The optimal intervention for preventing physical restraints among older adults living in the nursing home: A systematic review.
Su-Hua Liang, Tzu-Ting Huang
PMID 36826390WHAT IT FOUND
Multifactorial programs reduced physical restraint use in five of seven trials.
Education alone showed mixed results. No increase in falls or psychotropic drugs. Bed rail definition inconsistency limits certainty. Run by nurse specialists or unit leaders.
Key findings
01Five of seven included trials demonstrated effectiveness in reducing restraint rates among residents, while one showed no effect and another found the control group reduced restraint more than the intervention.
02Restraint reduction programs did not significantly increase falls, fall-related injuries, psychotropic drug use, or behavioural symptoms across the included studies.
03Multifactorial interventions combining policy, education, consultation, and alternatives were identified as more effective than education or consultation alone for improving care provider knowledge and reducing restraint use.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only Chinese and English literature and excluded unpublished studies, which may introduce publication bias. Meta-analysis was not possible due to incomplete data and significant heterogeneity in how physical restraint was defined, especially regarding bed rails. Four of the seven trials had dropout rates or loss to follow-up exceeding 20%, which may affect the reliability of the results. The search was limited to studies explicitly labeled as 'restraint reduction programs', potentially omitting relevant interventions with different terminology.
Declared interests
The authors received no specific funding for this work and declared no conflicts of interest.
The easy way to misread this
Do not assume that education alone is sufficient to reduce physical restraints. The evidence supports multifactorial interventions that include policy changes and consultation. Additionally, be aware that inconsistent definitions of restraint, particularly regarding bed rails, mean that reported success rates may vary significantly depending on local facility policies.