The effectiveness of physical restraints in reducing falls among adults in acute care hospitals and nursing homes: a systematic review.
BACKGROUND
Physical restraint was introduced as the primary measure to maintain patient safety in preventing falls. However, physical restraints may lead to complications such as functional loss, immobility, delirium, pressure sore, and even falls or injuries. Despite all these negative effects and many alternatives that are available, physical restraint is still commonly used in hospitals and nursing homes. Hence, it is crucial to understand the effectiveness of physical restraints in protecting adult patients from falling.


OBJECTIVE
The overall objective was to examine the effectiveness of physical restraints in reducing falls among adults in acute care hospitals and nursing homes.


METHODS
This review considered quantitative designs, including randomised controlled trials, quasi-experimental studies, cohort studies, case control studies and case series/reports.The participants of this review were male and female adult patients aged 18 years or over who are on authorized physical restraints in acute care hospitals and nursing homes.This review focused on studies that investigated physical restraint as an intervention for reducing falls among adults in acute care hospitals and nursing homes.The outcomes of interest were the number of individuals receiving restraints who fall, or the rate or number of falls in acute hospitals and nursing homes.


METHODS
A three-step search strategy was utilised in this review. An initial limited search of MEDLINE and CINAHL was undertaken, followed by a second search using all identified keywords and index terms across all included databases. Thirdly, the reference list of all identified reports and articles was searched for additional studies. All searches were limited to English Language studies and there was no limit in the timeframe.
The quality of the included studies was subjected to assessment by two independent reviewers using the standardised critical appraisal tools from the Joanna-Briggs Institute from the JBI-MAStARI (Joanna Briggs Institute-Meta-Analysis of Statistics Assessment and Review Instrument).


METHODS
Data was extracted from included papers using the standardised extraction tool from the JBI MASTARI.


RESULTS
Due to the heterogeneous nature of the study methods, the findings of this review are presented in a narrative summary.


RESULTS
Nine studies were included in the review. The majority of the findings showed that physical restraints were not associated with the reduction in falls and decreased restraint use did not contribute to more falls.


CONCLUSIONS
From the overall results, physical restraints are not effective in reducing falls or injuries among adults in acute care hospitals and nursing homes.National standards and application guides for physical restraints are recommended. The use of physical restraints should be assessed by trained staff based on individualised need and consideration of patient's autonomy and integrity. The awareness of appropriate physical restraint usage should be enhanced among the healthcare professionals.Large multicentre research to determine the risk and benefit ratio of physical restraints and to examine the effectiveness of alternative measures, different number of bedrails, intermittent restraint use and restraint reduction programs are needed respectively.
1. Tang Wing Sze. Singapore National University Hospital (NUH) Centre for Evidence Based Nursing. 2. Dr Chow Yeow Leng. Singapore National University Hospital (NUH) Centre for Evidence Based Nursing. Telephone: +65-94526773. Facsimile: +65-67767135. yeow_leng_chow@nuhs.edu.sg 3. Dr Serena Koh Siew Lin. Singapore National University Hospital (NUH) Centre for Evidence Based Nursing. Telephone: +65-91133702. Facsimile: +65-63258374. Email: serena_koh@nuhs.edu.sg.
Tang Wing
TW
Sze
Chow Yeow
CY
Leng
Serena Koh Siew
SK
Lin