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Meta-Analysis
. 2011 Feb 16;2011(2):CD007546.
doi: 10.1002/14651858.CD007546.pub2.

Interventions for preventing and reducing the use of physical restraints in long-term geriatric care

Ralph Möhler  1 , Tanja Richter, Sascha Köpke, Gabriele Meyer
Affiliations
Meta-Analysis

Interventions for preventing and reducing the use of physical restraints in long-term geriatric care

Ralph Möhler et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Physical restraints (PR) are commonly used in geriatric long-term care. Restraint-free care should be the aim of high quality nursing care.

Objectives: To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people who require long-term nursing care (either in community nursing care or in residential care facilities).

Search strategy: The Cochrane Dementia and Cognitive Improvement Group's Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, a number of trial registers and grey literature sources were searched on 7 September 2009. The following search terms were used: "physical restraint*", bedrail*, bedchair*, "containment measure*, elderly, "old people", geriatric*, aged, "nursing home*", "care home*", "geriatric care", "residential facilit*".

Selection criteria: Individual or cluster-randomised controlled trials comparing an intervention aimed at reducing the use of physical restraints with usual care in long-term geriatric care settings.

Data collection and analysis: Two reviewers independently assessed the retrieved articles for relevance and methodological quality and extracted data. Critical appraisal of studies addressed risk of bias through selection bias, performance bias, attrition bias, and detection bias, as well as critera related to cluster designa. We contacted study authors for additional information where necessary. PR were defined heterogeneously throughout the studies. Not all studies offered sufficient data for aggregated data meta-analysis, and therefore study results are presented in a narrative form.

Main results: Five cluster-randomised controlled studies met the inclusion criteria. All of them investigated educational approaches. Two studies offered consultation in addition and two other studies offered guidance for nursing staff in addition. Four studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Three studies included only one or two nursing homes per study condition. Overall, methodological quality of studies was low.The studies revealed inconsistent results. One study in the nursing home setting documented an increase of PR use in both groups after eight months, while the other three studies found reduced use of PR in the intervention groups after seven and 12 months of follow up respectively. The single study examining residents in group dwelling units found no change in PR use in the intervention group after six months whereas PR use increased significantly in the control group.

Authors' conclusions: There is insufficient evidence supporting the effectiveness of educational interventions targeting nursing staff for preventing or reducing the use of physical restraints in geriatric long-term care.

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Conflict of interest statement

None known.

Figures

1
1
Overview of the components of the interventions.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
See this image and copyright information in PMC

References

References to studies included in this review

Evans 1997 {published data only}
    1. Evans LK, Strumpf NE, Allen‐Taylor SL, Capezuti E, Maislin G, Jacobsen B. A clinical trial to reduce restraints in nursing homes. Journal of the American Geriatrics Society 1997; Vol. 45, issue 6:675‐81. - PubMed
Huizing 2009a {published data only}
    1. Huizing A, Hamers J, Gulpers M, Berger M. A cluster‐randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents. Journal of the American Geriatrics Society 2009;57(7):1138‐48. - PubMed
Huizing 2009b {published data only}
    1. Huizing A, Hamers J, Gulpers M, Berger M. Preventing the use of physical restraints on residents newly admitted to psycho‐geriatric nursing home wards. International Journal of Nursing Studies 2009;46(4):459‐69. - PubMed
Pellfolk 2010 {published data only}
    1. Pellfolk T, Gustafson Y, Bucht G, Karlsson S. Effects of a Restraint Minimization Program on Staff Knowledge, Attitudes, and Practice: A Cluster Randomized Trial. Journal of the American Geriatrics Society 2010;58:62‐9. - PubMed
Testad 2005 {published data only}
    1. Testad I, Aasland A, Aarsland D. The effect of staff training on the use of restraint in dementia: a single‐blind randomised controlled trial. International Journal of Geriatric Psychiatry 2005;20:587‐90. - PubMed
Testad 2010 {published data only}
    1. Testad I, Ballard C, Brønnick K, Aarsland D. The effect of staff training on agitation and use of restraint in nursing home residents with dementia: a single‐blind, randomized controlled trial. Journal of Clinical Psychiatry 2010;71(1):80‐6. - PubMed

References to studies excluded from this review

Branitzki 2005 {published data only}
    1. Branitzki S, Koczy P. [ReduFix‐ a study of reducing physical restraint: preventing risk of injury]. Pflege Zeitschrift 2005;58(5):310‐3. - PubMed
Capezuti 1998 {published data only}
    1. Capezuti E, Strumpf NE, Evans LK, Grisso JA, Maislin G. The relationship between physical restraint removal and falls and injuries among nursing home residents. The journals of gerontology. Series A, Biological sciences and medical sciences 1998;53(1):M47‐52. - PubMed
Capezuti 2007 {published data only}
    1. Capezuti E, Wagner L, Brush B, Boltz M, Renz S, Talerico K. Consequences of an intervention to reduce restrictive side rail use in nursing homes. Journal of the American Geriatrics Society 2007;55:334‐41. - PubMed
Choi 2009 {published data only}
    1. Choi K, Kim J. Effects of an educational program for the reduction of physical restraint use by caregivers in geriatric hospitals. Journal of Korean Academy of Nursing 2009;39(6):769‐80. - PubMed
Dewey 2000 {published data only}
    1. Dewey K, Brill C. Decrease in restraint use in a study of a geropsychiatric unit. Journal of Psychosocial Nursing and Mental Health Services 2000;38(10):14‐8, 44‐5. - PubMed
Ejaz 1994 {published data only}
    1. Ejaz FK, Jones JA, Rose MS. Falls among nursing home residents: an examination of incident reports before and after restraint reduction programs. Journal of the American Geriatrics Society 1994;42(9):960‐4. - PubMed
Evans 2002b {published data only}
    1. Evans D, Wood J, Lambert L. A review of physical restraint minimization in the acute and residential care settings. Journal of Advanced Nursing 2002;40:616‐25. - PubMed
Frank 1996 {published data only}
    1. Frank C, Hodgetts G, Puxty J. Safety and efficacy of physical restraints for the elderly. Review of the evidence. Canadian Family Physician 1996;42:2402‐9. - PMC - PubMed
Healey 2008 {published data only}
    1. Healey F, Oliver D, Milne A, Connelly J. The effect of bedrails on falls and injury: a systematic review of clinical studies. Age and Ageing 2008;37:368‐78. - PubMed
Huizing 2006 {published data only}
    1. Huizing A, Hamers J, Gulpers M, Berger M. Short‐term effects of an educational intervention on physical restraint use: a cluster randomized trial. BMC Geriatrics 2006;26:6‐17. - PMC - PubMed
Koczy 2005 {published data only}
    1. Koczy P, Klie T, Kron M, Bredthauer D, Rissmann U, Branitzki S, et al. Effectiveness of a multifactorial intervention to reduce physical restraints in nursing home residents with dementia [Effektivität einer multifaktoriellen Intervention zur Reduktion von körpernaher Fixierung bei demenzkranken Heimbewohnern]. Zeitschrift für Gerontologie und Geriatrie 2005;38:33‐9. - PubMed
Kotynia‐English 2005 {published data only}
    1. Kotynia‐English R, McGowan H, Almeida OP. A randomized trial of early psychiatric intervention in residential care: impact on health outcomes. International Psychogeriatrics 2005;17(3):475‐85. - PubMed
Levine 1995 {published data only}
    1. Levine JM, Marchello V, Totolos E. Progress toward a restraint‐free environment in a large academic nursing facility. Journal of the American Geriatrics Society 1995;43(8):914‐8. - PubMed
Levine 2000 {published data only}
    1. Levine JM, Hammond M, Marchello V, Breuer B. Changes in bedrail prevalence during a bedrails‐reduction initiative. Journal of the American Medical Directors Association 2000;1(1):34‐6. - PubMed
McCallion 1999 {published data only}
    1. McCallion P, Toseland RW, Freeman K. An evaluation of a family visit education program. Journal of the American Geriatrics Society 1999;47(2):203‐14. - PubMed
Moretz 1995 {published data only}
    1. Moretz C, Dommel A, Deluca K. Untied: a safe alternative to restraints. Medsurg Nursing 1995;4(2):128‐32. - PubMed
Patterson 1995 {published data only}
    1. Patterson JE, Strumpf NE, Evans LK. Nursing consultation to reduce restraints in a nursing home. Clinical Nurse Specialist 1995;9(4):231‐5. - PubMed
Ralphs‐Thibodeau 2006 {published data only}
    1. Ralphs‐Thibodeau S, Knoefel F, Benjamin K, Leclerc A, Pisterman S, Sohmer J, et al. Patient choice: an influencing factor on policy‐related research to decrease bedrail use as physical restraint. Worldviews Evid Based Nurs 2006;3(1):31‐9. - PubMed
Rovner 1996 {published data only}
    1. Rovner BW, Steele CD, Shmuely Y, Folstein MF. A randomized trial of dementia care in nursing homes. Journal of the American Geriatrics Society 1996;44(1):7‐13. - PubMed
Schnelle 1992 {published data only}
    1. Schnelle JF, Newman DR, White M, Volner TR, Burnett J, Cronqvist A, et al. Reducing and managing restraints in long‐term‐care facilities. Journal of the American Geriatrics Society 1992;40(4):381‐5. - PubMed
Si 1999 {published data only}
    1. Si M, Neufeld RR, Dunbar J. Removal of bedrails on a short‐term nursing home rehabilitation unit. Gerontologist 1999;39(5):611‐4. - PubMed
Siegler 1997 {published data only}
    1. Siegler EL, Capezuti E, Maislin G, Baumgarten M, Evans L, Strumpf N. Effects of a restraint reduction intervention and OBRA '87 regulations on psychoactive drug use in nursing homes. Journal of the American Geriatrics Society 1997;45(7):791‐6. - PubMed
Steinert 2009 {published data only}
    1. Steinert T, Bohnet U, Flammer E, Lüchtenberg D, Eisele F. Effects of a training of power and balance on the use of mechanical restraint among in‐patients with dementia [Effekte eines Kraft‐ und Bewegungstrainings auf die Fixierungshäufigkeit bei Demenzpatienten in der stationären gerontopsychiatrischen Versorgung]. Psychiatrische Praxis 2009;36(6):273‐8. - PubMed
Toseland 1997 {published data only}
    1. Toseland RW, Diehl M, Freeman K, Manzanares T, Naleppa M, McCallion P. The impact of validation group therapy on nursing home residents with dementia. Journal of Applied Gerontology 1997;16(1):31‐50.
Woods 2005 {published data only}
    1. Woods DL, Craven RF, Whitney J. The effect of therapeutic touch on behavioral symptoms of persons with dementia. Alternative Therapies in Health and Medicine 2005;11(1):66‐74. - PubMed

References to ongoing studies

Gulpers 2010 {published data only}
    1. Gulpers MJ, Bleijlevens MH, Rossum E, Capezuti E, Hamers JP. Belt restraint reduction in nursing homes: design of a quasi‐experimental study. BMC Geriatrics 2010;10(1):11. - PMC - PubMed
Haut 2009 {published data only}
    1. Haut A, Köpke S, Gerlach A, Mühlhauser I, Haastert B, Meyer G. Evaluation of an evidence‐based guidance on the reduction of physical restraints in nursing homes: a cluster‐randomised controlled trial. BMC Geriatrics 2009;9:42. - PMC - PubMed

Additional references

Boutron 2008
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, CONSORT Group. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Annals of Internal Medicine 2008;148(4):295‐309. - PubMed
Cameron 2010
    1. Cameron ID, Robinovitch S, Birge S, Kannus P, Khan K, Lauritzen J, Howland J, Evans S, Minns J, Laing A, Cripton P, Derler S, Plant D, Kiel DP. Hip protectors: recommendations for conducting clinical trials‐an international consensus statement (part II). Osteoporosis International 2010;21(1):1‐10. - PMC - PubMed
Campbell 2004
    1. Campbell MK, Elbourne DR, Altman DG, CONSORT group. CONSORT statement: extension to cluster randomised trials. BMJ 2004;328(7441):702‐8. - PMC - PubMed
Castle 1998
    1. Castle N, Mor V. Physical restraint in nursing homes: a review of the literature since the nursing home reform act of 1987. Medical Care Research and Review 1998;55:139‐70. - PubMed
Castle 2009
    1. Castle NG, Engberg J. The health consequences of using physical restraints in nursing homes. Medical Care 2009;47(11):1164‐73. - PubMed
Craig 2008
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655. - PMC - PubMed
de Veer 2009
    1. Veer AJ, Francke AL, Buijse R, Friele RD. The Use of Physical Restraints in Home Care in the Netherlands. Journal of the American Geriatrics Society 2009;57(10):1881‐6. - PubMed
de Vries 2004
    1. Vries O, Ligthart G, Nikolaus T, on behalf of the participants of the European Academy of Medicine of Ageing‐Course III. Differences in period prevalence of the use of physical restraints in elderly inpatients of European hospitals and nursing homes. Journals of Gerontology A, Biological Science Medical Science 2004;59:M922‐3. - PubMed
Dielis‐van Houts 2004
    1. Dielis‐van Houts A, Schuurmans M. The balance between safety, freedom of movement and use of restraints [Een balans tussen: Veiligheid, Vrijheid en Vrijheidsbeperking]. UMC‐Utrecht, Utrecht 2004.
Engberg 2008
    1. Engberg J, Castle N, McCaffrey D. Physical restraint initiation in nursing homes and subsequent resident health. Gerontologist 2008;48:442‐52. - PubMed
Evans 2002a
    1. Evans D, Wood J, Lambert L, Fitzgerald M. Physical Restraint in Acute and Residential Care. Adelaide, The Joanna Briggs Institute 2002.
Evans 2002b
    1. Evans D, FitzGerald M. Reasons for physically restraining patients and residents: a systematic review and content analysis. International Journal of Nursing Studies 2002;39(7):735‐43. - PubMed
Feng 2009
    1. Feng Z, Hirdes JP, Smith TF, Finne‐Soveri H, Chi I, Du Pasquier JN, Gilgen R, Ikegami N, Mor V. Use of physical restraints and antipsychotic medications in nursing homes: a cross‐national study. International Journal of Geriatric Psychiatry 2009;24(10):1110‐8. - PMC - PubMed
Flaherty 2004
    1. Flaherty J. Zero tolerance for physical restraints: difficult but not impossible. Journal of Gerontology 2004;59A:919‐20. - PubMed
Hahn 2005
    1. Hahn S, Puffer S, Torgerson D, Watson J. Methodological bias in cluster randomised trials. BMC Medical research methodology 2005;5(1):10. - PMC - PubMed
Hamers 2005
    1. Hamers J, Huizing A. Why do we use physical restraints in the elderly?. Zeitschrift für Gerontologie und Geriatrie 2005;38:19‐25. - PubMed
Higgins 2009
    1. Higgins J, Greene S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.2. Available online: http://www.cochrane‐handbook.org. Accessed 01/06/2010. 2009.
Huizing 2007
    1. Huizing AR, Hamers JP, Jonge J, Candel M, Berger MP. Organisational determinants of the use of physical restraints: a multilevel approach. Social Science and Medicine 2007;65(9):924‐33. - PubMed
Joanna Briggs Institute 2002
    1. Joanna Briggs Institute. Physical Restraint ‐ Pt 2: Minimisation in Acute and Residential Care Facilities. Best Practice 2002;6(4):1‐6.
Karlsson 1996
    1. Karlsson S, Bucht G, Eriksson S, Sandman PO. Physical restraints in geriatric care in Sweden: prevalence and patient characteristics. Journal of the American Geriatrics Society 1996;44(11):1348‐54. - PubMed
Kirkevold 2004
    1. Kirkevold Ø, Engedal K. Prevalence of patients subjected to constraint in norwegian nursing homes. Scandinavian Journal of Caring Sciences 2004;18(3):281‐6. - PubMed
Lamb 2005
    1. Lamb SE, Jørstad‐Stein EC, Hauer K, Becker C, Prevention of Falls Network Europe and Outcomes Consensus Group. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. Journal of the American Geriatrics Society 2005;53(9):1618‐22. - PubMed
Lenz 2007
    1. Lenz M, Steckelberg A, Richter B, Mühlhauser I. Meta‐analysis does not allow appraisal of complex interventions in diabetes and hypertension self‐management: a methodological review. Diabetologia 2007;50(7):1375‐83. - PubMed
Meyer 2009
    1. Meyer G, Köpke S, Haastert B, Mühlhauser I. Restraint use among nursing home residents: cross‐sectional study and prospective cohort study. Journal of Clinical Nursing 2009;18:981‐90. - PubMed
MRC 2008
    1. Medical Research Council. Developing and evaluating complex interventions: new guidance. Available online: www.mrc.ac.uk/complexinterventionsguidance. Accessed 01/06/2010 2008.
Puffer 2003
    1. Puffer S, Torgerson D, Watson J. Evidence for risk of bias in cluster randomised trials: review of recent trials published in three general medical journals. BMJ 2003;327(7418):785‐9. - PMC - PubMed
Retsas 1998
    1. Retsas A. Survey findings describing the use of physical restraints in nursing homes in Victoria, Australia. International Journal of Nursing Studies 1998;35:184‐91. - PubMed
Shepperd 2009
    1. Shepperd S, Lewin S, Straus S, Clarke M, Eccles MP, Fitzpatrick R, Wong G, Sheikh A. Can we systematically review studies that evaluate complex interventions?. PLoS medicine 2009;6(8):e1000086. - PMC - PubMed
Sullivan‐Marx 1999
    1. Sullivan‐Marx EM, Strumpf NE, Evans LK, Baumgarten M, Maislin G. Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts. Journal of the American Geriatrics Society 1999;47(3):342‐8. - PubMed
Tinetti 1991
    1. Tinetti ME, Liu WL, Marottoli RA, Ginter SF. Mechanical restraint use among residents of skilled nursing facilities. Prevalence, patterns, and predictors. JAMA 1991;265(4):468‐71. - PubMed