The RCS-E is Predictive of Outcomes and Resource Allocation in a Large Neuromotor Rehabilitation Setting.
retrospective_cohort · Level III
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- Also identified by DOI 10.1016/j.apmr.2025.10.001.
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Abstract
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. A retrospective observational study. Demographic and clinical variables were collected, including Length of Stay (LoS), modified Rankin Scale, modified Barthel Index (mBI), RCS-E, and reimbursement of stay. Study on inpatients admitted to the neuromotor Rehabilitation Units of the 16 Istituti Clinici Scientifici Maugeri IRCCS (November 2023 and June 2024). Of 5870 hospitalizations, 4091 (mean age 71.8 ±13 years; 42.2% male) met the inclusion criteria. The pre-post analysis was performed on 3792 patients (mean age 71.8 ±12.8 years; 41.6% male). Rehabilitation program for neurological or orthopedic condition [median (1<sup>st</sup> - 3<sup>rd</sup> quartile) duration: 27 days (20-41)] MAIN OUTCOMES AND MEASURES: RCS-E scores on admission were categorised as follows: <8 (low complexity); 8-10 (medium complexity); >10 (high complexity). For each patient, we calculated the mBI derived parameters: mBI Gain, rehabilitation efficiency, and rehabilitation effectiveness. A significant moderate Spearman correlation was found between RCS-E score and mBI (rho=-0.53, p<0.0001), LoS (rho=0.41, p<0.0001) and premorbid mRS (rho=0.23, p<0.0001). 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<0.0001, rho=0.48 and rho=-0.43, respectively). Regression models indicated a predictive effect of RCS-E at admission on mBI at discharge. This study demonstrates the reliability and utility of RCS-E in assessing neurological and orthopedic rehabilitation complexity, predicting outcomes, and informing funding models.