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. 2023 Aug 4;11(15):2204. doi: 10.3390/healthcare11152204

Table 2.

Reasons given for using physical restraint.

Author, Year, Country Aim and Purpose of Study Design and Study Population Reasons
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 experiencing physical restraint
Impaired mobility, dementia, risk of fall, history of repeated falls, mobility
Ben Natan et al., 2010 [64], Israel To identify and analyze major variables affecting the decision of nursing staff to physically restrain elder residents of long-term care facilities. Descriptive correlational study: 10 4 nurses in a geriatric care institution Dementia, physical state, stress of elder residents, cognitive impairment: 10%
Risk of fall: 53.8%
Risk of self-injury: 80.8%
Threatening the lives of others: 66.3%
Delvalle et al., 2020 [49], Brazil To estimate the prevalence of mechanical restraints in nursing homes and factors associated with their performance. Cross-sectional study:
443 elderly in 14 nursing homes
Risk of falls: 66.7%
Agitation, aggressiveness, wandering: 21.2%
Lack of institutional protocol or medical request: 9.1%
Alzheimer’s Disease: 3.0%
Estévez-Guerra et al., 2017 [50], Spain To examine the prevalence of physical restraint on long-term care residents with the ability to move voluntarily. Cross-sectional observational and correlational multi-center study: 920 long-term care residents Prevent falls, impaired cognitive status
Feng et al., 2009 [17], Canada, Finland, Hong Kong, Switzerland, and USA To compare inter- and intra-country differences in the prevalence of physical restraint and antipsychotic medications in nursing homes. Population-based, cross-sectional study: 14,504 residents of nursing homes Longer resident stays were associated with higher physical restraint use rate in Switzerland
Larger facilities had a lower rate of physical restraint use in Canada and Finland
Older age was associated with reduced physical restraint use only in the USA.
Foebel et al., 2016 [24], Czech Republic, England, Finland, France, Germany, Israel, Italy, and the Netherlands To explore antipsychotic medications and physical restraint 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 Dependent: 55.8%
Incontinence: 97.1%
Severe CI: 59.6%
Hallucinations: 14.4%
Delusions: 14.4%
Wandering: 24.0%
Disrobing in public: 34.6%
Verbally abusive: 27.9%
Physically abusive: 16.4%
Socially inappropriate: 30.8%
Resist care: 4.8%
History of falls: 12.5%
Hamers et al., 2004 [29], the Netherlands To examine the prevalence of physical restraint use in cognitively impaired nursing home residents, the manner in which restraints are used, reasons for using them, and relationships between residents’ characteristics and the use of physical restraint. A point prevalence study:
260 nursing home residents
Prevent falls: 80%
Restlessness: 24%
Safe use of medical devices: 1%
Poor mobility
Care dependency
Risk of falling in the opinion of nursing staff
Heckman et al., 2017 [12], Canada To describe the clinical complexity of older institutionalized persons with PD, and examine patterns and predictors of restraint use and prescription of antipsychotics in this population. Cross-sectional cohort study: 7851 Complex Continuing Care (CCC) residents with a recorded diagnosis of PD History of falls
Cognitive impairment
Aggressive behavior
Delusions or hallucinations
Behavioral symptoms
Functional impairment
Urinary incontinence
Shortage of physicians
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, 23 wards in 7 nursing homes
Bathing dependency
Transfer difficulties
Risk for falls
Frequent restlessness/agitation
Heinze et al., 2012 [38], Germany To investigate factors related to the use of restraints and to explore whether the number of nurses is an influencing factor regarding the use of restraints in German nursing homes and hospitals. A secondary analysis of a cross-sectional study:
5521 residents
Care dependency
Impaired mobility
Bedfast
Urinary incontinence
History of falls
Polypharmacy
High risk of falls
Disorientation/confusion
Hofmann et al., 2015 [41], Switzerland To investigate the prevalence and types of physical restraint 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 Age
Degree of care dependency
Mobility limitation
Verbal agitation
Physical agitation
Risk/history of fall and/or fracture
Huizing et al., 2007 [37], the Netherlands To investigate the relationship between the use of physical restraints with psycho-geriatric nursing home residents and the characteristics of organizations and residents. Cross-sectional study:
371 residents
Age: 84.0%
Female: 78.6%
Cognitive status: 4.5%
ADL: 4.6%
Nursing staff workload: 3.1%
Higher job autonomy (nursing staff): 3.0%
Immobility: 3.0%
Koczy et al., 2011 [54], Germany To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints on residents of nursing homes. Cluster-randomized controlled trial: 333 residents in 45 nursing homes Limited physical mobility
Female
High need for care
Köpke et al., 2012 [55], Germany To reduce physical restraint 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 Negative experiences of nurses
Concerns and uncertainties of relatives and legal guardians
Organizational problems (e.g., staff fluctuation)
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
Impaired activities of daily living
Impaired cognitive function
Negative mood
Bowel and bladder incontinence
Dementia
Mamun and Lim, 2005 [23], Singapore To assess the use and complications related to the use of physical restraints in Singapore nursing homes. Mixed method study:
390 nursing home residents
Dementia
Prevent falls: 18.7%
Prevent dislodgement of feeding tubes: 22%
Injury to self: 31.2%
Injury to others: 8.6%
Wandering: 23.7%
Shouting: 36.6%
Agitation: 8.8%
Meyer et al., 2009 [57], Germany To investigate the prevalence of physical restraints, the frequency with which the devices areapplied, 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
Degree of disablement
Cognitive impairment
Fracture
Repeated verbal agitation
Øye et al., 2017 [32], Norway To investigate what kind of restraint is used in three nursing homes and to investigate how staff use restraint under different nursing home contexts by comparing three nursing home settings. Mixed-method study:
38 nursing home staff
Resident mix
Staff culture
Location
Human resources
Agitation
Aggressiveness
Wandering
Saarnio and Isola, 2010 [65], Finland To describe the perceptions of nursing staff regarding the use of physical restraint in the institutional care of older people. Qualitative study:
21 nursing home nurses
Requests by the patient’s family
Aggressive
Untidy
Exposes him/herself
Wandering
Lack of legislation
Wang et al., 2022 [61], China To identify the relationship between the theory of planned behavior (TPB) constructs and the nursing staff’s use of physical restraint in LTCFs. Cross-sectional survey:
316 nursing staff in 6 Chinese LTCFs
Prevent falls
Residents with feeding tubes

CG: Control group; CI: Cognitive impairment; IG: Intervention group; LTCF: Long-term care facility; RCT: Randomized controlled trial.