Evaluation of an evidence-based guidance on the reduction of physical restraints in nursing homes: a cluster-randomised controlled trial [ISRCTN34974819]

Aims and objectives. To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people requiring long-term nursing care. Background. Physical restraints are commonly used in geriatric long-term care. However, they are associated with adverse outcomes. Therefore, freedom from physical restraints should be the aim of high-quality nursing care. Design. Systematic review of randomised controlled trials. Methods. This review followed the methods of the Cochrane Handbook of systematic reviews of interventions. The systematic search (September 2009) covered the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, MED-LINE, EMBASE, CINAHL, PsycINFO and LILACS. Results. Six cluster-randomised controlled trials met the inclusion criteria. All studies investigated educational approaches targeting nursing staff. In addition, two studies offered consultation, two guidance and one support and free access to technical aids. Five studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Overall, the methodological quality of studies was low. Their results were inconsistent. One study with good methodological quality in the nursing home setting documented an increase in physical restraints use in both groups, while the other four studies with lower quality found reduced use of physical restraints in the intervention group. The single study in group dwelling units found no change in physical restraints use in the intervention group but a significant increase in the control group. 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. Relevance to clinical practice. Our findings indicate that educational programmes targeting nursing staff might not be effective in reducing the use of physical restraints in geriatric long-term care. It remains unclear which components should be included in educational programmes aiming to reduce physical restraints.

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“…One unpublished study (Koczy et al. 2005) and two ongoing studies were identified (Haut et al. 2009, Gulpers et al.…”

Section: Resultsmentioning

confidence: 99%

“…Two further studies were identified through other sources (Pellfolk et al 2010, Testad et al 2010. One unpublished study (Koczy et al 2005) and two ongoing studies were identified (Haut et al 2009, Gulpers et al 2010. The final Cochrane review analysed five studies.…”

Section: Resultsmentioning

confidence: 99%

Interventions for preventing and reducing the use of physical restraints in long‐term geriatric care – a Cochrane review

Mohler

Richter

Köpke

et al. 2012

Journal of Clinical Nursing

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“…We compared our review results with the Cochrane Review ' Interventions for preventing falls in older people living in the community ' (Gillespie 2012), and identified six other systematic reviews incorporating meta-analyses (Chan 2015; Le Blanc 2015; Sherrington 2017; Silva 2013; Stubbs 2015; Vlaeyen 2015). …”

Section: Discussionmentioning

confidence: 99%

“…Vlaeyen 2015 included 13 randomised controlled trials of fall-prevention programmes conducted in nursing homes. The authors found no significant effect of the interventions overall on the number of falls (10 studies) or risk of falling (six studies).…”

Section: Discussionmentioning

confidence: 99%

Interventions for preventing falls in older people in care facilities and hospitals

Cameron

Dyer²,

Panagoda

et al. 2018

Cochrane Database of Systematic Reviews

355

370

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Background Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. Objectives To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. Selection criteria Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. Data collection and analysis One review author screened abstracts; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. Main results Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here. Care facilities Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence). There is low‐quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%). There is moderate‐quality evidence that vitamin D supplementation (4512 particip...

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“…In a study, restraint use promoted passivity [14]. Reduced psychological wellbeing has also been observed [15]. Sullivan-Marx (1995) found withdrawal, regression and denial to be adverse responses to routine restraint use in older adults [16].…”

Section: Adverse Effects Of Restraint Usementioning

confidence: 99%

Use of Physical Restraints in a Rehabilitation Setting: Findings from a Point Prevalence Survey

Lai¹

2015

J Nurs Care

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A point prevalence survey among 125 patients in two units of a rehabilitation facility showed that the physical restraint rate was 12.8% (n=16). The survey examined the reason(s) for restraint use, whether its use had been explained, consent obtained and documented, whether the restraint had been appropriately applied and patients monitored during the period when restraint was applied, and whether alternatives had been attempted. Interestingly, six patients were found to have had their restraints removed either before or after the survey. A slightly less restrictive form of restraint, boxing gloves, was used for seven patients instead of limbs holders. Three patients remained restrained. The results of this study revealed that there was room for improvement in practice of restraints, and that measures to reduce the use of restraints were not necessarily very costly. Applying physical restraints is counter-productive to rehabilitative care. Nurses and other health disciplines need to be better informed regarding restraint reduction programs.

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Evaluation of an evidence-based guidance on the reduction of physical restraints in nursing homes: a cluster-randomised controlled trial [ISRCTN34974819]

Cited by 14 publications

References 24 publications

Interventions for preventing and reducing the use of physical restraints in long‐term geriatric care – a Cochrane review

Interventions for preventing and reducing the use of physical restraints in long‐term geriatric care – a Cochrane review

Interventions for preventing falls in older people in care facilities and hospitals

Use of Physical Restraints in a Rehabilitation Setting: Findings from a Point Prevalence Survey

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