Interventions for preventing and reducing the use of physical restraints in long-term geriatric care

In geriatric long-term care, physical restraints (PR) such as bedrails and belts in bed or chair are commonly used. Nurses justify them as safety measures, primarily for the prevention of falls, for controlling disruptive behaviour and for the safe use of medical devices. However, it is questionable whether PR are effective and safe devices. There is evidence of various adverse effects such as injuries, reduced psychological well-being or decreased mobility related to the use of PR. Therefore, restraint-free care should be the aim of high quality nursing care. We reviewed whether interventions aimed at preventing and reducing the use of PR in geriatric long-term care settings are effective. We identified five small-sized randomised controlled studies suitable for inclusion. All studies examined educational interventions targeted at nursing staff. Four studies investigated residents in nursing homes and one in group dwelling units. The methodological quality of all studies was limited. Results of the studies were inconsistent. One study with higher methodological quality showed no reduction in PR use. Three other studies with lower methodological quality found their intervention to be effective. Thus, current evidence on interventions for the reduction or prevention of PR use in long-term geriatric care does not support a clear conclusion. Ongoing and unpublished research might alter the results of the review.