Table 7. Physical restraint use.

First author, year	Study design, intervention length, number of sites, baseline sample size	Control condition	Education material	Training	Reminders	Audit and feedback	Mentoring or support	Champion/s	Team meetings	Policy/procedure changes	Organizational restructure	Intervention description	Staff direct behavior outcomes	Staff indirect outcomes	Resident outcomes
Huizing, 2009	RCT, 26 wks, 15 wards in 7 nursing homes, CG: 163 res; IG: 208 res	Usual care		+			+					Training for all staff on physical restraints—effectiveness, consequences, decision making processes, strategies for analyzing and responding to residents’ risk behavior. Extensive training for nursing staff with key roles on ward. Consultant visited weekly, advised nursing staff, attended multidisciplinary meetings, evaluated the use of physical restraints and discussed difficulties.	In both groups use of restraints and intensity of restraints increased over time. Compared to the CG, over time IG had decreased use of sleep suits, use of belts in bed, bilateral bedrails, and increased use of deep/tipped chairs, increased use of belts and increased use of infrared systems.
Gulpers, 2011, 2013	NRCT, 35 wks, 13 nursing homes, 26 wards, CG: 201 res; IG: 317 res	Usual care; control received treatment after 35 wks		+			+			+		Policy change by management prohibiting new use of belts and for reduction of current use. Education for staff. Consultation to ward nurses by nurse specialists regarding challenges in reducing restraints and specific resident issues. Provision of alternative interventions e.g. sensor mats, balance training, exercises, low—height adjustable beds.	Compared to CG, IG significantly decreased over time on belt use and on any type of physical restraints. No differences between groups over time in psychotropic use. Decrease in restraint use continued through to 24 months.		Indirect outcomes: No differences between groups on falls or injuries.
Kopke, 2012	Stratified, block randomized RCT, 26 wks, 36 sites, CG: 1819 res; IG: 1952 res	Print information and short presentation	+	+				+				Training on guidelines on physical restraints and alternative approaches. Guidance provided on posters, pens, mugs, and notepads. Nominated nurse from each cluster home trained on implementation process. Endorsement by nursing home leaders.	Compared to CG, IG reduced in prevalence of physical restraints. No differences between groups in psychotropic use.		Indirect outcomes: no differences between groups on falls or fall-related fractures.

NRCT, non-randomized controlled trial; RCT, randomized controlled trial; CG, control group; IG, intervention group; wks, weeks; res, residents.