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.