Use of multicomponent intervention linked with decrease in using physical restraint in nursing homes

May 22, 2012

Nursing homes that used a multicomponent intervention that included staff training and supportive materials for staff, residents and relatives had a lower rate of use of physical restraints such as bilateral bed rails and belts, according to a study in the May 23/30 issue of JAMA.

Despite unambiguous legal regulation and evidence for lack of effectiveness and safety, are still frequently administered in , with a recent survey reporting physical restraint rates of more than 20 percent for U.S. nursing homes, according to background information in the article. "Nursing home care does not necessitate the administration of physical restraints, as demonstrated by our own epidemiological research. We found pronounced center variation, with best-practice centers applying very few physical restraints. Reasons for differences between centers are unclear, but the 'culture of care,' as reflected in the attitudes and beliefs of nursing staff, may determine observed variation. Accordingly, a 'culture change' has been demanded for nursing homes because avoidance of physical restraints is mandatory from a professional point of view," the authors write.

Sascha Kopke, Ph.D., of the University of Hamburg, Germany, and colleagues tested the effectiveness of a guideline- and theory-based multicomponent intervention to reduce the prevalence of physical restraints used in nursing homes. The of 6 months' duration was conducted in 2 German cities between February 2009 and April 2010. Nursing homes were eligible if they had 20 percent or more residents with physical restraints. Eighteen nursing home clusters were included in the intervention group (2,283 residents) and 18 in the (2,166 residents). All nursing homes completed the study and all residents were included in the analysis.

The intervention was based on a specifically developed evidence-based guideline and applied the theory of planned behavior. Components were group sessions for all nursing staff; additional training for nominated key nurses; and supportive material for nurses, residents, relatives, and legal guardians. Control group clusters received standard information. The primary measured outcome was the percentage of residents with physical restraints (bilateral bed rails, belts, fixed tables, and other measures limiting free body movement) at 6 months, as assessed through direct unannounced observation by investigators on 3 occasions during 1 day.

At the beginning of the study, the prevalence of physical restraint use was comparable between groups: 31.5 percent in the intervention group vs. 30.6 percent in the control group. After 6 months, physical restraint prevalence was significantly lower in the intervention group, 22.6 percent, vs. 29.1 percent in the control group. All physical restraints were used less frequently in the intervention group compared with the control group. At 3 months, results were similar: : 23.9 percent, vs. 30.5 percent in the control group.

The researchers also found that results for falls, fall-related fractures, and prescriptions of psychotropic medication showed no statistically significant differences between groups.

"… considering the consistent effects after 3 and 6 months, we are confident that a 'culture change' has been achieved, resulting in a continuing avoidance of physical restraints. As it seems infeasible to further optimize the intervention with justifiable effort, more pronounced reduction or even complete prevention of physical restraint use may require more stringent implementation of legal regulations with clear penalties. The results of this study are likely generalizable to countries with comparable legal and professional conditions."

The authors note that the guideline in their study was merely the basis for the intervention, not its central component. "As opposed to other guideline-based interventions, the central recommendation is not to perform a certain action, i.e., not to apply physical restraints. Therefore, the main message of the guideline and the related is that it is possible to refrain from using restraints."

Explore further: Prevalence of pressure ulcers among black high-risk nursing home residents related to site of care

More information: JAMA. 2012;307[20]:2177-2184.

Related Stories

Prevalence of pressure ulcers among black high-risk nursing home residents related to site of care

July 12, 2011
Among nursing home residents at high risk for pressure ulcers, black residents had higher prevalence rates than white residents from 2003 through 2008, with the disparity largely related to the higher rates among nursing ...

For expert comment: Missouri nursing homes have happy clients, MU researchers say

March 27, 2012
As loved ones age and face challenges that prevent them from living on their own, family members often struggle with the decision to place their relatives in nursing homes. Sometimes viewed as last alternatives, long-term ...

Recommended for you

To reduce postoperative pain, consider sleep—and caffeine

August 18, 2017
Sleep is essential for good mental and physical health, and chronic insufficient sleep increases the risk for several chronic health problems.

Despite benefits, half of parents against later school start times

August 18, 2017
Leading pediatrics and sleep associations agree: Teens shouldn't start school so early.

Doctors exploring how to prescribe income security

August 18, 2017
Physicians at St. Michael's Hospital are studying how full-time income support workers hired by health-care clinics can help vulnerable patients or those living in poverty improve their finances and their health.

Schoolchildren who use e-cigarettes are more likely to try tobacco

August 17, 2017
Vaping - or the use of e-cigarettes - is widely accepted as a safer option for people who are already smoking.

Federal snack program does not yield expected impacts, researchers find

August 17, 2017
A well-intentioned government regulation designed to offer healthier options in school vending machines has failed to instill better snacking habits in a sample of schools in Appalachian Virginia, according to a study by ...

In a nutshell: Walnuts activate brain region involved in appetite control

August 17, 2017
Packed with nutrients linked to better health, walnuts are also thought to discourage overeating by promoting feelings of fullness. Now, in a new brain imaging study, researchers at Beth Israel Deaconess Medical Center (BIDMC) ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.