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

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 RehabilitationAssessing 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.