title: Measuring acute rehabilitation needs in trauma: preliminary evaluation of the Rehabilitation Complexity Scale.
abstract: BACKGROUND
  Injury severity, disability and care dependency are frequently used as surrogate measures for rehabilitation requirements following trauma. The true rehabilitation needs of patients may be different but there are no validated tools for the measurement of rehabilitation complexity in acute trauma care. The aim of the study was to evaluate the potential utility of the Rehabilitation Complexity Scale (RCS) version 2 in measuring acute rehabilitation needs in trauma patients.
  
  
  METHODS
  A prospective observation study of 103 patients with traumatic injuries in a Major Trauma Centre. Rehabilitation complexity was measured using the RCS and disability was measured using the Barthel Index. Demographic information and injury characteristics were obtained from the trauma database.
  
  
  RESULTS
  The RCS was closely correlated with injury severity (r=0.69, p<0.001) and the Barthel Index (r=0.91, p<0.001). However the Barthel was poor at discriminating between patients rehabilitation needs, especially for patients with higher injury severities. Of 58 patients classified as 'very dependent' by the Barthel, 21 (36%) had low or moderate rehabilitation complexity. The RCS correlated with acute hospital length of stay (r=0.64, p=<0.001) and patients with a low RCS were more likely to be discharged home. The Barthel which had a flooring effect (56% of patients classified as very dependent were discharged home) and lacked discrimination despite close statistical correlation.
  
  
  CONCLUSIONS
  The RCS outperformed the ISS and the Barthel in its ability to identify rehabilitation requirements in relation to injury severity, rehabilitation complexity, length of stay and discharge destination. The RCS is potentially a feasible and useful tool for the assessment of rehabilitation complexity in acute trauma care by providing specific measurement of patients' rehabilitation requirements. A larger longitudinal study is needed to evaluate the RCS in the assessment of patient need, service provision and trauma system performance.
authors: Trauma Clinical Academic Unit, Blizard Institute of Cell and Molecular Science, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. Karen.hoffman@bartsandthelondon.nhs.uk
authors: Karen
authors: K
authors: Hoffman
authors: Anita
authors: A
authors: West
authors: Philippa
authors: P
authors: Nott
authors: Elaine
authors: E
authors: Cole
authors: Diane
authors: D
authors: Playford
authors: Clarence
authors: C
authors: Liu
authors: Karim
authors: K
authors: Brohi
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology / Q000534:rehabilitation*