The Delphi of ORACLE: An Expert Consensus Survey for the Development of the Observational Risk Assessment of Contractures (Longitudinal Evaluation).
Hina Tariq, Kathryn Collins, Joel Dunn and 2 others
PMID 38332642WHAT IT FOUND
Experts agreed on ten clinical factors for assessing contracture risk in care homes, including muscle weakness and pain.
They excluded spasticity and passive exercises from the tool because care assistants cannot reliably identify spasticity and evidence for passive exercises is weak.
Key findings
01The expert panel reached consensus on ten clinical factors for inclusion in the ORACLE tool, such as bed confinement, muscle weakness, and pain, but excluded spasticity.
02Passive exercises were excluded from the preventive care recommendations because the panel cited insufficient evidence for their effectiveness in preventing contractures.
03Contextual factors like staffing levels and caregiver training were identified as essential for the tool's successful implementation, though they are not part of the assessment score itself.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The panel was restricted to English-speaking experts, potentially limiting cultural diversity in the consensus. The tool has not yet been validated for reliability or usability in actual care home settings; these findings represent expert opinion on what should be included, not evidence that the tool works. There was a contradiction between expert consensus favoring stretching and systematic reviews showing limited short-term effects, leading to its exclusion from non-physiotherapist use.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by Bournemouth University and Dorset Healthcare University Foundation Trust through a match-funded PhD studentship.
The easy way to misread this
Do not assume the ORACLE tool is currently validated or ready for clinical use. This study only established expert consensus on which items to include; the tool's reliability and effectiveness in preventing contractures have not yet been tested.