BackgroundPhysical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily.MethodsWe conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated.ResultsThe prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7–88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1–87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents.ConclusionsThe prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.

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Título: Validación de la Escala de Vínculos Interpersonales de Apoyo VIDA. Resumen: El Apoyo Social es uno de los factores determinantes del nivel de salud mejor documentados. Las diferencias culturales y en el uso de la lengua entre España y otros países de habla española aconsejan prudencia en el empleo de los mismos instrumentos de medida. Además, los instrumentos validados en España se han basado en muestras muy específicas y pequeñas. El objetivo de este estudio ha sido el desarrollo de un cuestionario de Apoyo Social para propósitos generales que supere esas limitaciones. Método: se llevaron a cabo análisis factoriales exploratorio y confirmatorio, así como un estudio de la consistencia interna, la fiabilidad, validez convergente, validez de contenido y legibilidad en una muestra de 1080 participantes (48.2% mujeres, edad media 33.51). Resultados: hallamos, replicamos y confirmamos (con muy buen ajuste) una estructura de tres factores (Apoyo de Amigos, Familia y Personas Relevantes) que explican una varianza cercana al 73%, con una excelente consistencia interna (.94 o más) y fiabilidad, y con indicios significativos de validez convergente con otras medidas de Apoyo Social y de salud relacionadas. Conclusiones: los paráme-tros de validez estructural, consistencia interna, fiabilidad y validez convergente tomados en su conjunto, presentan un perfil optimizado en comparación con el resto de los cuestionarios revisados. Palabras clave: apoyo social; análisis factorial exploratorio; análisis factorial confirmatorio; consistencia interna; fiabilidad; validez convergente; validación cruzada.Abstract: Social Support is one of the most well documented factors influencing health outcomes. Cultural differences and language use between Spain and other Spanish-speaking countries advise caution in the use of the same measurement instruments. Furthermore the instruments validated in Spain have been developed with very specific or small samples. The aim of this instrumental study was to develop a new general purpose Social Support Questionnaire that overcomes these limitations. Method: With a sample of 1080 participants (48.2% women, mean age 33.51), an exploratory and confirmatory factor analysis was conducted, examining its internal consistency, reliability, convergent validity, content validity and readability. Results: A three-factor structure (Friends, Family and Significant Others Support) was replicated and confirmed (with a very good fit), explaining nearly 73% of the variance with an excellent internal consistency (.94 or more) with significant evidence of convergent validity with other related measurements of Social Support and Health. Conclusions: The parameters of structural validity, internal consistency, reliability and convergent validity, taken together, present an optimized profile when compared to the rest of the reviewed surveys.

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