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The Rehabilitation Complexity Scale version 2: a clinimetric evaluation in patients with severe complex neurodisability
  1. Lynne Turner-Stokes1,2,
  2. Heather Williams2,
  3. Richard J Siegert1
  1. 1King’s College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK
  2. 2Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
  1. Correspondence to Professor Lynne Turner-Stokes, Regional Rehabilitation Unit, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK; lynne.turner-stokes{at}


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 (κ 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-α 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.

  • Rehabilitation
  • casemix
  • measurement
  • clinimetrics

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  • See Editorial Commentary, p127

  • A supplementary appendix is published online only at

  • Linked articles 178863

  • Funding The Luff Foundation, The Dunhill Medical Trust.

  • Competing interests Outcome measurement is a specific research interest of our centre. The RCS, NPDS and NPCNA were all developed through this department, but are disseminated free of charge. Professor Turner-Stokes is lead author on the papers which describe their initial development and validation, as well as that of the UK version of the FIM+FAM. However, none of the authors has any personal financial interests in the work undertaken or the findings reported.

  • Ethics approval Ethics approval was provided by Harrow Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • i FIM is a trademark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities.

  • ii The RCS version 1 may be found in the original article Turner-Stokes.10

  • Copies of the Rehabilitation Complexity Scale, and indeed the NPDS and NPTDA, are available free of charge from the corresponding author.

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