Rehabilitation Complexity Scale Research Articles

Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries.

To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs. Multicentre prospective cohort study. Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

Rehabilitation complexity scale and reimbursement of in-hospital pulmonary rehabilitation.

The use of case-based reimbursement for medical rehabilitation is greatly discussed. The investigators explored the relationship between disability and reimbursement opportunities in individuals with respiratory diseases undergoing in-hospital pulmonary rehabilitation (PR), considering the correlation (if any) between the Rehabilitation Complexity Scale (RCS-E v13) scores used at admission and the actual reimbursement. This study is part of a larger prospective multicenter study conducted by eight Pulmonary Rehabilitation Units in Italy. Here, investigators considered only data from the Lombardy Region. On January 30th or February 28th, 2023, participants were allocated according to the main DRG into 4 groups [tracheostomized/ventilated (TX/V), chronic respiratory failure (CRF), COPD, and miscellaneous group]. We recorded anthropometrics, diagnosis, international outcome measures, and calculated admission and discharge RCS-E v13 scores and hospital stay reimbursement according to the healthcare system (HS). Three hundred and sixteen participants were evaluated. Patients were elderly, in the majority of cases with CRF, presenting comorbidities, disability, dyspnea, and reduced effort tolerance. At admission, RCS-E v13 showed an average moderate value of complexity. The median (IQR) HS reimbursement/stay was different among groups. RCSE v13 evaluated at admission was weakly (r=0.3471), but significantly related to the HS reimbursement/stay (p<0.0001) mainly due to TX/V and miscellaneous subgroups, while no relationship was found for COPD and CRF patients. After PR, all outcome measures improved significantly in all groups (p<0.001 for all). Higher RCS-E v13 scores at admission did not correspond to a proper amount of reimbursement, being this latter under- or over-estimated if compared to needs assessed by RCS-E v13. RCS-E v13 at discharge decreased for all subgroups (range from -6 to -11) reaching a low value of complexity. The RCS-E v13 disability score does not fully mirror the HS reimbursement for patients undergoing inhospital PR.

The ability of the Rehabilitation Complexity Scale (RCS) to capture disability in respiratory patients admitted for in-hospital rehabilitation.

The aim of this pilot retrospective study was to test the Rehabilitation complexity scale (RCS-E v13) in patients from 15 Italian pulmonary rehabilitation (PR) units and correlate RCS-E v13 to the most used clinical and functional outcome measures. At admission and discharge, clinical data [comorbidities with the Cumulative Illness Rating Scale (CIRS)], Barthel Index (BI), Barthel Index dyspnea (BI-d), COPD Assessment Test (CAT), and six-minute walking test (6MWT) were collected, and RCS-E total score calculated. Two-hundred nineteen patients [30.6% COPD, 43.4% chronic respiratory failure (CRF), and 26% with invasive ventilation (IV)], aged 69.9 (11.2) years were considered. RCS-E at admission 8.63 (1.69), 11.06 (2.50), 16.56 (2.97) and discharge 0.84 (1.02), 2.19 (1.5), 7.09 (1.47)] for COPD, CRF and IV respectively were statistically differed among groups (ANOVA p = <0.0001). RCS-E v13 total score strongly negatively correlated with 6MWT [(rho= -0.7305 (-07883; -0.6598)] and BI [(rho= - 0.6989 ( -0.7626; - 0.6217)]) while weakly with CAT [(rho = 0.2939 (0.1601; 0.4170)] and BI-d [(rho = 0.3512 (0.2243; 0.4663)]. Change in RCS-E v13 total score [(mean change of -8.70 (95% IC -9.00; -8.40)] ) as in all single RCS-E v13 items [care -0.59 (95%IC -0.69, -0.48); risk -0.56 (95%IC -0.78;-0.46); nursing needs -2.11 (95%IC -2.22;-2.01); medical needs -2.29 (95%IC -2.39;-2.18); therapy disciplines -1.45 (95%IC -1.57; -1.33); therapy intensity -2.00 (95%IC -2.07; -1,93); equipment -0.23( 95%IC -0.30; -0.16)] was found significant after PR. The RCS-E v13 application for patients with respiratory diseases is feasible and highlights a huge difference among different conditions. Its application seems to present an important care burden and relation with motor disability and effort tolerance but a lower relation with dyspnea during activities of daily living, comorbidities, and disease impact. A more robust sample and prospective analysis on the usefulness of the RSC-E v13 in patients with respiratory diseases during rehabilitation are welcomed. @ The Rehabilitation Complexity Scale in respiratory patients - Italian Network • Michele Vitacca, MD, FERS ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Lumezzane, Brescia, Italy • Luca Bianchi, MD Fondazione Don Carlo Gnocchi ONLUS, "Centro Spalenza", Respiratory rehabilitation, Rovato, Brescia, Italy • Piero Ceriana, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Pavia, Italy • Francesco Gigliotti, MD Fondazione Don Carlo Gnocchi ONLUS, IRCCS "Don Carlo Gnocchi", Respiratory rehabilitation Firenze, Italy • Rodolfo Murgia, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Montescano, Pavia, Italy • Alessia Fumagalli, MD Istituto nazionale Riposo e Cura per Anziani di Casatenovo, Respiratory rehabilitation, Casatenovo, Lecco, Italy • Antonio Spanevello, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Tradate, Varese, Italy • Giuseppe La Piana, MD Ospedale "Santa Marta" di Rivolta d'Adda, Respiratory rehabilitation Rivolta d'Adda, Cremona, Italy • Bruno Balbi, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Veruno Veruno, Novara, Italy • Sara Forlani, MD, Presidio Ospedaliero di Sant'Angelo Lodigiano, Respiratory rehabilitation Sant'Angelo Lodigiano, Lodi, Italy • Maria Aliani, MD ICS Maugeri IRCCS, Respiratory rehabilitation of the Institute of Bari, Italy • Gianfranco Beghi, MD Ospedale Villa Pineta, Respiratory rehabilitation, Pavullo nel Frignano, Modena, Italy • Mauro Maniscalco, MD ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Benevento, Italy • Giuseppe Fiorentino, MD Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Respiratory rehabilitation, Napoli, Italy • Paolo Banfi, MD Fondazione Don Carlo Gnocchi ONLUS, IRCCS "Centro S. Maria Nascente", Respiratory rehabilitation, Milano, Italy.

156 Capturing older adults’ rehabilitation needs and complexity in a rehabilitation hospital

Abstract Background The Rehabilitation Complexity Scale Extended (RCSE) can measure both the rehabilitation needs and complexity of a patient group as well as the services and resources required to meet their needs. The tool is now used in Ireland to identify rehabilitation needs for both trauma and neurological rehabilitation. This pilot explored its application in an older adult’s rehabilitation unit to measure both rehabilitation complexity and outcome. Methods The RCSE was completed on admission and discharge for all older adults admitted to the unit during the pilot (March–May 2023). An analysis of the RCSE scores was completed using Microsoft Excel. Paired T Test was used to measure change in RCSE from admission to discharge. Results Forty-four patients were admitted during the RCSE pilot. The mean admission RCSE score was 10.5, median 10. The highest scoring domain was therapy need (mean 2.6, median 3) indicating 4–5 HSCP disciplines were required to meet their rehabilitation needs. The mean therapy intensity score was 2 indicating that daily individual therapy sessions was required to meet their rehabilitation needs. The mean nursing need score was 2 indicating most patients required nursing staff who were training or experienced in rehabilitation. Discharge RCSE was completed on 20 patients (mean score 1.7) and there was a significant decrease in mean discharge RCSE score (p &amp;lt; 0.0001) compared to admission. On discharge most patients had minimal rehabilitation needs, the mean therapy need score was 0.7 (median 1) reflecting those referred onward for low-intensity or maintenance rehabilitation input. Conclusion The RCSE was feasible to use as an outcome measure in an older adult’s rehabilitation unit. The primary domain of complexity in this sample was the number of disciplines needed and the high intensity of intervention required. This highlights the need for appropriately resourced and skilled rehabilitation services for older people in Ireland.

Occupational therapy improves social participation of complex patients discharged from hospital: results of a powered randomized controlled trial

Purpose To verify the effectiveness of experimental occupational therapy plus intensive standard rehabilitation compared to intensive standard rehabilitation alone on the reintegration to social activities of complex patients three months after hospital discharge. Materials and methods Patients with a score ≥ 9 on the Rehabilitation Complexity Scale at admission to an intensive rehabilitation ward were randomized to the control or experimental group. Both groups received intensive multidisciplinary rehabilitation aimed at recovering independence in the basic activities of daily life (ADL). The experimental group also received experimental occupational therapy services to address goals identified through the administration of the Canadian Occupational Performance Measure (COPM). Experimental occupational therapy began during the in-hospital phase and continued in the home-based setting. It consisted of teaching strategies, recommending aids, and providing personalized information regarding available community support. Results Ninety-two individuals with a mean age of 65 years (female 44.6%) were enrolled. The experimental group significantly improved participation measured by the Reintegration to Normal Living Index (mean changes 8.61, 95% CI: 1–16.23, p = 0.027). The performance and satisfaction scores of the COPM, both during hospitalization and after discharge, and independence in ADL also improved. No differences in mood disturbances were found. Conclusion Early post-discharge occupational therapy integrated with multidisciplinary rehabilitation improves the social participation of complex patients. Future research should investigate the concrete feasibility of implementing this complex intervention cost-effectively and in different contexts. Trial registration ClinicalTrials.gov Identifier NCT03668938 (first posted date 13/09/2018)

Prediction of emergence from prolonged disorders of consciousness from measures within the UK rehabilitation outcomes collaborative database: a multicentre analysis using machine learning

Purpose Predicting emergence from prolonged disorders of consciousness (PDOC) is important for planning care and treatment. We used machine learning to examine which variables from routine clinical data on admission to specialist rehabilitation units best predict emergence by discharge. Materials and methods A multicentre national cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes (UKROC) database 2010–2018. Patients (n = 1170) were operationally defined as “still in PDOC” or “emerged” by their total UK Functional Assessment Measure (FIM + FAM) discharge score. Variables included: Age, aetiology, length of stay, time since onset, and all items of the Neurological Impairment Scale, Rehabilitation Complexity Scale, Northwick Park Dependency Scale, and the Patient Categorisation Tool. After filtering, prediction of emergence was explored using four techniques: binary logistic regression, linear discriminant analysis, artificial neural networks, and rule induction. Results Triangulation through these techniques consistently identified characteristics associated with emergence from PDOC. More severe motor impairment, complex disability, medical and behavioural instability, and anoxic aetiology were predictive of non-emergence, whereas those with less severe motor impairment, agitated behaviour and complex disability were predictive of emergence. Conclusions This initial exploration demonstrates the potential opportunities to enhance prediction of outcome using machine learning techniques to explore routinely collected clinical data. Implications for rehabilitation Predicting emergence from prolonged disorders of consciousness is important for planning care and treatment. Few evidence-based criteria exist for aiding clinical decision-making and existing criteria are mostly based upon acute admission data. Whilst acknowledging the limitations of using proxy data for diagnosis of emergence, this study suggests that key items from the UKROC dataset, routinely collected on admission to specialist rehabilitation some months post injury, may help to predict those patients who are more (or less) likely to regain consciousness. Machine learning can help to enhance our understanding of the best predictors of outcome and thus assist with clinical decision-making in PDOC.

Rehabilitation in post-COVID patients. A single center experience

The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients.The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3±11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5±10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment.In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7±20 vs discharge 72.7±28.6 p<0.005, SMWT admission 146±25 vs 318±18 m, p<0.005) and in clinical complexity (RCS admission 10.9±1.1 vs discharge 5.3, p<0.05).At admission the comparison between Group A vs B has show:1. a reduced pre-rehabilitation hospital stay (days) in Group Vs A (B 8.2±2 vs 31±5 0.005)2. a similar degrre of clinical complexity (RCS scale A 10.9±1.1 vs 1.6±11.2 p ns)3. a greater loss autonomy in post-COVID patients (BI scale A 29.7±20 vs B 47.7±19, p 0.05; SMWT A 145±25 m vs B 255±18 m, p 0.05)After a similar period of rehabilitation (A 29.7±12.8 days vs B 29.6±10 days, p ns) we observed in both Groups:1. a reduction of clinical complexity ((RCS scale A 5.3±2 vs 6.6±2 p ns2. an improvement of degree of autonomy recovery ((BI scale A 72.7±28 vs B 47.7±19, p ns; SMWT A 385±18 m vs B 410±25m, p ns)ConclusionsPost-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative.FUNDunding AcknowledgementType of funding sources: None.

Cross-cultural adaptation and psychometric validation of the Korean version of rehabilitation complexity scale for the measurement of complex rehabilitation needs.

The aim of this study was to translate and cross-culturally adapt the Rehabilitation Complexity Scale-Extended version 13 (RCS-E v13) to develop the Korean version of the Rehabilitation Complexity Scale (KRCS), and to explore its reliability, and concurrent and construct validity.This research was an observational study of a series of consecutive rehabilitation inpatients who were previously assessed with KRCS and grouped with the Korean rehabilitation patient group version 1.1 (KRPG v1.1). Translation and cross-cultural adaptation of the RCS-E v13 were implemented according to internationally recognized standards. Four hundred thirty inpatients diagnosed with complex neurological or musculoskeletal disabilities were enrolled. Physiatrists were asked to finish the KRCS at admission and to complete a second time with an interval of a minimum of 3 weeks to a maximum of 4 weeks for reliability evaluation. At discharge, the KRCS was completed a third time to explore constructive validity.The Cronbach-α was 0.63. The intraclass correlation coefficient values of the total score, Medical, Nursing, Care, Therapy Disciplines, Therapy Intensity, and Especial Needs domains were 0.86, 0.69, 0.84, 0.83, 0.74, 0.74, and 0.79, respectively (P < .01). The scale was repeatable (Spearman rho 0.69–0.86) and correlated strongly with disability measures (Spearman rho 0.37–0.50). Exploratory factor analysis revealed 2 clear factors (“Medical/Nursing” and “Care/Therapy Disciplines/Therapy Intensity/Equipment”). The goodness-of-fit index in the confirmatory factor analysis was 0.87. The KRCS was associated with a higher explanatory power for rehabilitation resources and length of stay than the KRPG v1.1.Our data suggest that the KRCS is a feasible, reliable, and valid tool that is appropriate for the measurement of clinical complexity in Korean intensive rehabilitation units. Further, it may provide case-mix adjustment to improve the rehabilitation delivery system in Korea.

Effectiveness of rehabilitation in post-COVID compared with post-cardiosurgery patients. A single Center experience

Funding AcknowledgementsType of funding sources: None.The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients.The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3± 11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5± 10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment.In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7 ± 20 vs discharge 72.7 ± 28.6 p <0.005, SMWT admission 146 ± 25 vs 318 ± 18 m, p <0.005) and in clinical complexity (RCS admission 10.9 ± 1.1 vs discharge 5.3, p< 0.05)ConclusionsPost-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative.Group A vs Group BGroup AGroup Bppre-rehabilitation hospital stay (days)31 ± 58 ± 20.005RCS admission10.9 ± 1.111.6 ± 1.2nsBI admission29.7 ± 2047.7 ± 190.05SMWT admission (m)146 ± 25255 ± 180.05Rehabilitation duration (days)29.7 ± 12.829.6 ± 10.1nsRCS discharge5.3 ± 26.5 ± 2nsBI discharge72.7 ± 2871.5 ± 22.5nsSMWT discharge (m)385 ± 18410 ± 25nsRCS rehabilitation complexity scale, BI: Barthel Index, SMWT: six-minute walking test

Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study.

BackgroundTraumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available.ObjectiveThis study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts.MethodsThis is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected.ResultsThe project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022.ConclusionsThis study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation.International Registered Report Identifier (IRRID)DERR1-10.2196/25980

Following severe childhood stroke, specialised residential rehabilitation improves self-care independence but there are ongoing needs at discharge

Introduction Stroke is a major cause of mortality and disability in childhood. There is a false belief that children will recover better than adults and recent research confirms that younger age at injury can have a negative impact on rehabilitation outcomes, resulting in lifelong disability. Self-care is a key rehabilitation outcome for children and young people. Methods This service evaluation reviews routinely collected clinical self-care data from one specialised residential rehabilitation centre in the United Kingdom. Admission and discharge scores from the United Kingdom Functional Independence Measure +Functional Assessment Measure, Rehabilitation Complexity Scale – E and Northwick Park Nursing Dependency Scale were analysed. Results Twenty-six children and young people age 8 years and over with severe stroke were included. Mean scores of independence increased and mean scores of complexity and dependency decreased. A proportion of the sample had ongoing self-care needs in relation to support needed in washing, dressing and bathing. A small number remained highly dependent, requiring assistance from two carers. Conclusion Children and young people make significant gains in self-care independence during specialised rehabilitation. However, a proportion return to the community with high self-care needs. Occupational therapists and the wider care team should address ongoing self-care needs in this population.

Predicting length of stay in specialist neurological rehabilitation

Aims: A retrospective case series was performed to determine which measures of complexity, dependency and function most accurately predict inpatient neurorehabilitation length of stay for individuals with post-acute neurological disorders.Methods: Sociodemographic, medical and functional variables were extracted from data submitted to the UK Rehabilitation Outcomes Collaborative. Length of stay was calculated as the total number of inpatient days, functional status was measured using Barthel Index, rehabilitation complexity was measured using Extended Rehabilitation Complexity Scale, and nursing dependency was measured using the Northwick Park Dependency Scale.Results: The mean rehabilitation length of stay was 70.9 days, with length of stay being 35.1 days higher in inpatients with acquired brain injury than inpatients with spinal cord injury. Diagnostic category, Barthel Index scores, Extended Rehabilitation Complexity Scale scores and Northwick Park Dependency Scale scores at admission independently predicted length of stay. Multiple regressions including diagnostic group, Barthel Index, Extended Rehabilitation Complexity Scale and Northwick Park Dependency Scale statistically significantly predicted 37.9% of the variability in length of stay (p < 0.005). Northwick Park Dependency Scale on admission was most closely correlated with inpatient length of stay.Conclusions: In conclusion, inpatient length of stay is predicted by diagnostic category, Extended Rehabilitation Complexity Scale, Northwick Park Dependency Scale and Barthel Index. The most influential predictor of rehabilitation length of stay was Northwick Park Dependency Scale score at admission. These results may help facilitate rehabilitation resource planning and implementation of effective commissioning plans.Implications for RehabilitationThe most accurate predicting variable for length of stay in inpatient neurological rehabilitation was nursing need as measured by the Northwick Park Dependency Scale score on admission.Service users and commissioners can be provided with more realistic predictions of length of stay derived from admission variables that can be used in planning inpatient rehabilitation.Age and gender do not seem to have an effect on the total length of stay in rehabilitation.

Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis

ObjectivesTo evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions.DesignA multicentre cohort analysis of prospectively...

Referral decision support in patients with subacute brain injury: evaluation of the Rehabilitation Complexity Scale – Extended

Purpose: To test if the Rehabilitation Complexity Scale Extended (RCS-E) can be used as decision support for patient referral to primary rehabilitation as either complex specialized services (CSS) or district specialist services (DSS).Method: Two independent expert teams analyzed medical records on 299 consecutive patients admitted for CSS or DSS rehabilitation. One team provided a golden standard for the patient referrals, and the other team provided RCS-E scores. Models for predicting referrals from RCS-E scores were developed on data for 149 patients and tested on the remaining 150 patients.Results: The optimal RCS-E sum score threshold for referral prediction was 11, predicting the golden standard for patient referral with sensitivity 88%, specificity 78% and correct classification rate 81%. Improved referral prediction performance was achieved by using RCS-E item-wise score thresholds (sensitivity 81%, specificity 89%, correct classification rate 87%). The RCS-E sum score range for patients referred CSS and DSS by the item-wise model was, respectively, 0–12 and 2–22 suggesting strong non-linear interaction of the RCS-E items.Conclusions: We found excellent referral decision support in the RCS-E and the item specific threshold model, when patients with acquired brain injury are to be referred to CSS or DSS as their primary rehabilitation.Implications for RehabilitationEfficient rehabilitation after acquired brain injury requires rehabilitation settings that meet patient needs.Validated tools for referral decision support make the process more transparent.Patient rehabilitation complexity can be stratified by the RCS-E with high sensitivity, specificity and predictive value of positive test.RCS-E is an excellent tool for referral decision support.

Dermatological disease in the older age group: a cross-sectional study in aged care facilities

ObjectivesTo estimate the prevalence of dermatological disease in aged care facilities, and the relationship between cognitive or physical disability and significant disease.Setting2 large aged care facilities in Auckland, New Zealand,...

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

Primary objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury.Research design: A retrospective case note review assessed total rehabilitation unit admission.Methods and procedures: Assessment of 52 consecutive patients with acquired brain/spinal injury and neuropathy in an in-patient neuro-rehabilitation unit of a UK university hospital. Data analysed included: Northwick Park Dependency Score (NPDS), Rehabilitation complexity Scale (RCS), Functional Independence Measure and Functional Assessment Measure FIM-FAM (UK version 2.2), LOS and ACB. Outcome was different in RCS, NPDS and FIM-FAM between admission and discharge.Main outcomes and results: A positive change was reported in ACB results in a positive change in NPDS, with no significant effect on FIM-FAM, either Motor or Cognitive, or on the RCS. Change in ACB correlated to the length of hospital stay (regression correlation = −6.64; SE = 3.89). There was a significant harmful impact of increase in ACB score during hospital stay, from low to high ACB on NPDS (OR = 9.65; 95% CI = 1.36–68.64) and FIM-FAM Total scores (OR = 0.03; 95% CI = 0.002–0.35).Conclusions: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort.

Rehabilitation Complexity Scale: Italian translation and transcultural validation

Purpose: The aim of the present study was translation, cultural adaption and validation of the extended version 12 of the Rehabilitation Complexity Scale (RCS-E) in a sample of patients with stroke and total hip replacement. Method: The cross-cultural validation required RCS-E forward–backward translation, revision by an expert committee and its application in an Intensive Rehabilitation setting through a retrospective collection of data from clinical records. The evaluation of the psychometric properties was carried out by analyzing the correlations between RCS-E score and other measures (Functional Independence Measure, Braden, Morse, Cumulative Illness Rating Scale) and the assessment of reliability in terms of reproducibility (inter-observer agreement) and repeatability (intra-observer agreement). Results: The backward and forward processes of translation of the scale did not create problems of interpretation of terms. Some adaptation was required for the items nursing (N), medical care (M) and therapeutic intensity (TI) due to differences on the national health system structure. The Italian version of the scale proved to be valid, reliable with high reproducibility and repeatability. Conclusions: The Italian version RCS-E has been successfully validated, showing good psychometric properties, which partly reproduce the results obtained for the original version. However, some assumption was made for some items thus preventing possible comparison with other countries.Implications for RehabilitationAdmittance at an Intensive Rehabilitation care setting in Italy requires to evaluate the complexity of rehabilitation needs.The Rehabilitation Complexity Scale (RCS-E) has proved to be reliable for assessing clinical complexity and consequently for planning rehabilitation needs.The Italian version of RCS-E has been successfully validated, showing good psychometric properties, which reproduce the results obtained for the original version.The items included in the therapy intensity subscale do not fit the Italian health system rules for intensity of rehabilitation care and needs adaptation.

The Northwick Park Therapy Dependency Assessment scale: a psychometric analysis from a large multicentre neurorehabilitation dataset

Purpose: To assess the internal reliability, construct and concurrent validity and responsiveness of the Northwick Park Therapy Dependency Assessment (NPTDA) scale. Method: A cohort of 2505 neurorehabilitation patients submitted to the UK Rehabilitation Outcomes Collaborative database. Cronbach’s coefficient-α was used to assess internal reliability and factor analysis (FA) to assess construct validity. We compared NPTDA scores at admission and discharge to determine responsiveness. Results: Coefficient-α for the whole scale was 0.74. The exploratory FA resulted in a four-factor model (Physical, Psychosocial, Discharge planning and Activities) that accounted for 43% of variance. This model was further supported by the confirmatory FA. The final model had a good fit: root-mean-square error of approximation of 0.069, comparative fit index/Tucker–Lewis index of 0.739/0.701 and the goodness of fit index of 0.909. The NPTDA scores at admission and discharge were significantly different for each of the factors. Expected correlations were seen between the admission scores for the NPTDA, the Rehabilitation Complexity Scale (r = 0.30, p < 0.01) and the Functional Independence Measure (r = −0.25, p < 0.01). Conclusions: The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA may be used to describe and quantify changes in therapy inputs in the course of a rehabilitation programme.Implications for RehabilitationThe Northwick Park Therapy Dependency Assessment (NPTDA) is designed as a measure therapy intervention, which reflects both quantitative and qualitative aspects of the inputs provided (including staff time and the different types of intervention) during inpatient rehabilitation.The scale demonstrated acceptable internal reliability and good construct and concurrent validity.NPTDA is responsive to change in the therapy inputs provided during neurorehabilitation between admission and discharge.

Measuring complexity in neurological rehabilitation: the Oxford Case Complexity Assessment Measure (OCCAM)

Objective: To investigate validity and reliability of a new measure of case complexity, the Oxford Case Complexity Assessment Measure (OCCAM). Design: Data collection on inpatients and outpatients attending for rehabilitation. In subsets, repeat assessments were undertaken two weeks apart, by clinicians unaware of initial data, and on admission and on discharge from inpatient rehabilitation. Setting: Specialist neurological rehabilitation service. Subjects: Patients receiving rehabilitation after acute onset disability. Interventions: Assessment by clinical staff as part of routine care. Measures: OCCAM, the INTERMED, Rehabilitation Complexity Scale – Extended (RCS-E), clinical judgement of complexity (0–10 numerical rating scale), length of stay and discharge destination (for inpatients). Results: For the OCCAM, the Cronbach’s α coefficient was 0.69 and item-total correlations were moderate to high except for pathology and time. The correlation coefficients with OCCAM were: INTERMED (ρ = 0.694), RCS-E (ρ = 0.736), and team judgement (ρ = 0.796). Inter-rater agreement was excellent (Weighted κ = 0.95). Correlation between admission and discharge scores was ρ = 0.917. Test–retest agreement was good (intraclass correlation coefficient 0.86). Higher mean admission scores were associated with prolonged stays (38.6 ± 12.2 versus 32.9 ± 13.7, P = 0.04) and failure to return home (48.0 ± 13.7 versus mean 32.1 ± 10.7, P < 0.001). The optimal cut-off of OCCAM to detect patients not discharged home was ≥ 34, with corresponding sensitivity and specificity of 84.6% and 62.8%, respectively. Conclusions: This preliminary evidence suggests that the OCCAM may measure case complexity reliably, and may predict rehabilitation resource used and outcome. Further research is warranted.

Journey in trying to achieve eligibility level 1 rehabilitation service

Purpose – This article aims to cover the experience of working with the new framework/criteria for specialist neuro‐rehabilitation services to meet the needs of patients with rare or complex conditions to achieve eligibility for a level 1 status.Design/methodology/approach – Royal Leamington Spa Rehabilitation Hospital is currently collecting the full UK Rehabilitation Outcomes Collaborative (UKROC) dataset for all in‐patient episodes. A number of tools for measuring rehabilitation needs were gathered by the multi‐disciplinary team (i.e. costing of the service including staffing, building, equipments, etc.), and a range of clinical measures including needs: (the rehabilitation complexity scale); inputs: the Northwick Park nursing and therapy dependency scales (NPDS, NPTDA); and outcomes: the UK functional assessment measure (UK FIM+FAM) which are collated on the national UKROC database.Findings – These measures have been used to assess the level of a patient's complex needs and to help formulate bandings,...