The Effectiveness of Educational Training or Multicomponent Programs to Prevent the Use of Physical Restraints in Nursing Home Settings: A Systematic Review and Meta-Analysis of Experimental Studies

Abstract

This review assesses the effectiveness of interventions to reduce physical restraint (PR) use in older people living in nursing homes or residential care facilities. A systematic search of studies published in four electronic databases (MEDLINE, CINHAL, PsycINFO, Cochrane Central Register of Controlled Trials). The review included individual and cluster randomized controlled trials that compared educational training and multicomponent programs to avoid PR use. Risk bias of randomized controlled trials (RCTs) was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. This review includes 16 studies in a qualitative synthesis that met the inclusion criteria, nine of them offered a multicomponent program and seven offered only educational training. The results of the 12 studies included in the meta-analysis showed a significant trend in favor of intervention over time and intensity of PR use tends to decrease. The review indicates that educational programs and other supplementary interventions should be effective, but the heterogeneous operative definition of physical restraints can make difficult data generalization.

The Use of Physical Restraints on Geriatric Patients: Culture and Attitudes among Healthcare Professionals at Intermediate Care Hospitals in Majorca. A Qualitative Study Protocol

“…Among the outcomes expected from this study, we hope to identify the factors that determine the use of restraints as it concerns the patients themselves, their families, the healthcare professionals, and the institution. Such factors may include the educational training received [ 2 , 15 ], beliefs about restraints such as protectors [ 2 , 16 ], the evaluation and understanding of patients’ behaviour, and the professional’s responsibility towards the care recipient [ 28 ]. Furthermore, the discourse is expected to vary according to the respondent’s area of professional activity.…”

“…A study conducted in eight European countries in nursing home residents suffering from dementia revealed a prevalence of 31.4%, ranging from 6.1% in France to 83.2% in Spain [ 9 ]. The most common means of physical restraint are bilateral bed rails, trunk or limb belts, and devices such as mobility-limiting chairs or immobilising sheets [ 1 , 2 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…For all these reasons, an absence of physical restrictions, whenever possible, is recommended as the standard of care for geriatric patients [ 11 ]. Accordingly, various policies have been implemented to reduce the use of such restraints [ 11 , 15 , 25 , 37 , 38 , 39 , 40 , 41 ], including educational programmes and consultation or guidance by an expert nurse [ 15 ]. Indeed, studies have shown that the removal of physical restraints does not increase the number of falls, the severity of associated injuries [ 11 , 15 , 25 , 37 , 38 ], or the use of psychotropic drugs [ 11 , 25 , 37 , 38 , 39 , 40 ].…”

“…Accordingly, various policies have been implemented to reduce the use of such restraints [ 11 , 15 , 25 , 37 , 38 , 39 , 40 , 41 ], including educational programmes and consultation or guidance by an expert nurse [ 15 ]. Indeed, studies have shown that the removal of physical restraints does not increase the number of falls, the severity of associated injuries [ 11 , 15 , 25 , 37 , 38 ], or the use of psychotropic drugs [ 11 , 25 , 37 , 38 , 39 , 40 ]. In consequence, these restraints are neither necessary nor effective elements in preventing falls and injuries in individuals with behavioural problems [ 11 , 37 , 41 ].…”

“…In short, healthcare without physical restraint should be the paradigm of quality geriatric care. However, to achieve this, a better understanding is needed of the knowledge, attitudes, and practices regarding physical restraint in intermediate care [ 15 ]. Only by understanding the reasons for its use in this context will it be possible to determine and address the underlying factors.…”