1. Rehabilitation Complexity Scale in Oncology Is it useful
Rehabilitation Complexity Scale in Oncology Is it useful? A mixed methods approach
Leanne Williams, Catherine Sandsund, Karen Thomas, Deborah Harding, Dr Clare Shaw
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Background
Within UK health care system, measuring rehabilitation complexity is important from an organisational and clinical perspective.
Rehabilitation Complexity Scale –Extended (RCS-E) is a tool which has demonstrated to be valid in neurological and trauma rehabilitation (Turner-Stokes, 2011) .
No validated tools for the measurement of rehabilitation complexity in acute oncology care.

3. Aims Primary Aim: To explore whether there is an agreement between a
The aim of the study is to explore whether there is an agreement between a standardised scale of complexity, the Rehabilitation Complexity Scale – Extended (RCS-E) and physiotherapists subjective clinical opinion.
The aim of the study is to explore whether there is an agreement between a standardised scale of complexity, the Rehabilitation Complexity Scale – Extended (RCS-E) and physiotherapists subjective clinical opinion.
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Aims
Primary Aim:
To explore whether there is an agreement between a
standardised scale of complexity, the RCS-E and
physiotherapists subjective clinical opinion in an oncology tertiary care setting.
Secondary Aim:
Whether there is a correlation between the RCS-E and length of stay (LOS) and discharge destination.

4. Method Explanatory, sequential, mixed methods design.
This study involved physiotherapists at a specialised oncology centre using the RCS-E to assess complexity in 143 acute cancer patients, while continuing with their usual practice of subjectively assessing complexity. Agreement was assessed with statistical analysis.
Following this a focus group involving the physiotherapists took place to explore the quantitative data further. Thematic analysis was completed on the transcribed data.
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Method
Explanatory, sequential, mixed methods design.
Physiotherapists at a specialised oncology centre used the RCS-E to assess complexity while continuing with their usual practice of subjectively assessing complexity.
Focus group to explore the results from quantitative data further.

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Analysis
Primary Aim RCS-E and subjective opinion was assessed using the Chi square and ROC analysis Secondary Aim Correlation between RCS-E and LOS was tested using scatterplots and Spearmans Rank. Focus Group Data Thematic analysis was completed on the transcribed data. Subsequent integration of quantitative and qualitative data

6. This study involved physiotherapists at a specialised oncology centre using the RCS-E to assess complexity in 143 acute cancer patients, while continuing with their usual practice of subjectively assessing complexity. Agreement was assessed with statistical analysis.
Following this a focus group involving the physiotherapists took place to explore the quantitative data further. Thematic analysis was completed on the transcribed data.
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Box plot demonstrating the agreement of RCS-E and clinicians subjective opinion
RCS-E score of 11 or above suggests clinical complexity (Turner-Stokes, 2016)

7. This study involved physiotherapists at a specialised oncology centre using the RCS-E to assess complexity in 143 acute cancer patients, while continuing with their usual practice of subjectively assessing complexity. Agreement was assessed with statistical analysis.
Following this a focus group involving the physiotherapists took place to explore the quantitative data further. Thematic analysis was completed on the transcribed data.
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Results
The Chi-Square found a significant association between the RCS-E score and the physiotherapists’ decision to refer to the complex rehabilitation meeting p=>0.001.
The RCS-E did not correlate with acute hospital length of stay (r=0.114) and descriptively did not demonstrate a correlation with discharge destination.

8. This study involved physiotherapists at a specialised oncology centre using the RCS-E to assess complexity in 143 acute cancer patients, while continuing with their usual practice of subjectively assessing complexity. Agreement was assessed with statistical analysis.
Following this a focus group involving the physiotherapists took place to explore the quantitative data further. Thematic analysis was completed on the transcribed data.
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Focus Group Findings
Potential utility within practice due to the excellent significance shown in the quantitative data analysis.
Support business cases for staffing services
Commissioning of cancer rehabilitation provision
Support referrals to specialised rehabilitation services
Weakness
Sensitivity to rapid post-op improvements
The influence of the trajectory of the cancer patient pathway
The personal beliefs of therapists should be considered .

9. Limitations Small sample
This study involved physiotherapists at a specialised oncology centre using the RCS-E to assess complexity in 143 acute cancer patients, while continuing with their usual practice of subjectively assessing complexity. Agreement was assessed with statistical analysis.
Following this a focus group involving the physiotherapists took place to explore the quantitative data further. Thematic analysis was completed on the transcribed data.
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Limitations
 Small sample
Risk of bias as same physiotherapist were completing the RCS-E as carrying out subjective assessment
Reduction in professional representative spectrum
Inter-rater reliability was not assessed
Only completed on admission

10. Conclusions and Future Recommendations
This study involved physiotherapists at a specialised oncology centre using the RCS-E to assess complexity in 143 acute cancer patients, while continuing with their usual practice of subjectively assessing complexity. Agreement was assessed with statistical analysis.
Following this a focus group involving the physiotherapists took place to explore the quantitative data further. Thematic analysis was completed on the transcribed data.
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Conclusions and Future Recommendations
RCS-E did demonstrate significant agreement with the physiotherapists’ clinical opinion on complexity though did not show any benefit in predicting length of stay and discharge destination in the acute cancer patients.
Physiotherapists support the use of the scale within practice though considerations of the potential limitations need to be taken into account.
Further research is required to assess the RCS-E in a variety of oncology settings, with differing therapists and to encorporate the ideas from the qualitative data.
Larger sample of patients in differing geographical locations involving a variety of rehabilitation professionals
Collect prospective longitudinal normative data across differing tumour groups
Potential adaptation to include the impact of emotional and psychological influences and the effect of cancer treatments.

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References
Hoffman, K., West, A., Nott, P., Cole, E., Playford, D., Lui, C., Brohi, K (2013) ‘Measuring acute rehabilitation needs in trauma: Preliminary evaluation of the Rehabilitation Complexity Scale’, Injury International Journal of Care, 44, Turner- Stokes, L., Sutch, S. and Dredge, R. (2011) ‘Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology’, Clinical Rehabilitation, 26, 3,

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With thanks to
The supporting clinical teams at Royal Marsden Sutton and Chelsea. The authors acknowledge support from National Institute of Health Research, Royal Marsden/Institute if Cancer Research Biomedical Research Centre