Educational intervention on physical restraint use in long-term care facilities - Systematic review and meta-analysis

Abstract

"Physical restraint" formerly used as a measure of protection for psychiatric patients is now widely used. However, existing studies showed that physical restraint not only has inadequate effect of protection but also has negative effects on residents. To analyzes the impact of educational program on the physical restraint use in long-term care facilities.

Design: A systematic review with meta-analysis and meta-regression. Eight databases, including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, Ovid Medline and Physiotherapy Evidence Database (PEDro), were searched up to January 2017. Eligible studies were classified by intervention and accessed for quality using the Quality Assessment Tool for quantitative studies. Sixteen research articles were eligible in the final review; 10 randomize control trail studies were included in the analysis. The meta-analysis revealed that the use of physical restraint was significantly less often in the experimental (education) group (OR = 0.55, 95% CI: 0.39 to 0.78, p < 0.001) compared to the control group. Meta-regression revealed the period of post education would have decreased the effect of the restraint educational program (β: 0.08, p = 0.002); instead, the longer education period and more times of education would have a stronger effect of reducing the use of physical restraint (β: -0.07, p < 0.001; β: -0.04, p = 0.056). The educational program had an effect on the reduced use of physical restraint. The results of meta-regression suggest that long-term care facilities should provide a continuous education program of physical restraint for caregivers.

Keywords: Education; Elder; Long term care; Meta-analysis; Physical restraint.

Figure 1

Flowchart of the study selection process. The electronic searches found a total of 8051 records and 100 of additional snowball records; of these 57 full texts were retrieved for closer examination. A total of 16 articles were included in the final review and 10 randomize control trials published of studies included in meta‐analysis.

Figure 2

Forest plot of physical restraint use. The health care staffs who received educational program intervention had significant change on reduce physical restraint use.

Figure 3

Meta‐regression for post education (A), education period (B) and number of education times (C). Longer post education period, the effect of reduced physical restraint use was even less ($\text{β}$= 0.08, Q = 9.17, df = 1, p‐value: 0.002) (Fig. 3A). Longer education period, the effect of reduced physical restraint use was stronger ($\text{β}$  =  −0.07, Q = 9.68, df = 1, p‐value: 0.001) (Fig. 3B). More times of education, the effect of reduced physical restraint use was also stronger ($\text{β}$  =  −0.04, Q = 3.6, df = 1, p‐value: 0.056) (Fig. 3C).