Development, Validation and Evaluation of the Feasibility of the Observational Risk Assessment of Contractures (Longitudinal Evaluation) Tool: THE ORACLE STUDY.

Abstract

Background Joint contractures are a prevalent and debilitating complication of prolonged immobility in individuals living in care homes. Despite high prevalence rates, there is no standard, evidence-based risk assessment tool to evaluate the risk of contractures and prompt early intervention. This project aimed to develop and validate ORACLE (Observational Risk Assessment of Contractures: Longitudinal Evaluation), a novel assessment tool tailored to help care staff in early identification of risk of contractures and timely initiation of preventive measures. Methods A multi-phase, sequential, mixed-methods design was adopted. The project was structured into two main phases: 1) Content validation and 2) External validation. In the first phase, three consecutive studies were conducted: a systematic review, a Delphi survey and a quality improvement (QI) study to develop an educational video. The second phase consisted of two streams of work: a) psychometric testing and b) qualitative interviews with care staff. Results Study 1: The systematic review included 47 studies and identified three categories of associated factors: sociodemographic factors, physical factors, and proxies for bed confinement. The findings informed the design of the Delphi study. Study 2: The experts demonstrated a high level (70-100%) of consensus regarding the clinical factors (10 out of 15 items), preventive care approaches (9 out of 10 items), and contextual factors (12 out of 13 items). The findings informed the development of ORACLE. Study 3: Baseline data revealed that most care staff lacked contracture knowledge. Post-intervention, the level of knowledge and understanding increased, demonstrating that introducing the educational video is a feasible and positively received method of enhancing care staff's awareness of contractures. Study 4: ORACLE demonstrated high inter-rater and intra-rater reliability and good convergent validity with Barthel Index. Study 5: Three overarching themes were identified: 1) usability of ORACLE, 2) acceptability of ORACLE and 3) contextual factors that can potentially influence the practical implementation of ORACLE in a care home setting. Conclusions This project offers new knowledge in contracture prevention by providing a novel evidence-based risk assessment tool for contractures. ORACLE is a reliable and practical tool for assessing contracture risk in care home residents, with the potential to improve preventive care in this setting. However, qualitative insights emphasise the importance of organisational support, continued staff training and ongoing support to ensure consistent application, implementation and sustainability of ORACLE.