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

Abstract

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.

Quality of reporting of complex healthcare interventions and applicability of the CReDECI list - a survey of publications indexed in PubMed

“…The quality of reporting in these trials was judged as good for the intervention development and piloting phases. Thus, our findings are contrary to previous analyses of the quality of reporting on complex interventions [12,13,41]. However, the trials included in our sample are more likely to fulfil the CReDECI criteria, since all trials confirmed adherence to the MRC framework.…”

“…While two trials reported on nearly all criteria, six trials offered information only on half of the items or even less. These results confirm the findings from previous studies [9,11,12,42]. Only half of the trials included an evaluation of the implementation process (CReDECI criterion 12).…”

“…These studies evaluated interventions on defined topics, e.g. care of people after stroke [13] and reduction of physical restraints in geriatric care [12], or specific methodological aspects of research on complex interventions [10,11]. An evaluation of the reporting quality of a sample of systematically identified complex interventions explicitly adhering to the MRC framework has not been performed so far.…”

Community-Based Home Healthcare Project for Korean Older Adults

“…A previous study reported that educational programs targeting nursing staff might not be effective in reducing the use of physical restraints in geriatric long-term care [28]. However, our results show that the participation in the education program on the prevention of elderly abuse increased by 160.2% through this project.…”

Psychometric Testing of the Agitation Severity Scale for Acute Presentation Behavioral Management Patients in the Emergency Department

“…In fact, although there is a paucity of literature reporting restraint-associated benefit, there is an abundance of literature reporting complications of restraint use, such as injury and death (Bowers et al, 2012;Gerolamo, 2006;Hatta et al, 2007;Mohr, Petti, & Mohr, 2003;Zun, 2003). In addition, restraint use has been associated with increased length of hospital stay (Mion et al, 1989, Robbins, Boyko, Lane, Cooper, & Jahnigen, 1987, higher mortality (Mion et al, 1989;Robbins et al, 1987;Zun, 2003), increased rates of nosocomial infections (Mion et al, 1989;Robbins et al, 1987), increased incidence of falls (Mion et al, 1989;Möhler, Richter, Köpke, & Meyer, 2012;Tinetti, Liu, & Ginter, 1992), and aggression-coercion cycles for both patients and staff (Goren, Singh, & Best, 1993;Substance Abuse and Mental Health Service Administration, 2011). A recent integrative review of the qualitative literature revealed that patients often experience physical restraint as demeaning and with negative psychological impacts such as retraumatization in those with previous traumatic experiences (Strout, 2010).…”