In general, my experience of programming is that the real benefit of automated refactoring tools is most fully realised when working in teams. When programming on a personal project (or as a single pair), there is less conceptual drift, and its easier to make design changes without trampling on other people. Its also okay for design changes to take a while without risk of confusion.
This may be why the Ruby/Rails community don’t (at present) find the lack of a strong IDE for ruby to be a big impediment. I think that when larger teams (6+ devs) starting developing significant projects in Ruby, the lack of tool support will begin to be felt, particularly by those who have become used to the refactoring style of working, where its okay to defer decisions like what to call methods, parameters, classes etc.