The ability of the Rehabilitation Complexity Scale (RCS) to capture disability in respiratory patients admitted for in-hospital rehabilitation.

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.