The ORACLE study
Research type
Research Study
Full title
Development, validation, and evaluation of a risk assessment tool for contractures: the ORACLE study
IRAS ID
318311
Contact name
Sam Porter
Contact email
Sponsor organisation
Bournemouth University
Clinicaltrials.gov Identifier
Pending, Clinicaltrials.gov
Duration of Study in the UK
1 years, 6 months, 3 days
Research summary
Contractures, usually defined as the reduction in the passive joint movement, are a debilitating consequence of prolonged immobility, eventually resulting in structural abnormalities within the affected joint, limiting functional use of the joint. Consequently, leading to physical impairments, decreased independence with everyday activities, and reduced social participation.
To our knowledge, there is no standardised risk predictor for contracture development or contracture progression in adults. The Observational Risk Assessment for Contractures- Longitudinal Evaluation (ORACLE) was originally developed by Dorset Health Care University NHS Foundation Trust (DHUFT) to address this gap.
To establish the academic validation of the tool, DHUFT sponsored a match-funded PhD Studentship with Bournemouth University (BU). This PhD research project aims to further develop, validate, and evaluate the tool through the available evidence, expert opinion, and testing it on a target sample population.
This project has been structured into two phases:
In the first phase, the content (items) of the tool was evaluated through the analysis of the available literature and expert opinion. This was achieved through a systematic review of the literature (published) followed by a two-round online survey with 30 field experts (Delphi Survey) which was conducted after getting favourable opinion and approval from the BU ethics panel. The experts in the survey rated the items of the tool on an importance scale and those which gained consensus (70% agreement) were used to redesign and modify the tool.
The current study (Phase II) consists of two streams of work: Stream A: aims to establish the validity and reliability of the newly modified tool by testing it on a sample of adults (aged 18 and above) in private/independent care homes located in Dorset. In Stream B, the acceptability and usability of the tool among the care home staff will be explored. The results from these two streams of work will then inform further revisions of the tool if required.Lay summary of study results:
People who live in care homes can sometimes develop contractures. A contracture happens when a joint, such as a knee, elbow or finger, becomes stiff or stuck in one position. This can occur when a person is unable to move easily, for example, after a stroke or when they spend long periods in bed or sitting in a chair.
Contractures can cause pain, make everyday activities such as getting dressed or eating more difficult, and increase the amount of support a person needs from care staff. The good news is that contractures can often be prevented if people at risk are identified early and encouraged to move safely and regularly.
At present, there is no standard way for care home staff to assess who might be at risk of developing contractures.
To address this, we developed a new assessment tool called the Observational Risk Assessment for Contractures: Longitudinal Evaluation, known as ORACLE. The tool helps care staff identify residents who may be at risk of developing contractures and decide when to ask for specialist support.
The ORACLE project had two parts. The first part tested whether the tool works well and gives reliable results. The second part explored how care home staff felt about using it in everyday practice. Together, these studies form what is known as a mixed methods study, which means that the researchers combined numbers and statistics with people’s experiences to get a full understanding.
The first study looked at how well the ORACLE tool worked in real care home settings. It involved 224 residents from eight care homes in Dorset, England. The researchers compared ORACLE scores with another well-known measure called the Barthel Index, which looks at how much help a person needs with daily activities. They also checked whether different members of staff gave similar scores when using ORACLE. Overall, the study showed that ORACLE is a valid and reliable way to identify residents who may be at risk of developing contractures.The second study focused on the views and experiences of care home staff using ORACLE in their daily work.
Researchers interviewed ten members of care staff, including senior carers and healthcare assistants, from five care homes in England. Overall, staff found ORACLE to be a practical, useful and acceptable tool for everyday care.When the results from both studies are combined, they show that ORACLE is both scientifically sound and suitable for use in real care homes.
This means that the tool works well in theory and is also practical and easy for care staff to use in practice.
ORACLE has real potential to help care staff recognise people who are at risk of contractures early, take action sooner, and improve the quality of life for residents.
The next step will be to test how well ORACLE works over time, for example whether regular use helps reduce the number or severity of contractures.REC name
London - Camberwell St Giles Research Ethics Committee
REC reference
22/LO/0818
Date of REC Opinion
18 Jan 2023
REC opinion
Further Information Favourable Opinion