Approaches used to prevent and reduce the use of restrictive practices on adults with learning disabilities: Protocol for a realist review

Abstract

Introduction The use of restrictive practices has significant adverse effects on the individual, care providers and organisations. This review will describe how, why, for whom, and in what circumstances approaches used by healthcare organisations work to prevent and reduce the use of restrictive practices on adults with learning disabilities. Methods and analysis Evidence from the literature will be synthesised using a realist review approach - an interpretative, theory-driven approach to understand how complex healthcare approaches work in reducing the use of restrictive practices in these settings. In step 1, existing theories will be located to explore what approaches work by consulting with key topic experts, holding consultation workshops with healthcare professionals, academics, and experts by experience, and performing an informal search to help develop an initial programme theory. A systematic search will be performed in the second step in electronic databases. Further searches will be performed iteratively to test particular subcomponents of the initial programme theory, which will also include the use of the CLUSTER approach. Evidence judged as relevant and rigorous will be used to test the initial programme theory. In step three, data will be extracted and coded inductively and deductively. The final step will involve using a realist logic of analysis to refine the initial programme theory in light of evidence. This will then provide a basis to describe and explain what key approaches work, why, how and in what circumstances in preventing and reducing the use of restrictive practices in adults with learning disabilities in healthcare settings. Results Findings will be used to provide recommendations for practice and policymaking. Registration In accordance with the guidelines, this realist review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 4th December 2019 (CRD42019158432).

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“…The review protocol has been registered with PROSPERO (CRD42023443783) on the 13/10/23 prior to review commencement. The review will follow five iterative stages based on Pawson’s realist methodology, although the process of moving through the steps will proceed in a non-linear fashion [ 26 , 29 , 30 ] Fig 1 provides an overview of the five steps to be applied in this review [ 31 , 32 ].…”

“…Further programme theory refinement will use data identified via formal literature searches [ 25 – 27 ]. Once the initial programme theory has been developed as per Step 1, we will then be able develop the search strategy in full, as in other reviews [ 25 , 26 , 33 , 34 , 35 ]. For all searches, searching will be designed, piloted and conducted by one researcher (IF) with support from the project team and an academic librarian.…”

“…Inclusion and exclusion criteria will be finalised by the project team following Step 1. Disagreements will be resolved by discussion and recourse to an independent member of the project team until consensus is achieved [ 26 , 32 ].…”

“…All 1–3-star documents will be reviewed again before finalisation of the programme theory (ies) to confirm appropriate classification [ 35 , 43 , 44 ]. A random subsample of the 10% of final documents for inclusion based on their assigned relevance and rigour judgement will be selected and assessed independently by another member of the research team (LS/EC/IM/JH/EW) to identify systematic errors [ 26 , 32 ]. The remaining 90% of decisions will be made by IF, although a number of these may require further discussion/joint reading between the wider project team due to issues of uncertainty regarding relevance and/or rigour.…”

“…This need to account for context and to address questions of how and why interventions work provides the rationale for using realist review methods in this evidence synthesis [ 25 ]. Realist reviews aim to move from empirical observation to developing theoretical causal explanations to understand what it is about interventions that generate change (i.e., the mechanisms), and under what circumstances the mechanisms are triggered (i.e., the contexts), which result in changes in behaviour of the participants of the intervention (i.e., the outcome) [ 26 ]. These three elements i.e., context, mechanism, and outcome configurations (CMOC), are presented together as a programme theory which attempts to describe what needs to happen for the intervention to work.…”