The ability of the Rehabilitation Complexity Scale (RCS) to capture disability in respiratory patients admitted for in-hospital rehabilitation
Authors: Italian network The Rehabilitation Complexity Scale for respiratory patients 
Published: November 2023

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