A multicomponent intervention resulted in lower rates of physical restraint for residents of nursing homes, according to German researchers.
The 6-month, randomized controlled trial included 18 nursing homes (2,283 residents) in the intervention group and 18 homes (2,166 residents) in the control group. The intervention, based on evidence-based guidelines, applied the theory of planned behavior. Intervention components included group information sessions for nursing staff, training for nominated key nurses, plus supportive materials for nurses, residents, relatives and legal guardians. Control groups received traditional information.
The primary outcome measure (assessed by unannounced, masked external investigators at three time points during 1 day) was percentage of residents with restraints, including bilateral bed rails, belts, fixed tables, and other measures limiting free movement. Assessments were done at 6 months. Secondary outcomes (measured at 3 months) included restraints, falls, fall-related fractures and psychotropic medication rates.
Before the intervention, 30.6% of control group residents had restraints vs. 31.5% of intervention group residents. After 6 months, restraint rates were 29.1% for control and 22.6% for intervention residents, a difference of 6.5% between the two groups (95% CI, 0.6%-12.4%; cluster-adjusted OR=0.71; 95% CI, 0.52-0.97.
Researchers reported that rates were stable from 3 to 6 months, with all physical restraints used less frequently in the intervention group.
“As opposed to other guideline-based interventions, the central recommendation is not to perform a certain action, ie, not to apply physical restraints,” the researchers wrote. “Therefore, the main message … is that it is possible to refrain from using restraints.”