The ability of the Rehabilitation Complexity Scale to capture the burden of care and disability in patients with respiratory diseases admitted for in-hospital rehabilitation: a pilot study

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 it to the most used clinical and functional outcome measures. At admission and discharge, clinical data [comorbidities with the Cumulative Illness Rating Scale, Barthel Index (BI), Barthel Index Dyspnea (BI-d), Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT), and 6-minute walking test (6MWT)] were collected, and RCS-E v13 total score was calculated. A total of 219 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 v13 at admission [8.63 (1.69), 11.06 (2.50), 16.56 (2.97)], and at discharge [0.84 (1.02), 2.19 (1.5), 7.09 (1.47)] for COPD, CRF, and IV, respectively, were statistically differed among groups (analysis of variance 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 it correlated 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% confidence interval (CI) -9.00; -8.40)] as in all single RCS-E v13 items [care -0.59 (95% CI -0.69, -0.48); risk -0.56 (95% CI -0.78;-0.46); nursing needs -2.11 (95% CI -2.22;-2.01); medical needs -2.29 (95% CI -2.39;-2.18); therapy disciplines -1.45 (95% CI -1.57; -1.33); therapy intensity -2.00 (95% CI -2.07; -1,93); equipment -0.23(95% CI -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.

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List of authors
1. Michele Vitacca, MD, FERS ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
2. Luca Bianchi, MD Fondazione Don Carlo Gnocchi ONLUS, “Centro Spalenza”, Respiratory Rehabilitation, Rovato, Brescia, Italy
3. Piero Ceriana, MD ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Pavia, Italy
4. Francesco Gigliotti, MD Fondazione Don Carlo Gnocchi ONLUS, IRCCS “Don Carlo Gnocchi”, Respiratory Rehabilitation, Firenze, Italy
5. Rodolfo Murgia, MD ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Pavia, Italy
6. Alessia Fumagalli, MD Istituto nazionale Riposo e Cura per Anziani di Casatenovo, Respiratory Rehabilitation, Casatenovo, Lecco, Italy
7. Antonio Spanevello, MD ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Varese, Italy
8. Giuseppe La Piana, MD Ospedale “Santa Marta” di Rivolta d’Adda, Respiratory Rehabilitation Rivolta d’Adda, Cremona, Italy
9. Bruno Balbi, MD ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Veruno, Novara, Italy
10. Sara Forlani, MD, Presidio Ospedaliero di Sant’Angelo Lodigiano, Respiratory Rehabilitation Sant’Angelo Lodigiano, Lodi, Italy
11. Maria Aliani, MD ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Bari, Italy
12. Gianfranco Beghi, MD Ospedale Villa Pineta, Respiratory Rehabilitation, Pavullo nel Frignano, Modena, Italy
13. Mauro Maniscalco, MD ICS Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Benevento, Italy
14. Giuseppe Fiorentino, MD Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Respiratory Rehabilitation, Napoli, Italy
15. Paolo Banfi, MD Fondazione Don Carlo Gnocchi ONLUS, IRCCS “Centro S. Maria Nascente”, Respiratory Rehabilitation, Milano, Italy