Table 2.
Results of included studies.
| Author (Year) [Ref] | MA * | Results on Physical Restraint Use | Results on Fall Rate–Fall-Related Injuries |
|---|---|---|---|
|
Abraham et al. (2019) [27] A pragmatic cluster of randomized controlled trial |
Y | Change in any physical restraint prevalence from baseline to follow-up CG −1.2; 95% CI −0.04 to 0.11; p = 0.294 IG 1 update version: −2.8; 95% CI −5.5 to −0.01; p = 0.042 IG 2 concise version: −3.9; 95% CI −6.8 to −1.0; p = 0.009 |
≥1 Fall 12 months OR (95% CI) IG1 vs. CG: 1.17 (0.89–1.53) OR (95% CI) IG2 vs. CG: 1.03 (0.79–1.35) ≥1 Fall- related fractures OR (95% CI) IG1 vs. CG: 1.31 (0.87–1.97) OR (95% CI) IG2 vs. CG: 1.11 (0.73–1.71) |
|
Capezuti et al. (2002) [39] Pre-Post test design |
N | Side rail use immediately post (1 month) e 12 months Statistically significant effects of time and site, indicating a change over time Only one NH Site 3 showed a statistically significant decrease in the rate of restrictive side rail use over time (p = 0.01) |
Fall rate 12 months reduced discontinue restrictive side rail group −0.053; 95% CI (−0.083 to −0.024) p-value < 0.001 continued restrictive side rail group −0,013; 95% CI (−0.056 to 0.030) p-value = 0.17 |
|
Evans et al. (1997) [28] Cluster RCT |
Y | Prevalence restraint use (Individual as units of analysis) 6 month CG:45% (83/184); IG: RE: 18% (27/152); REC: 16% (20/127) 9 month CG: 42% (77/184); IG: RE: 16% (24/152); REC: 12% (15/127) 12 month CG: 43% (79/184);IG: RE: 19% (29/152);REC: 14% (18/127) Nursing home as units of analysis 6 month CG:40%; IG: RE: 19%; REC: 18% 9 month CG: 40%; IG: RE: 17%; REC: 14% 12 month CG: 42%; IG: RE: 19%; REC: 16% |
Fall rate 3 months GC vs. RE or REC (64.7% vs. 41.5% or 42.5%) p < 0.001 6 months GC vs. RE or REC (53.3% vs. 32.2% or 37.8%) p-value < 0.001 |
|
Gulpers et al. (2011) [37] Quasi Experimental |
N | At least one physical restraint device 4 months CG 64%; IG 54%; p-value 0.06 8 months CG 69%; IG 54%; p-value 0.003 |
Falls 4 months GC 14%; GI 20%; p-value 0.10 8 months GC 16%; GI 16%; p-value 0.98 Fall-related injuries 4 months GC 8%; GI10%; p-value 0.44 8 months GC 11%; GI 10%; p-value 0.66 |
|
Gulpers et al. (2012) [38] Quasi Experimental |
N | At least one physical restraint device 4 months CG 31%; IG 30%; p-value 1.00 8 months CG 36%; IG 21%; p-value 0.15 |
Falls 4 months GC 40%; GI 38%; p-value 1.00 8 months GC 30%; GI 21%; p-value 0.51 Fall-related injuries 4 months GC 10%; GI 24%; p-value 0.28 8 months GC 10%; GI 14%; p-value 1.00 |
|
Gulpers et al. (2013) [36] Quasi experimental |
N | At least one physical restraint 24 months IG: 80/134 (60%); CG: 68/91 (75%) OR 0.50, 95% CI 0.28 to 0.90, p-value = 0.020 |
|
|
Huizing et al. (2006) [29] Cluster RCT |
Y | Restraint use (prevalence) CG 40/58; IG: 45/86 OR 0.50, 95% CI 0.24 to 0.99 p-value = 0.048 Restraint intensity over time CG t0 56% t1 70%; IG t0 54%–t1 56% p-value > 0.05 |
|
|
Huizing et al. (2009a) [30] cluster RCT |
Y | Change in restrain status CG 69/115 (60%); IG: 81/126(64%) IG change t0 54% vs. t3 (8 months) 64% (p = 0.02)—at post-test 2 there were no differences CG: t0 49% vs. t2 (4 months) 57% (p = 0.02); t3 60% (p = 0.007) |
|
|
Huizing et al.(2009b) [31] cluster RCT |
Y | Not restrained vs. restraint 1 month CG: 70% (14/20)–IG: 61.8% (21/34) vs. CG 30% (6/20)–IG 38,2% (13/34); p-value 0.541 4 months CG: 67.7% (21/31) – IG: 48.8% (21/43) vs. CG 32.3% (10/31) vs. IG: 51.2% (22/43) p-value 0.105 8 months GC 59.5% (22/37)–IG: 52.8% (28/53) vs. CG 40.5% (15/37)–IG 47.2% (25/53) p-value 0.53 |
|
|
Koczy et al. (2011) [32] cluster RCT |
Y | 100% not restrained (free) 3 months CG 8.8% vs. IG 16.8% OR 2.16 (IC 95% 1.05–4.46) Restraint 3 months CG: 114/125 (91.2%); IG: 173/208 (83.2%) |
Falls 3 months GI 16.3% vs. GC 8.0%; OR 2.08 (IC 95% 0.98–4.40) |
|
Köpke et al. (2012) [15] RCT |
Y | Any physical restraint 3 months CG 30.5 (26.6–34.4) vs. IG 23.9 (19.3–28.5) MD 6.6%; 95% CI (0.6–12.6) Cluster adjusted OR 0.72; 95% CI (0.53–0.97) p-value 0.03; ICCC 0.029 6 months Difference 6.5%; 95% CI (0.6–12.4) Cluster adjusted OR 0.71; 95% CI (0.52–0.97) p-value 0.03; ICCC 0.029 |
Residents ≥1 fall during period study Difference 3%; 95% CI (−3.5 to 9.4) Cluster adjustice OR 0.85; 95% CI (0.60 to 1.21) Fractures during period study Difference 0.5%; 95% CI (−0.5 to 1.4) OR (95% CI) = 0.76 (0.42 to 1.38) |
|
Pellfolk et al. (2010) [9] cluster RCT |
Y | Physical restraint 6 months CG 38.1% (53/139); IG 20.1% (30/149) p-Value baseline/ 6 months: 0.78/0.001 OR 0.21, 95% CI 0.08–0.57, p-value 0.002 restrained baseline vs. unrestraint 6 months CG 3.6% (n = 1/28) vs. IG 31.3% (n = 10/32) (p = 0.007). unrestrained baseline vs. restrained 6 months CG 23.4% (n26/111) vs. IG 6.8% (n8/117) (p-value 0.001). |
Falls 6 months IG 10.1% vs. CG 8.6% p-Value baseline/ Follow-Up: 0.45/0.68 |
|
Rovner et al. (1996) [35] RCT |
Y | Physical restraint 6 months CG 20/38 (52.6%) vs. IG 14/41 (34.1%) OR 0.47 [95% CI 0.19 to 1.16] p-value = 0.10 |
|
|
Testad et al. (2005) [33] RCT |
Y | Frequency of use of restraint–mean (range) 7 months CG 4/55; IG 2/96 CG 3.7 (0–25); GI 1.5 (0–10); p-value = 0.016 |
|
|
Testad et al. (2010) [34] RCT |
Y | Structural restraint 6 months CG 23/70 (33%); IG 48/75 (64%) 12 months CG 6/70 (13%) IG 8/75 (18%) |
|
|
Testad et al. (2016) [26] cluster RCT |
Y | Change in any physical restraint physical restraint prevalence from baseline to /7months CG t0 10.5% vs. t1 6.1% p < 0.001; IG t0 14.5% vs. t1 10.5% p-value 0.007 |
* MA, meta-analysis; Y, yes: studies included in meta-analysis; N, Not included; CG, control group; IC, intervention group; RE, educational rehabilitation; REC, educational rehabilitation with consultation.