title: A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short-term management of violence in adult psychiatric inpatient settings and emergency departments.
abstract: OBJECTIVE
  The aim of this review was to assess whether restraint and seclusion are safe and effective interventions for the short-term management of disturbed/violent behaviour. Staff and service user perspectives on the use of these interventions were also considered. The review was undertaken as part of the development process for a national guideline on the short-term management of disturbed/violent behaviour in adult psychiatric inpatient settings and emergency departments in the United Kingdom.
  
  
  METHODS
  An exhaustive literature search was undertaken. Systematic reviews, before and after studies, as well as qualitative studies were included. Searches were run from 1985 to 2002.
  
  
  RESULTS
  Thirty-six eligible studies were identified. However, none were randomised controlled trials. Most of the included studies had many limitations, such as small sample sizes, confounders not adequately accounted for, potential selection bias, poorly reported results, and lack of clarity as to whether mechanical restraints were used. This review must therefore be viewed as a mapping exercise, which illustrates the range and quality of studies that have been undertaken in this area to date.
  
  
  CONCLUSIONS
  Insufficient evidence is available to determine whether seclusion and restraint are safe and/or effective interventions for the short-term management of disturbed/violent behaviour in adult psychiatric inpatient settings. These interventions should therefore be used with caution and only as a last resort once other methods of calming a situation and/or service user have failed.
authors.affiliation: Royal College of Nursing Institute, Radcliffe Infirmary, Oxford, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Nelstrop
authors.forename: Jackie
authors.initials: J
authors.lastname: Chandler-Oatts
authors.forename: William
authors.initials: W
authors.lastname: Bingley
authors.forename: Tony
authors.initials: T
authors.lastname: Bleetman
authors.forename: Frank
authors.initials: F
authors.lastname: Corr
authors.forename: Jane
authors.initials: J
authors.lastname: Cronin-Davis
authors.forename: Donna-Maria
authors.initials: DM
authors.lastname: Fraher
authors.forename: Phil
authors.initials: P
authors.lastname: Hardy
authors.forename: Sophie
authors.initials: S
authors.lastname: Jones
authors.forename: Kevin
authors.initials: K
authors.lastname: Gournay
authors.forename: Sue
authors.initials: S
authors.lastname: Johnston
authors.forename: Stephen
authors.initials: S
authors.lastname: Pereira
authors.forename: Peter
authors.initials: P
authors.lastname: Pratt
authors.forename: Rick
authors.initials: R
authors.lastname: Tucker
authors.forename: Aki
authors.initials: A
authors.lastname: Tsuchiya
mesh_terms: D032763:Behavior Control / Q000379:methods; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D006801:Humans; D001523:Mental Disorders; D010356:Patient Isolation; D012149:Restraint, Physical; D017751:Safety Management; D014754:Violence / Q000517:prevention & control*