid, and occupation-based PPCS outcome
• The Oxford Scale was used to determine each article’s level of evidence. measure