title: Effectiveness of a multifactorial intervention to reduce physical restraints in nursing home residents.
abstract: OBJECTIVE
  To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes.
  
  
  METHODS
  Cluster-randomized controlled trial.
  
  
  METHODS
  Forty-five nursing homes in Germany.
  
  
  METHODS
  Three hundred thirty-three residents who were being restrained at the start of the intervention.
  
  
  METHODS
  Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used, the adverse effects, and alternatives to their use. Technical aids, such as hip protectors and sensor mats, were provided. The training was designed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints.
  
  
  METHODS
  The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention. Secondary outcomes were partial reductions in restraint use, percentage of fallers, number of psychoactive drugs, and occurrence of behavioral symptoms.
  
  
  RESULTS
  The probability of being unrestrained in the intervention group (IG) was more than twice that in the control group (CG) at the end of the study (odds ratio=2.16, 95% confidence interval=1.05-4.46). A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG. No negative effect was observed regarding medication or behavioral symptoms. The percentage of fallers was higher in the IG.
  
  
  CONCLUSIONS
  The intervention reduced restraint use without a significant increase in falling, behavioral symptoms, or medication.
authors.affiliation: Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany. petra.koczy@rbk.de
authors.forename: Petra
authors.initials: P
authors.lastname: Koczy
authors.forename: Clemens
authors.initials: C
authors.lastname: Becker
authors.forename: Kilian
authors.initials: K
authors.lastname: Rapp
authors.forename: Thomas
authors.initials: T
authors.lastname: Klie
authors.forename: Denis
authors.initials: D
authors.lastname: Beische
authors.forename: Gisela
authors.initials: G
authors.lastname: Büchele
authors.forename: Andrea
authors.initials: A
authors.lastname: Kleiner
authors.forename: Virginia
authors.initials: V
authors.lastname: Guerra
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rissmann
authors.forename: Susan
authors.initials: S
authors.lastname: Kurrle
authors.forename: Doris
authors.initials: D
authors.lastname: Bredthauer
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D004185:Disability Evaluation; D004389:Durable Medical Equipment; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes; D011379:Prognosis; D011482:Protective Devices; D012149:Restraint, Physical / Q000009:adverse effects* / Q000706:statistics & numerical data