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

Disabil Rehabil. 2012;34(9):715-20. doi: 10.3109/09638288.2011.615880. Epub 2011 Nov 24.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Delivery of Health Care / organization & administration
  • Dependency, Psychological
  • Disability Evaluation*
  • Disabled Persons*
  • Factor Analysis, Statistical
  • Female
  • Health Services Needs and Demand
  • Humans
  • Inpatients
  • Male
  • Middle Aged
  • Needs Assessment*
  • Nervous System Diseases / rehabilitation*
  • Observer Variation
  • Outcome Assessment, Health Care
  • Patient Care / standards*
  • Prospective Studies
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Young Adult