Table 1.
Author, Year Country |
Aim/Purpose of Study | Design and Study Population | PR Use and Methods |
---|---|---|---|
Abraham et al., 2019 [47], Germany | To evaluate the effectiveness of two versions of a guideline and theory-based multicomponent intervention to reduce physical restraints in nursing homes. | RCT-120 nursing home residents The mean age: 82.5 years |
PR: (Baseline) 18.6% Bed rails: 16.1% Any belt: 0.8% Belt in chair: 0.8% Fixed table: 1.1% Belt in bed: 0.1% Other: 3.0% |
Aranda-Gallardo et al., 2018 [48], Spain | To determine the characteristics of a typical institutionalized elderly patient who suffers a fall and to describe the physical harms resulting from this event. | Prospective cohort, multi-center study—647 nursing home residents The mean age: 81.81 years |
PR: 16.79% Bed rails: 53.53% |
Bellenger et al., 2017 [16], Australia | To investigate the nature and extent of physical restraint deaths reported to Coroners in Australia over a 13-year period. | Retrospective cohort study— 58 nursing home residents placed under physical restraint. The median age: 83 years |
PR: NI Chair restraint Bed rails Fixed table Cot sides with webbing |
Delvalle et al., 2020 [49], Brazil | To estimate the prevalence of mechanical restraint in nursing homes and the factors associated with its performance. | Cross-sectional study— 443 elderly in 14 nursing homes The mean age: 83.8 years |
PR: 7.45% Wheelchair: 27.3% Plastic chair: 18.2% Bandage: 3.0% Bed rail: 45.5% Adapted wooden rail: 3.0% Sheeting: 48.5% |
Castle and Engberg, 2009 [21], USA | To examine whether physical restraint use contributes to subsequent physical or psychological health decline. | Longitudinal study—264,068 nursing home residents | PR: 1.9% |
Estévez-Guerra et. al., 2017 [50], Spain | To examine the prevalence of PR use in long-term care residents with the ability to move voluntarily. | Cross-sectional observational and correlational multi-center study— 920 long-term care residents The mean age: 81 years |
PR: 84.9% Side rails: 84.5% Belts in chair: 26.9% Belts in bed: 9.9% Chair with attached table: 6.2% Vest: 6.1% Wrist/ankle belt: 1.2% Sleep suits: 1.2% |
Feng et al., 2009 [17], Canada, Finland, Hong Kong, Switzerland, and USA | To compare inter- and intra-country differences in the prevalence of PR and antipsychotic medications in nursing homes. | Population-based, cross-sectional study—14,504 residents of nursing homes The average age: 82–84 years |
Switzerland: 6% The USA: 9% Hong Kong: 20% Finland: 28% Canada: 31% |
Foebel et al., 2016 [24], Czech Republic, England, Finland, France, Germany, Israel, Italy, and the Netherlands | To explore antipsychotic medications and PR use and their effects on physical function and cognition in older nursing home residents. | Retrospective cohort study— 532 residents with dementia in 57 nursing homes The mean age: 85.2 years |
PR: 19.6% Trunk: 45% Chair: 55% |
Freeman et al., 2017 [25], Canada | To examine the role of physical restraint use, use of antipsychotic medications, and engagement in social activities in affecting change in cognitive status and driving cognitive decline among residents newly admitted to a Long term care facilities (LTCF). | Longitudinal Secondary data analysis— 111,052 residents in 635 LTCFs The mean age: 82.9 |
PR: 13.2% Trunk restraint: 8.5% Limb restraint: 0.3% Chair that prevents rising: 6.9% |
Gulpers et al., 2011 [35], the Netherlands | To test the effectiveness of EXBELT on reducing belt restraint usage in psychogeriatric nursing home care. | A quasi-experimental longitudinal study—405 nursing home residents The mean age: 83.3 years |
PR (Baseline): 61% Belts: 18% Wheelchair: 15% Bed: 6% Wheelchair with a locked table: 12% Special sheet: 9% Full-enclosure bedrails: 55.5% Chair on a board:1.5% Deep or overturned wheelchair: 8.5% Sleep suits: 7.5% |
Hamers et al., 2004 [29], the Netherlands | To examine the prevalence of PR use in cognitively impaired nursing home residents, the manner in which restraints are used, the reasons for using them, and the relationships between residents’ characteristics and the use of PR. | A point prevalence study— 260 nursing home residents The mean age: 81 years |
PR: 49% Bed and chair-26% Bed: 23% Bed rails: 98% Belts: 27% Belt with chairs: 57% Chairs with a table: 36% |
Heckman et al., 2017 [12], Canada | To describe the clinical complexity of older institutionalized persons with Parkinson’s disease (PD); and examine patterns and predictors of restraint use and the prescription of antipsychotics in this population. | Cross-sectional cohort study— 7851 Complex Continuing Care (CCC) residents with a recorded diagnosis of PD The mean age: 82.6 years |
PR: 18.9% Trunk: 11.3% Limb: 0.4% Chair: 11.6% |
Heeren et al., 2014 [51], USA | To examine the relationship between staffing levels and the use of physical restraints in nursing homes. | Multi-center study—570 Residents in 23 wards in nursing homes (NHs) The median age: 86 years |
PR: 47.5% |
Heinze et al., 2012 [38], Germany | To investigate factors related to the use of restraints and to explore whether the number of nurses was an influencing factor regarding the use of restraints in German NHs and hospitals. | A secondary analysis of a cross-sectional study—5521 residents The mean age: 84.9 years |
PR: 26.3% Bed rails: 25.77% Belts for fixation: 4.8% |
Hofmann et al., 2015 [41], Switzerland | To investigate the prevalence and types of physical restraints used in nursing homes in two Swiss cantons and to explore whether resident-related and organizational factors are associated with the use of physical restraints. | A multi-center cross-sectional study—1362 residents The mean age: 85.1 years |
PR: 26.8% Centre prevalence: 2.6% to 61.2% Bilateral bedrails: 20.3% Unilateral bedrails at one side of the bed with the other positioned at the wall: 5.7% Wheelchair with a locked tray table: 1.8% Belt in chair: 1.1% Sleep suits: 1.1% Chair preventing rising: 0.5% Chair with a locked tray table: 0.3% |
Huizing et al., 2007 [37], the Netherlands | To investigate the relationship between the use of physical restraints on psycho-geriatric nursing home residents and the characteristics of organizations and residents. | Cross-sectional study— 371 residents The mean age: 83 years |
PR: 56% |
Huizing et al., 2009 [52], the Netherlands | To investigate the effects of an educational intervention on the use of physical restraints on psychogeriatric nursing home residents. | A cluster-randomized trial—371 residents in a psychogeriatric nursing home The mean age: 83 years |
PR (Baseline): 51.5% Belt in chair: 10% Belt in bed: 9% Bilateral bedrails: 45% Deep or tipped chair: 18% Special sheet: 4% Sleep suits: 8% Sensor mat: 4% Infrared system: 4% |
Kirkevold and Engedal, 2004 [53], Norway | To describe the prevalence of various types of constraint in Norwegian nursing homes. | Descriptive study—1501 residents in 222 nursing home special care units The mean age: 84.4 years |
PR: 36.1% Bedrails without patients consent; 32.2% Belts or other fixing to bed: 2.3% Belts or other fixing to chair: 8.5% Other physical restraint: 3% |
Koczy et al., 2011 [54], Germany | To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes. | Cluster-randomized controlled trial—333 residents in 45 nursing homes | PR (Baseline): 6.1% |
Köpke et al., 2012 [55], Germany | To reduce PR prevalence in nursing homes using a guideline- and theory-based multicomponent intervention. | Parallel group cluster RCT—2283 residents (IG), 2166 residents (CG) in 36 nursing homes | PR (Baseline): 31.1% Restrictive bed rails: 29.1% Any waist belt: 2.9% Waist belt in bed: 0.8% Waist belt in chair: 2.4% Fixed table: 1.9% Other physical restraint: 3.8% |
Lam et al., 2017 [56], China | To review the change in the prevalence of physical and chemical restraint use in LTCFs over a period of 11 years in Hong Kong and to identify the major factors associated with their use. | Longitudinal Study—2896 Residents in 10 residential LTCFs Mean age: 83.3 years |
PR: 70.2% |
Luo et al., 2011 [27], USA | To estimate the use of different types of physical restraint and assess their association with falls and injuries among residents with and without AD or dementia in US nursing homes. | Cross-sectional study—5057 nursing home residents with Alzheimer Disease (AD) or dementia and 4224 residents without | PR: 6.99% Bed rails: 36.79% Limp: 0.40% Trunk: 3.87% Chair restraints: 3.35% |
Mamun and Lim, 2005 [23], Singapore | To assess the use and complications related to physical restraints in Singapore nursing homes. | Mixed-method study—390 nursing homes residents The mean age: 80.1 years |
PR: 23.3% |
Meyer et al., 2009 [57], Germany | To investigate the prevalence of physical restraints, the frequency with which the devices being applied and the frequency with which psychoactive medication is available on demand during 12-month follow-up, and characteristics associated with restraint use in nursing homes. | Cross-sectional study—2367 nursing homes residents The mean age: 86 years |
PR: 26.2% Bed rails: 24.5% Waist belt used in a chair or bed: 2.7% Chair with a table: 2.1% Other devices: 2.3% |
Muniz et al., 2016 [40], Spain | To implement a dementia-friendly culture as well as specific organizational skills relevant to person-centered care and environmental improvement. | Longitudinal study 4361, 2410 residents with dementia—41 Spanish nursing homes Mean age: 84.6 |
PR: 18.1% and 29.1% with dementia Bed rails: 43.5% and 56.8% Chair abdominal belt: 9.4% and 15.1% Upper body vest and perineal belt: 3.4% and 5.7% Belt in bed: 5.9% and 9.8% Wrist restraint: 0.8–1.4% |
Pellfolk et al., 2010 [58], Sweden | To evaluate the effects of a restraint minimization education program on staff knowledge, attitudes and use of PRs. | Cluster RCT—184 staff and 191 residents (IG), and 162 staff and 162 residents (CG) in dwelling units for people with dementia The mean age: 43.5 years |
PR (Baseline): 25.2% |
Pivodic et al., 2020 [59], Belgium, England, Finland, Italy, the Netherlands and Poland | To determine the frequency of physical limb and/or trunk restraint use in the last week of nursing home residents’ lives in six European countries and its association with country, resident and nursing home characteristics. | Epidemiological cross-sectional survey study—1384 deceased residents from 322 nursing homes The mean age: 83–89 years |
Belgium: 8% England: 1% Finland: 4% Italy:12% Poland: 0.4% |
Testad et al., 2016 [60], Norway | To evaluate the effect of a tailored 7-month training intervention, entitled “Trust Before Restraint”, on reducing the use of restraint, agitation, and antipsychotic medications in care home residents with dementia. | RCT—274 residents with dementia in 24 care homes. The mean age: 88.2 years |
PR: 12.4% Bedrails without the patient’s consent: 4.7% Belts or other fixing to bed: 0.4% Belts or other fixing to chair: 0.4% Physical retention: 2.9% |
Wang et al., 2022 [61], China | To identify the relationship between the Theory of Planned Behavior constructs and nursing staffs’ use of PR in LTCFs. | Cross-sectional survey—316 nursing staff in six Chinese LTCFs The mean age: 43.52 years |
PR: 25.83% |
te Boekhorst et al., 2013 [62], the Netherlands | To explore the social, mood and behavioral dimensions of the quality of life of residents under surveillance technology compared with those of residents under PR. | An explanatory study—150 nursing home residents | PR: 5.4% Fixation: 52% Restrictive chair: 48% |
Verbeek et al., 2014 [63], the Netherlands | To examine the effects of small-scale living facilities on the behavior of residents with dementia and the use of physical restraints and psychotropic drugs. | A quasi-experimental study—259 nursing home residents with AD or dementia The mean age: 82.4 years |
PR: 44% Belt: 11% (Wheel) chair with a locked table/chair on a board: 10% Deep or overturned chair: 8% Bilateral full enclosed bed rails: 40% Sleepsuits: 16% |
PR: Physical restraint; LTCF: Long-term care facilities; AD: Alzheimer’s disease; RCT: Randomized controlled trial; IG: Intervention group; CG: Control group.