Initial Validation of the Observational Risk Assessment of Contractures (Longitudinal Evaluation) tool in care homes: The ORACLE study - 04/11/26
, Kathryn Collins a , Joel Dunn b , Sam Porter a Highlights |
• | Care home residents are at high risk of developing joint contractures. |
• | Contractures reduce independence and increase care needs and costs. |
• | We developed an evidence-based contracture screening tool for care home residents. |
• | This study provides initial validation evidence for the screening tool. |
• | The tool may support early referral and preventive contracture management. |
Abstract |
Background |
Individuals in long-term care are highly vulnerable to contractures due to immobility and neurological impairments. Contractures cause functional decline, reduced quality of life, and increased care burden. Although early identification and intervention are important, no standardized screening tool exists to screen for their development or progression in care home settings.
Objective |
To evaluate the initial validation of the Observational Risk Assessment for Contractures: Longitudinal Evaluation (ORACLE), a newly developed evidence-based screening tool for contractures for care home residents.
Methods |
We conducted a cross-sectional observational study across 8 care homes in Dorset, UK, involving 224 adult residents. We assessed convergent validity against the modified Barthel Index (mBI). We evaluated reliability using intraclass correlation coefficients (ICCs) and weighted kappa. We examined floor and ceiling effects, and used receiver operating characteristic (ROC) analysis to assess discriminative performance and determine the optimal cut-off score for referral to specialist assessment.
Results |
ORACLE demonstrated strong convergent validity with mBI (Pearson’s r = -0.86; P P < 0.001), with > 75% of results supporting a priori hypotheses. Intra-rater (ICC = 0.99) and inter-rater reliability (ICC = 0.99) for total scores were excellent, with weighted kappa values ranging from 0.82 to 1.00 across subscales. We observed no floor or ceiling effects. ROC analysis demonstrated excellent discriminative performance (AUC = 0.89; 95% CI, 0.85–0.93), with an optimal cut-off score of 11 for referral to specialist assessment.
Conclusion |
This study provides preliminary evidence supporting the initial validation of ORACLE as a screening tool for contractures in care home residents, with good convergent validity, excellent reliability, and discriminative performance. As the cross-sectional design supports discriminative rather than predictive validity, future longitudinal studies are warranted to evaluate ORACLE's predictive validity, responsiveness, and effectiveness in reducing the incidence and/or ameliorating the severity of contractures.
Trial registration |
ClinicalTrials.gov [Details blinded for peer review].
Le texte complet de cet article est disponible en PDF.Keywords : contractures, acquired deforming hypertonia, long-term care, immobility, joint mobility, care homes
Abbreviations : ADLs, AUC, COSMIN, CQC, GCP, HCA, ICC, ICF, LoA, mBI, NHS, ORACLE, PIR, ROC, ROM, SPSS, STROBE
Plan
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?