Table 4.

Summary of the review according to the PAGER framework.

Patterns	Advances	Gaps	Evidence for Practice	Research Recommendations
Prevalence of Physical Restraint	Strong evidence supports the substantial use of PR in nursing homes, particularly from studies in countries with large elderly populations. Discussion of the possibility of creating physical restraint-free nursing homes.	Lack of extensive observational studies on the prevalence of physical restraints in long-term care facilities. Lack of understanding of the variation in physical restraint use rates among countries.	Physical restraint use indicates poor clinical practice and should be avoided.	Research is needed to explore the reasons for using physical restraint for performing daily activities. Future research should address interventions to avoid falls to reduce physical restraint use, especially for people with cognitive impairment/dementia.
Type of PRs	A variety of physical restraint devices are used in nursing homes among elderly populations. Studies about the everyday use of bed rails and chair restraints among the elderly.	Lack of research on the reasons for using different types of physical restraint and their effects on elderly residents’ behavior.	Evidence from future research is needed.	Further investigation is required to understand whether physical restraints are associated with various health outcomes.
Factors affecting PR use	The largest number of studies reported prevention and/or fall risk as the main reason for using physical restraints, followed by challenging behaviors.	Research has only focused on patient-related reasons for using PR among the elderly in nursing homes.	Improving the skills of nursing home staff, especially nurses, to care for the elderly with cognitive and functional impairment, aggressive behavior, and fall risk is warranted to eliminate physical restraint use in nursing homes.	Further research is needed to understand the variation in physical restraint use rates among countries; it is essential to determine the individual factors specific to each country.