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The Needs and Provision Complexity Scale: a first psychometric analysis using multicentre data

Objective: A psychometric evaluation of the Needs and Provision Complexity Scale (NPCS). Main measure: The NPCS is designed to evaluate both needs for health and social support (NPCS-Needs) and services provided to meet those needs (NPCS-Gets). Design: A consecutive cohort of patients were recruited from nine specialist neurorehabilitation units in London. Subjects: Four hundred and twenty-eight patients were assessed at discharge (63.1% males; mean age 49 years) of whom 73.6% had acquired brain injury (49.5% stroke/subarachnoid, 14.7% traumatic brain injury, 9.3% ‘other acquired brain injury’), 8.9% spinal cord injury, 6.1% peripheral neuropathy, 4.9% progressive neurological and 6.3% other neurological conditions. Results: The NPCS-Needs was completed by the clinical team at discharge and 212 patients reported NPCS-Gets after six months. NPCS-Gets repeatability was tested in a subsample (n = 60). Factor analysis identified two principal domains (‘Health and personal care’ and ‘Social care and support’) accounting for 66% of variance, and suggested a large general factor underpinning the NPCS. Internal consistency was high (alpha = 0.94) and repeatability acceptable. Intraclass coefficients for domain scores were healthcare 0.67 (95% confidence interval (CI) 0.48–0.80); personal care 0.83 (0.73–0.90); rehabilitation 0.65 (0.45–0.78); social/family support 0.66 (0.46–0.79) and environment 0.84 (0.74–0.90). Linear-weighted kappas for item-by-item agreement ranged from 0.42 to 0.83. Concurrent validity was demonstrated through correlations with measures of dependency and community integration. Conclusions: Notwithstanding a 50% response rate after six months, the NPCS has good internal consistency, a robust two-factor structure, acceptable test–retest reliability and initial evidence of concurrent validity.