A review of the scientific literature related to the adverse impact of physical restraint: gaining a clearer understanding of the physiological factors involved in cases of restraint-related death

Abstract

Deaths occurring during and/or in close proximity to physical restraint have been attributed to positional asphyxia, a conclusion primarily based on opinion and reviews of case studies. This review sought to identify the current scientific evidence available in regard to the aetiology of adverse events or death occurring during or in close proximity to physical restraint. A systematic search of electronic databases (SPORTDiscus, AMED, CINAHL, MEDLINE, PsycINFO) for papers published in English, between 1980 and 2011, using keywords that related to restraint, restraint position and cardiovascular function resulted in 11 experimental papers being found for review. The term positional asphyxia as a mechanism for sudden death is poorly understood. The literature shows that restraint position has the ability to impede life-maintaining physiological functions, but that the imposed impediment is not uniform across all restraint positions/techniques. Further research is required to ascertain the risks posed by struggling during restraint for more prolonged periods of time and in different positions using varied techniques of restraint. This research should seek to and rank known or future risk factors of adverse events occurring during restraint, seeking to understand the interactions and if present the cumulative effect of these risk factors. Finally, future research should focus on populations other than apparently healthy male adults.

The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

“…A review of the literature on the adverse impact of physical restraint by Barnett et al . () also identified positional asphyxia as problematic and in particular the ‘forceful prone’ position. This was reported to be hazardous because breathing can be reduced by 15% in a face down position.…”

“…Restraint can take the singular or combined form of physical, mechanical, chemical or environmental, and has been cited as a contributory factor in the death of some individuals (Barnett et al . ).…”

Risk factors associated with physical restraints in residential aged care facilities: a community‐based epidemiological survey in Taiwan

“…Barnett et al . (), in a literature review, pointed out the mortality related to PR use. Furthermore, restrained residents, when compared with the non‐restrained, had poorer muscle strength in their legs, significantly lower Barthel Index, lower MMSE scores and took longer time for the Get‐Up & Go Test (Engberg et al .…”

Contentions mécaniques en psychiatrie : étude phénoménologique de l’expérience vécue du personnel infirmier

“…Leur utilisation est associée à une durée d'hospitalisation ainsi qu'à un taux de mortalité supérieur par rapport aux patients non « contentionnés » (Evans et al, 2003;Mohr et al, 2003;Zun, 2003). Les complications physiques incluent les blessures orthopédiques, les infections, la rhabdomyolyse, la thrombose, l'asphyxie et la mort (Mohr et al, 2003;Barnett, Stirling & Pandyan, 2012;Levinson, 2006). Strout (2010) a réalisé une recension des recherches qualitatives centrées sur l'expérience du patient « contentionné ».…”