RCS-E is Predictive of Outcomes and Resource Allocation in a Large Neuromotor Rehabilitation Setting

Davide Antonio Di Pietro; Adriana Olivares; Laura Comini; Alessia Saverino; Stefania De Trane; Rachele Piras; Giuliana Vezzadini; Sharon Cammisuli; Stefano Corna; Giorgio Ferriero; Francesco Negrini; Laura Marcuccio; Chiara Ferretti; Antonio Nardone; Valeria Pingue; Christian Lunetta

doi:10.1016/j.apmr.2025.10.001

RCS-E is Predictive of Outcomes and Resource Allocation in a Large Neuromotor Rehabilitation Setting

Arch Phys Med Rehabil. 2025 Oct 15:S0003-9993(25)00973-6. doi: 10.1016/j.apmr.2025.10.001. Online ahead of print.

Authors

Davide Antonio Di Pietro¹, Adriana Olivares², Laura Comini², Alessia Saverino³, Stefania De Trane⁴, Rachele Piras⁵, Giuliana Vezzadini⁶, Sharon Cammisuli³, Stefano Corna⁷, Giorgio Ferriero⁸, Francesco Negrini⁸, Laura Marcuccio⁹, Chiara Ferretti¹⁰, Antonio Nardone¹¹, Valeria Pingue¹¹, Christian Lunetta⁵

Affiliations

¹ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Lumezzane, Brescia. Electronic address: davide.dipietro@icsmaugeri.it.
² Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia.
³ Istituti Clinici Scientifici Maugeri SpA SB, Neurorehabilitation Unit of the Institute of Genova Nervi, Genova.
⁴ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Bari, Bari.
⁵ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Milano, Milan.
⁶ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Castel Goffredo, Castel Goffredo.
⁷ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Veruno, Veruno.
⁸ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Tradate, Varese; Department of Biotechnology and Life Sciences, University of Insubria, Varese.
⁹ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Telese, Telese Terme.
¹⁰ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Montescano, Pavia.
¹¹ Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of the Institute of Pavia, Pavia; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.

PMID: 41106531
DOI: 10.1016/j.apmr.2025.10.001

Abstract

Objective: To assess the reliability of the Rehabilitation Complexity Scale-Extended (RCS-E) as a measure of rehabilitation complexity. Secondary outcomes include identifying which baseline data, including the RCS-E, are most predictive of rehabilitation stay effectiveness and exploring its role as a predictor of reimbursement for hospital admissions.

Design: A retrospective observational study. Demographic and clinical variables were collected, including length of stay, modified Rankin Scale, modified Barthel Index (mBI), RCS-E, and reimbursement of stay.

Setting: Study on inpatients admitted to sixteen neuromotor rehabilitation units.

Participants: Of 5870 hospitalizations, 4091 cases (mean age, 71.8 ± 13y; 42.2% men) met the inclusion criteria. The pre-post analysis was performed on 3792 patients (mean age, 71.8 ± 12.8y; 41.6% men).

Interventions: Rehabilitation program for neurologic or orthopedic condition (median [1st-3rd quartile], duration: 27 days [20-41]).

Main outcomes and measures: RCS-E scores on admission were categorized as follows: <8 (low complexity), 8-10 (medium complexity), and >10 (high complexity). For each patient, we calculated the mBI-derived parameters: mBI gain, rehabilitation efficiency, and rehabilitation effectiveness.

Results: A significant moderate Spearman correlation was found between RCS-E score and mBI (rho=-0.53, P<.0001), length of stay (rho=0.41, P<.0001), and premorbid mRS (rho=0.23, P<.0001). Rehabilitation efficiency and effectiveness were significantly lower in the high complexity group. Both RCS-E and mBI at admission significantly correlated with total reimbursement (both P<.0001, rho=0.48, and rho=-0.43, respectively). Regression models indicated a predictive effect of RCS-E at admission on mBI at discharge.

Conclusions: This study demonstrates the reliability and utility of RCS-E in assessing neurologic and orthopedic rehabilitation complexity, predicting outcomes, and informing funding models.

Keywords: Costs; Neuromotor diseases; Orthopedic; Outcomes; Rehabilitation.