Rehabilitation Complexity Scale – Extended (RCS-E v13)

The Rehabilitation Complexity Scale has developed through iterative application and testing since the early 2000s. The three versions implemented within the UK ROC dataset over that time are summarised below: 

Original Rehabilitation Complexity Scale (RCS) 

The original RCS tool (version 8) was developed for use in Level 3 rehabilitation settings (e.g. stroke, care of the elderly) to identify patients with more complex rehabilitation needs who might require referral to specialist rehabilitation 

Source References  

• Turner-Stokes L, Disler R, Williams H. The Rehabilitation Complexity Scale: a simple, practical tool to identify “complex specialised” services in neurological rehabilitation. Clinical Medicine 2007; 7:593-599
• Turner-Stokes L, Williams H, Siegert RJ. The Rehabilitation Complexity Scale version 2: a clinimetric evaluation in patients with severe complex neurodisability. Journal of Neurosurgery and Psychiatry 2010; 2: 146-153 

The Rehabilitation Complexity Scale – Extended (RCS-E v12) 

The first extended version (RCS-E v12) was published in 2012 to support specialised commissioning by NHS England. It addressed feedback from users in relation to the following:  

• A ceiling effect for very complex needs,
• The RCS did not identify needs for special equipment and
• It did not capture the need for supervision due to “risk” in cognitive/behavioural settings.

Source Reference 

• Turner-Stokes L, Scott H, Williams H. Siegert RJ.  The Rehabilitation Complexity Scale – extended version: detection of patients with highly complex needs. Disability and Rehabilitation 2012; 34 (9): 715-720 

The Rehabilitation Complexity Scale – Extended (RCS-E v13) 

The RCS v13 followed to address continued ceiling effects.

Implementation of the RCS-E 

The RCS-E version 13 is the version currently recommended for most rehabilitation settings.  

• The mandated UK ROC dataset requires scoring at east every fortnight
• Scores should be based on what the patient received (gets) rather than needs. Both “needs” and “gets” can be recorded for short periods of time to assist in demonstrating a potential shortfall in service.
• For care/risk - either the C or R score can be recorded. If both are relevant, the highest of the two item scores is included in the total RCS-E score.  

For calculation of the weighted bed day tariff, the UK ROC software has an in-built algorithm that assigns the RCS-E banding from the total RCS-E scores. 

RCS-E Banding 

The following cut-off points are currently used to assign RCS-E scores to the 5 bands in the weighted bed day tariff

Parallel scores and tariff weightings 

The weighting factors for each band within the tariff are derived from parallel ratings of the RCS-E, and the Northwick Nursing and Therapy Dependency scores which provide a direct estimation of the average care, nursing and therapy hours within each of the 5 bands. 

Development of the methodology for the weighted bed day tariffs is described below 

Source Reference 

• Turner-Stokes L, Sutch S, Dredge R.Healthcare tariffs for specialist inpatient neurorehabilitation services: Rationale and development of a UK casemix and costing methodology. Clinical Rehabilitation. 2012: 26(3): 264-279
• Turner-Stokes L, Bill A Dredge R.A cost analysis of specialist inpatient neurorehabilitation services in the UK. Clinical Rehabilitation. 2012: 26(3):256-263 

The RCS-E continued to form the basis for weighting in the published weighted bed day tariffs for specialist rehabilitation. 

They are also incorporated into the Patient Level costing standards 

Licensing and accreditation 

• The RCS-E is designed to be intuitive. No specific accreditation is required.
• It is free to use and does not incur any licencing fee.

Guidelines 

The RCS-E tools include all of the descriptors that should be needed for accurate rating 

If teams are unsure or would like further clarification on the scoring, please email LNWH-tr.ukroc@nhs.net

Training 

For those who want further training in the use of the RCS-E, sessions are provided annually through the UK Rehabilitation Outcomes Collaborative as part of its Outcome Measures Training Course

For further information on the date of the next course, please contact the UK ROC team – LNWH-tr.ukroc@nhs.net

Additional References 

Find out more additional RCS references on PURE.

Use of RCS-ET v13 

The RCS-ET v13 was used by Major Trauma Centres that participated in the National Clinical Audit of Specialist Rehabilitation for Patients with Complex needs following Major Injury (NCASRI) review. Trauma Audit and Rehabilitation Network (TARN) and the United Kingdom Rehabilitation Outcomes Collaborative (UK ROC) worked in partnership on the audit from 2015-2018 

• More information about NCASRI

Use of RCS-EA v13 

The RCS-EA v13 was used within the Post-Intensive Care Unit Presentation Screen (PICUPS) project that was conducted in 2019/20 between the Intensive Care Society and UK ROC. 

• More information about PICUPS 

The RCS was designed for use within UK Specialist in-patient Neurorehabilitation Settings. For community settings the Needs, Provision and Complexity Scale provides equivalent information. (NPCS)  

Requests for the RCS-E v13 have been received from many other countries including, Australia, Nigeria, Chile, New Zealand, South Korea, Norway, Italy, Belgium, Texas, Ireland, Wales and Scotland. 

Translation of the RCS-E v13 

The RCS-E v13 has been translated into Italian, Swedish, Korean and Danish.