A Cochrane review [Abstract] 1 included 5 studies with a total of 1551 subjects. All trials investigated educational approaches vs. usual care aimed at reducing the use of physical restraints (PR) in long-term geriatric care settings. PR was defined as any limitation of freedom of movement, including belts or chairs with fixed tables, but also restrictive clothes and electronic measures which could restrict a person's movement (e.g. sensor mats or motion alarm systems). In all studies the interventions comprised an educational program. In addition, consultation or guidance for nursing staff was offered in 4 studies. Four studies examined nursing home residents and one study residents in group dwelling units. Follow-up ranged from 6 to 12 months. Studies revealed inconsistent results. One study in the nursing home setting documented an increase of PR use in both groups after 8 months; while the other 3 studies found reduced use of PR in the intervention groups after 7 and 12 months of follow up, respectively. The single study examining residents in group dwelling units found no change in PR use in the intervention group after 6 months, whereas PR use increased significantly in the control group.
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment), inconsistency (heterogeneity in patients and interventions), imprecise results (limited study size for each comparison) and indirectness of evidence (differences in usual care).
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