Data collection procedure  

Care home staff received a short training session covering education on contractures21 and the use of the assessment tools prior to the data collection.  A senior staff member completed the screening document to assess the eligibility of the residents. Following consent, a senior staff member completed a general demographic questionnaire asking for personal and health-related information about the resident (e.g., age, gender, pre-existing contractures, location of contractures, co-morbidities, etc.).  Thereafter, BI was completed by senior staff while the healthcare assistants (HCAs) conducted the ORACLE assessments. 

Outcomes  

Construct Validity: This refers to the extent to which an outcome measure reflects the theoretical construct it intends to assess. Convergent validity, a subtype of construct validity, indicates the degree to which two tools measuring similar constructs correlate. In this study, convergent validity was assessed by comparing ORACLE scores with the modified BI,  a standard measure of physical disability and assessment of performance in ADLs.  

Reliability: Reliability refers to the consistency or repeatability of a measure.

Intra-rater reliability examines how consistently a single rater scores a measure across time points, assuming no clinical change occurs between the observations. This was tested by HCAs administering ORACLE twice to the same resident during a single shift (morning and evening), with the item order shuffled in the second assessment form to reduce the learning effects and bias.

Inter-rater reliability assesses consistency between two different raters scoring the same participant. Both observations were made on the same day to ensure no clinical change occurred in the resident’s condition.  

Floor and Ceiling Effects: These occur when values of the dataset cluster at the extreme ends of a scale. The presence of these reflects limited content validity and suggests an inability to discriminate between the participants’ conditions who score at extremes, thereby reducing the overall reliability of the tool.