{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T17:41:07Z","timestamp":1761932467035,"version":"build-2065373602"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008473","name":"Bournemouth University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008473","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Dorset HealthCare University Foundation Trust"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Contractures are a common but preventable consequence of immobility and inactivity among residents living in care homes. There is a rising prevalence and subsequent impact of contractures on care home residents, leading to the development of a risk assessment tool for contractures, Observational Risk Assessment for Contractures: Longitudinal Evaluation (ORACLE). This qualitative study aims to explore the experience of care staff regarding the usability, acceptability, and practical implementation of ORACLE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative study using a partly deductive and pragmatic approach was conducted through semi-structured interviews with care home staff in England. The care staff members were selected via purposive sampling and were interviewed either through videoconferencing or in person in a private room at care homes. The interviews were recorded and transcribed verbatim. The data collected was coded using NVivo and synthesised using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten care staff members were interviewed from five care homes (four senior staff members and six healthcare assistants). Three overarching themes were identified: 1) usability of ORACLE, 2) acceptability of ORACLE and 3) contextual factors that can potentially influence the practical implementation of ORACLE in a care home setting. Respondents found the tool to be user-friendly and well-integrated within existing care routines. The study also identified factors relating to care home processes, the people involved, the training environment, and the policy context that tend to support or inhibit the effective implementation of ORACLE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study offers preliminary insights into the usability and acceptability of ORACLE and its application in a care home setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0335658","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T17:27:48Z","timestamp":1761931668000},"page":"e0335658","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Insights from the care home staff on the use of observational risk assessment of contractures: Longitudinal evaluation (ORACLE): A qualitative study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6273-5921","authenticated-orcid":true,"given":"Hina","family":"Tariq","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Collins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Porter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"pone.0335658.ref001","volume-title":"DeLisa\u2019s physical medicine and rehabilitation. principles and practice","author":"E Halar","year":"2012"},{"key":"pone.0335658.ref002","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/BLO.0b013e3180308456","article-title":"The epidemiology of major joint contractures: a systematic review of the literature","volume":"456","author":"D Fergusson","year":"2007","journal-title":"Clin Orthop Relat Res"},{"issue":"8","key":"pone.0335658.ref003","first-page":"26","article-title":"Are joint contractures in patients with Alzheimer\u2019s disease preventable?","volume":"18","author":"N Jamshed","year":"2010","journal-title":"Ann Long-Term Care"},{"issue":"11","key":"pone.0335658.ref004","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1080\/09638288.2022.2071480","article-title":"Factors associated with joint contractures in adults: a systematic review with narrative synthesis","volume":"45","author":"H Tariq","year":"2023","journal-title":"Disabil Rehabil"},{"issue":"3","key":"pone.0335658.ref005","first-page":"147","article-title":"Joint contractures in older age. A systematic literature review","volume":"43","author":"I Gnass","year":"2010","journal-title":"Z Gerontol Geriatr"},{"issue":"8","key":"pone.0335658.ref006","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1111\/j.1532-5415.1988.tb07172.x","article-title":"Risk factors associated with immobility","volume":"36","author":"S Selikson","year":"1988","journal-title":"J Am Geriatr Soc"},{"issue":"13","key":"pone.0335658.ref007","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1080\/09638280010029930","article-title":"Contractures in orthopaedic and neurological conditions: a review of causes and treatment","volume":"23","author":"SE Farmer","year":"2001","journal-title":"Disabil Rehabil"},{"issue":"2","key":"pone.0335658.ref008","doi-asserted-by":"crossref","first-page":"110","DOI":"10.5435\/JAAOS-D-15-00697","article-title":"Joint Contractures Resulting From Prolonged Immobilization: Etiology, Prevention, and Management","volume":"25","author":"CT Born","year":"2017","journal-title":"J Am Acad Orthop Surg"},{"issue":"1","key":"pone.0335658.ref009","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1186\/s13063-019-3522-1","article-title":"Improved participation of older people with joint contractures living in nursing homes: feasibility of study procedures in a cluster-randomised pilot trial","volume":"20","author":"S Saal","year":"2019","journal-title":"Trials"},{"issue":"3","key":"pone.0335658.ref010","first-page":"269","article-title":"Prevalence of functioning and disability in older patients with joint contractures: a cross-sectional study","volume":"51","author":"U Fischer","year":"2015","journal-title":"Eur J Phys Rehabil Med"},{"key":"pone.0335658.ref011","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1471-2318-13-18","article-title":"Impact of joint contractures on functioning and social participation in older individuals--development of a standard set (JointConFunctionSet): study protocol","volume":"13","author":"M M\u00fcller","year":"2013","journal-title":"BMC Geriatr"},{"issue":"9","key":"pone.0335658.ref012","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1007\/s11136-016-1262-1","article-title":"Quality of life in older individuals with joint contractures in geriatric care settings","volume":"25","author":"M Heise","year":"2016","journal-title":"Qual Life Res"},{"issue":"3","key":"pone.0335658.ref013","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3109\/09638288.2014.913707","article-title":"Joint contractures in the intensive care unit: quality of life and function 3.3 years after hospital discharge","volume":"37","author":"H Clavet","year":"2015","journal-title":"Disabil Rehabil"},{"issue":"4","key":"pone.0335658.ref014","first-page":"338","article-title":"The prevalence of joint contractures in residents in NHS continuing care","volume":"54","author":"B Yip","year":"1996","journal-title":"Health Bull (Edinb)"},{"issue":"4","key":"pone.0335658.ref015","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.gerinurse.2007.09.002","article-title":"Contractures in frail nursing home residents","volume":"29","author":"LM Wagner","year":"2008","journal-title":"Geriatr Nurs"},{"issue":"1","key":"pone.0335658.ref016","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jamda.2021.05.036","article-title":"Factors associated with development of new joint contractures in long-term care residents","volume":"23","author":"K Lam","year":"2022","journal-title":"J Am Med Dir Assoc"},{"issue":"7","key":"pone.0335658.ref017","doi-asserted-by":"crossref","first-page":"529","DOI":"10.3109\/09638288.2013.800596","article-title":"Contractures with special reference in elderly: definition and risk factors - a systematic review with practical implications","volume":"36","author":"M Offenb\u00e4cher","year":"2014","journal-title":"Disabil Rehabil"},{"issue":"3","key":"pone.0335658.ref018","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0029-6465(22)01539-0","article-title":"The omnibus budget reconciliation act of 1987. A policy analysis","volume":"24","author":"M Kelly","year":"1989","journal-title":"Nurs Clin North Am"},{"issue":"5","key":"pone.0335658.ref019","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1177\/02692155241229285","article-title":"The Delphi of ORACLE: An Expert Consensus Survey for the Development of the Observational Risk Assessment of Contractures (Longitudinal Evaluation)","volume":"38","author":"H Tariq","year":"2024","journal-title":"Clin Rehabil"},{"issue":"10","key":"pone.0335658.ref020","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1002\/jac5.1441","article-title":"Research and scholarly methods: semi\u2010structured interviews","volume":"4","author":"OA Adeoye\u2010Olatunde","year":"2021","journal-title":"J Am Coll Clin Pharm"},{"issue":"6","key":"pone.0335658.ref021","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"1","key":"pone.0335658.ref022","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough? An experiment with data saturation and variability","volume":"18","author":"G Guest","year":"2006","journal-title":"Field Methods"},{"key":"pone.0335658.ref023","first-page":"19","article-title":"Doing reflexive thematic analysis","volume-title":"Supporting research in counselling and psychotherapy: Qualitative, quantitative, and mixed methods research","author":"V Braun","year":"2023"},{"issue":"1","key":"pone.0335658.ref024","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/160940690600500107","article-title":"Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development","volume":"5","author":"J Fereday","year":"2006","journal-title":"Int J Qual Methods"},{"issue":"4","key":"pone.0335658.ref025","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2024-002923","article-title":"Development and evaluation of a quality improvement educational video on joint contractures for care home staff","volume":"13","author":"H Tariq","year":"2024","journal-title":"BMJ Open Qual"},{"issue":"1","key":"pone.0335658.ref026","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1186\/s12913-021-07214-5","article-title":"Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions","volume":"21","author":"R Flynn","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"5","key":"pone.0335658.ref027","doi-asserted-by":"crossref","first-page":"218","DOI":"10.12968\/ijpn.2005.11.5.218","article-title":"A research study to identify facilitators and barriers to outcome measure implementation","volume":"11","author":"M Dunckley","year":"2005","journal-title":"Int J Palliat Nurs"},{"key":"pone.0335658.ref028","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jclinepi.2015.05.006","article-title":"Simplification of a scoring system maintained overall accuracy but decreased the proportion classified as low risk","volume":"69","author":"S Sanders","year":"2016","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"pone.0335658.ref029","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s13012-020-01027-6","article-title":"Implementation outcome instruments for use in physical healthcare settings: a systematic review","volume":"15","author":"Z Khadjesari","year":"2020","journal-title":"Implement Sci"},{"key":"pone.0335658.ref030","unstructured":"Oates JL. Skills fade: a review of the evidence that clinical and professional skills fade during time out of practice, and of how skills fade may be measured or remediated. 2014."},{"issue":"2","key":"pone.0335658.ref031","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"E Proctor","year":"2011","journal-title":"Adm Policy Ment Health"},{"issue":"6","key":"pone.0335658.ref032","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/j.1945-1474.2005.tb00583.x","article-title":"Organizational change and quality improvement in nursing homes: approaching success","volume":"27","author":"J Rosen","year":"2005","journal-title":"J Healthc Qual"},{"issue":"1","key":"pone.0335658.ref033","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1002\/gps.4727","article-title":"Feasibility of a staff training and support programme to improve pain assessment and management in people with dementia living in care homes","volume":"33","author":"A Petyaeva","year":"2018","journal-title":"Int J Geriatr Psychiatry"},{"issue":"14","key":"pone.0335658.ref034","doi-asserted-by":"crossref","first-page":"7581","DOI":"10.3390\/ijerph18147581","article-title":"The effect of providing staff training and enhanced support to care homes on care processes, safety climate and avoidable harms: evaluation of a care home quality improvement programme in England","volume":"18","author":"S Damery","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"pone.0335658.ref035","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afac014","article-title":"Contextual factors influencing complex intervention research processes in care homes: a systematic review and framework synthesis","volume":"51","author":"G Peryer","year":"2022","journal-title":"Age Ageing"},{"key":"pone.0335658.ref036","unstructured":"Goodman C, Sharpe R, Russell C, Meyer J, Gordon A, Dening T. Care home readiness: a rapid review and consensus workshops on how organisational context affects care home engagement with health care innovation. 2017."},{"issue":"3","key":"pone.0335658.ref037","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1002\/rnj.190","article-title":"Examining Functioning and Contextual Factors in Individuals with Joint Contractures from the Health Professional Perspective Using the ICF: An International Internet-Based Qualitative Expert Survey","volume":"41","author":"U Fischer","year":"2016","journal-title":"Rehabil Nurs"},{"issue":"4","key":"pone.0335658.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0250595","article-title":"Nutritional status, dementia, and mobility among nursing home\u2019s residents: First exhaustive cross-sectional study in Limousin territory (France)","volume":"16","author":"P Fayemendy","year":"2021","journal-title":"PLoS One"},{"issue":"3","key":"pone.0335658.ref039","doi-asserted-by":"crossref","first-page":"145","DOI":"10.4274\/ejgg.galenos.2022.2021-10-5","article-title":"Relationship between polypharmacy and geriatric syndromes in older nursing home residents","volume":"4","author":"F\u00d6K Ko\u00e7ak","year":"2022","journal-title":"Eur J Geriatric Gerontol"},{"issue":"6","key":"pone.0335658.ref040","doi-asserted-by":"crossref","DOI":"10.3399\/BJGPO.2021.0167","article-title":"Excessive polypharmacy and potentially inappropriate prescribing in 147 care homes: a cross-sectional study","volume":"5","author":"C MacRae","year":"2021","journal-title":"BJGP Open"},{"issue":"4","key":"pone.0335658.ref041","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1111\/j.1365-2648.2012.06076.x","article-title":"Institutional peer support mediates the impact of physical declines on depressive symptoms of nursing home residents","volume":"69","author":"DY Yeung","year":"2013","journal-title":"J Adv Nurs"},{"issue":"7","key":"pone.0335658.ref042","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-016875","article-title":"Associations between physical function and depression in nursing home residents with mild and moderate dementia: a cross-sectional study","volume":"7","author":"LAH Kv\u00e6l","year":"2017","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0335658.ref043","first-page":"59","article-title":"Enhancing well-being and quality of life: the importance of physiotherapy and physical activity for the elderly in nursing home facilities","volume":"25","author":"J Khalaily","year":"2023","journal-title":"Cross-Cultural Manag J"},{"key":"pone.0335658.ref044","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1159\/000491818","article-title":"Effects of physical activity in nursing home residents with dementia: a randomized controlled trial","volume":"46","author":"M Henskens","year":"2018","journal-title":"Dement Geriatr Cogn Disord"},{"key":"pone.0335658.ref045","volume-title":"The state of health care and adult social care in England in 2011\/12","author":"Commission CQ.","year":"2012"},{"issue":"7","key":"pone.0335658.ref046","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/00000446-200207000-00046","article-title":"Developing a restorative care program","volume":"102","author":"B Resnick","year":"2002","journal-title":"Am J Nurs"},{"issue":"1","key":"pone.0335658.ref047","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1123\/japa.2012-0139","article-title":"Barriers to physical activity and restorative care for residents in long-term care: a review of the literature","volume":"22","author":"K Benjamin","year":"2014","journal-title":"J Aging Phys Act"},{"key":"pone.0335658.ref048","unstructured":"The fundamental standards [updated 4 April 2024. Care Quality Commision (CQC)]. Available from: https:\/\/www.cqc.org.uk\/about-us\/fundamental-standards"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335658","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T17:27:56Z","timestamp":1761931676000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335658"}},"subtitle":[],"editor":[{"given":"Van Thanh Tien","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0335658","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}