The Rehabilitation Complexity Scale – extended version: detection of patients with highly complex needs

Abstract

Purpose: To describe the extended Rehabilitation Complexity Scale (RCS-E) and its factor structure, and to determine whether it provides added value over the RCS-version 2 to identify patients with highly complex rehabilitation needs. Method: A cohort analysis of prospectively-collected routine clinical data from 331 patients with complex neurological disabilities undergoing inpatient rehabilitation in a tertiary specialist neurorehabilitation unit in the UK. RCS-E and RCS-v2 scores were recorded in parallel by the multi-disciplinary team (MDT) at fortnightly intervals, alongside the Northwick Park nursing (NPDS) and therapy (NPTDA) dependency scales, capturing nursing care and therapy interventions in staff hours/week. Results: Very strong correlations were found between total RCS-v2 and RCS-E scores (ρ = 0.954); the RCS-E “Care & nursing” subscale and care/nursing hours/week (ρ = 0.838, p < 0.001); and the RCS-E “Therapy” subscale and total therapy hours/week (p = 0.697, p < 0.001). The RCS-E showed better discrimination for complex therapy needs than the RCS-v2, but not for complex care/nursing needs. The RCS-E factor structure was similar to the RCS-v2, with moderate internal consistency overall, separating into two distinct dimensions (“Nursing/medical care + Equipment” and “Therapy”). Conclusion: The RCS-E provides an equivalent measure of complexity to the RCS-v2, but offers added value in identifying patients with highly complex therapy and equipment needs.

Implications for Rehabilitation

• Assessing complexity of rehabilitation needs presents a challenge throughout the world.

• The Rehabilitaton Complexity Scales provide a simple measure of complexity of rehabilitation needs, which take account of basic care, specialist nursing, therapy and medical interventions.

• The extended version (RCS-E) presented here may offer a more sensitive tool for detecting patients with highly complex needs for therapy and equipment in specialist rehabilitation settings.

Keywords::

• Rehabilitation Complexity Scale – extended
• complexity of rehabilitation needs
• factor analysis

Acknowledgements

The authors gratefully acknowledge the hard work of the RRU staff in collecting the data presented in this study, and the co-operation of the patients to whom it belongs. Special thanks to Jo Clark, Sarah Harris, Hilary Rose and Aung Thu, for their roles in co-ordinating data collection. Copies of the Rehabilitation Complexity Scales (RCS-v2 and RCS-E), and indeed the NPDS and NPTDA, are available free of charge from the corresponding author. The Regional Rehabilitation Unit gathers this outcome data routinely in the course of clinical practice. Research Ethics Committee permission has been obtained to report the data retrospectively for research and audit purposes.

Declaration of interest: Outcome measurement is a specific research interest of our centre. The Rehabilitation Complexity scales and Northwick Park nuring and therapy Dependency Scales were all developed through this department, but are disseminated free of charge. Professor Turner-Stokes is lead author on the papers which describe their initial development and validation. However, none of the authors has any personal financial interests in the work undertaken or the findings reported. This article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0407-10185). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Financial support for the preparation of this manuscript was also provided by the Dunhill Medical Trust, the Luff Foundation.