Introduction: Rehabilitation care is becoming increasingly complex due to an aging population and higher survival rates following catastrophic injuries. The Townsville Rehabilitation Unit (TRU) uses an unvalidated physiotherapy acuity tool, primarily focused on physical dependency. This study evaluates the psychometric properties of rehabilitation complexity tools and the validity of the TRU tool.
Methods: A multi-phase approach was used. Phase one explored the relevance of the existing tool through focus groups with rehabilitation physiotherapists. Phase two reviewed the evidence for the Rehabilitation Complexity Scale-Extended, Northwick Park Therapy Dependency Assessment (NPTDA), and Oxford Case Complexity Measure. Based on focus group and literature data, a concurrent validation study compared the TRU tool with the NPTDA using data from 39 inpatients. Spearman’s rank correlation assessed the relationship between TRU and NPTDA scores, with analysis via SPSS (p<0.05).
Results: The TRU tool showed moderate correlations with NPTDA overall complexity scores (rho = 0.566, p < 0.001) and a stronger correlation with the physical dependency domain (rho = 0.609, p < 0.001). It showed weak correlations with cognitive, psychosocial, and family support domains (e.g., rho = 0.186, p = 0.256). It demonstrated moderate correlations for time-related domains (rho = 0.525, p < 0.001), but weaker results for discharge planning (rho = 0.244, p = 0.134).
Conclusion: The TRU physiotherapy acuity tool is valid for assessing physical dependency but lacks comprehensive coverage of patient complexity. Despite these limitations, it is quick to administer, reliably measures physical dependency, and facilitates workload management. It should be refined to include cognitive, psychosocial, and discharge planning factors to better support decision-making.
Relevance to Clinical Practice: This study highlights the need for a comprehensive tool incorporating physical and non-physical factors to assess rehabilitation complexity. While the TRU tool helps prioritize based on physical dependency, it requires refinement to optimize resource use and improve rehabilitation outcomes.