Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, February 15, 2024

The Delphi of ORACLE: An Expert Consensus Survey for the Development of the Observational Risk Assessment of Contractures (Longitudinal Evaluation)

 If your assessment decided that contractures were likely; WHAT EXACTLY ARE THE PROTOCOLS TO PREVENT THAT?  With no answer your research was woefully lacking in usefulness. LEADERS SOLVE PROBLEMS, DON'T JUST DESCRIBE THEM!

The Delphi of ORACLE: An Expert Consensus Survey for the Development of the Observational Risk Assessment of Contractures (Longitudinal Evaluation)

Abstract

Objective

Despite rising prevalence rates, no standard tool is available to identify individuals at risk of developing contractures. This study aimed to gain expert consensus on items for the development of the Observational Risk Assessment Tool for Contractures: Longitudinal Evaluation (ORACLE) for care home residents.

Design

A two-round, online modified Delphi study.

Participants

Panellists were qualified healthcare professionals with a background in physiotherapy, occupational therapy, nursing, and rehabilitation medicine.

Main outcome measures

In the first round, the experts were asked to rate the predesigned list of items on a Likert scale while in the second round, consensus was sought in the areas of disagreement identified in the previous round.

Results

The two rounds of the Delphi survey included 30 and 25 panellists, respectively. The average clinical and academic experience of the panellists was 22.2 years and 10.5 years, respectively. The panel demonstrated a high level 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) ranging from 70% to 100%.

Conclusion

This Delphi study determined expert consensus on items to be included in a contracture risk assessment tool (ORACLE). The items were related to factors associated with joint contractures, appropriate preventive care interventions, and potentially relevant contextual factors associated with care home settings. The promise of a risk assessment tool that includes these items has the capacity to reduce the risk of contracture development or progression and to trigger timely and appropriate referrals to help prevent further loss of function and independence.

Introduction

Contractures, commonly defined as restrictions in the passive joint range, are preventable but debilitating consequence of prolonged immobility, eventually leading to structural abnormalities within the impacted joint.1 This can lead to further deterioration in the limb and joint flexibility and physical mobility, potentially leading to further physical impairments, decreased independence with everyday activities, and reduced quality of life.2,3 Contractures may vary from marginal restriction at a single joint to severe limitations in the range of motion affecting several joints simultaneously.4 Based on the severity of functional loss at a joint, contractures can be categorised as (i) severe, (ii) moderate or clinically relevant, or (iii) clinically non-relevant.5 The development of progressive joint contractures often follows an insidious pattern, and their initial progression is neither painful nor disabling. Joints only become painful when stretched beyond the point of soft-tissue restriction. For this reason, contractures are often unrecognised by individuals and their caregivers until they become clinically relevant, that is, start interfering with daily functional activities.6
Evidence suggests that individuals living in long-term care facilities are predominantly sedentary7; hence, they are at a higher risk of developing contractures.8 Long-term care settings demonstrate a considerable variation in the prevalence of contractures spanning from 22% to 75% in at least one joint.4,912 Contracture prevalence was found to be higher in the upper extremities compared with the lower extremities,4,10 with the shoulder and knees being the most commonly affected joints.4 When considering the impact of mobility on contracture development, there is evidence that 70.5% of non-ambulatory care home residents developed a contracture compared with the ambulatory group, which developed none.13
Structured risk assessments play an important role in referring patients to the appropriate healthcare practitioner and enacting early treatment strategies to reduce the risk of the condition progressing. In addition, standard risk assessments are also vital to offer appropriate guidance for risk protection and to have confidence in the tool being used.14 The need for a structured and systematic risk assessment of individuals at risk of developing contractures has been identified in the literature.15 Despite the reported high prevalence rates, there is a clear lack of a standard, evidence-based measure that can actively identify individuals at risk of developing contractures or worsening of existing contractures in long-term facilities and trigger appropriate and timely referrals to healthcare professionals.
The aim of the current study was to systematically establish the components of Observational Risk Assessment for Contractures: Longitudinal Evaluation (ORACLE) for care home residents, based on multidisciplinary healthcare expert consultation and consensus. The aimed users of the tool will be a range of staff, including healthcare assistants and registered nurses, who are the primary care providers in a care home. During the delivery of care, their regular clinical observations are vital in order to identify the individuals at risk of developing contractures. ORACLE will potentially translate the clinical observations of the care home staff in a systematic fashion, thereby ensuring consistency in identifying the risk, calibrating that risk, helping them prescribe a set of actions in response to the level of risk, and tracking subsequent changes in the risk regularly.


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