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The Rehabilitation Complexity Scale version 2: a clinimetric evaluation in patients with severe complex
Lynne Turner-Stokes1, Heather Williams, Richard J Siegert
1King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK. lynne.turner-stokes@dial.pipex.com
Objective:
To evaluate the clinimetric properties of the Rehabilitation Complexity Scale (RCS) in a neurorehabilitation inpatient sample.
Design:
Observational cohort analysis in a tertiary specialist setting.
Subjects:
179 consecutive patients (mean age 44.5 years (SD 15 years), males:females 110:69) with complex neurological disabilities, mainly following acquired brain injury.
Methods:
Repeat RCS ratings of the level of care, nursing, therapy and medical interventions were examined for dimensionality, repeatability, consistency and responsiveness, and compared with the Northwick Park Nursing and Therapy Dependency Scales, the Functional Independence Measure (FIM) and Barthel Index, recorded at the start and end of treatment.
Results:
The test-retest reliability confirmed the RCS to be repeatable (kappa 0.93 to 0.96) and moderately responsive to changes in levels of intervention over the course of the programme, suggesting the need for serial evaluation. Coefficient-alpha was 0.76 and item-total correlations all >0.50, with moderate to high loadings on the first principal component. Factor analysis revealed two clear factors ('Nursing/medical care,' and 'Therapies'). The RCS demonstrated good convergent and discriminant validity with the Northwick Park Nursing and Therapy Dependency Scales but some ceiling effect. FIM motor and Barthel scores correlated well with basic care and nursing scores (Spearman rho -0.65 to -0.79) but less well with therapy (rho -0.26) and medical (rho -0.28 to -0.33) scores.
Conclusion:
In this cohort, the RCS provided a reliable, valid and moderately responsive profile of rehabilitation interventions, separating into two main subscales. It usefully identified medical and therapy inputs not captured by the FIM and Barthel Index, which are commonly used to define case complexity in rehabilitation.
