The integration of the Italian Rehabilitation Complexity Scale in the assessment of patients admitted to different levels of care in public and private accredited settings and belonging to the main rehabilitative MDCs: a national experience

BACKGROUND: The Italian version of Rehabilitation Complexity Scale-Extended v13 (RCS-E v13) introduced the possibility to objectively assessing rehabilitation patients' needs in terms of clinical complexity integrating tools to assess disability and comorbidity in Italy. AIMS: To evaluate the contribution of RCS-E v13 in combination with Barthel Index and Cumulative Illness Rating Scale in profiling patients at admission in intensive rehabilitation (IR), extensive rehabilitation (ER) and highly specialized post-acute rehabilitation (HSR). DESIGN: Observational multicenter prospective cross-sectional study. SETTING: Adult patients admitted to 25 Italian Rehabilitation accredited facilities both public and private in eight different regions. POPULATION: Overall, 2809 subjects were included (2454 in IR; 333 in HSR and 22 in ER). RESULTS: Only IR and HSR data were analyzed since the paucity of ER data. Spearman correlation showed a strong association between RCS-E v13 and BI (ρ=-0.61) and weak correlation with CIRS total score (ρ=0.36 and 0.32), SI (ρ=0.35 and 0.29) and CI (ρ=0.30 and 0.27). EFA revealed two factors (85% variance; KMO=0.747; P<0.001): Factor 1 (CIRS) weakly correlated with LoS (ρ=0.219), Factor 2 (RCS, BI) strongly (ρ=0.677). RCS-Ev13 and BI predicted rehabilitation LoS, with their interaction significantly improving model fit (ΔR²=+0.034; P<0.001) and were able to profile differences across IR levels within various MDCs (Kruskal-Wallis Test P<0.001). Brunner-Munzel Test showed Statistical differences (P<0.001) between neurological patients admitted to IR and HSR, as assessed by RCS-E and BI, respectively. Sensitivity analyses — stratified by age (≥75), LoS (> median), and outlier status (±1.5 IQR) confirmed the robustness of the main results across subgroups and conditions. CONCLUSIONS: Findings support the combined use of RCS-E v13 and BI for patient profiling at admission, with CIRS showing comparatively lower effectiveness in this context. CLINICAL REHABILITATION IMPACT: This study contributes to defining rehabilitation complexity in the Italian context. RCS-E v13 and BI emerged as complementary, objective tools for profiling care needs across MDCs and settings, with potential use for admission appropriateness, prognostic stratification, and care planning. Findings highlight that rehabilitation complexity requires a multifactorial assessment, not fully captured by comorbidity alone.