New Interventions Reduce Restraint Use in Nursing Homes

Researchers at the University of Hamburg (Germany) conducted a cluster randomized controlled trial in two German cities for a six month duration between February 2009 and April 2010. Nursing homes were eligible if they had 20% or more residents with physical restraints. In all, using concealed randomization, 18 nursing home clusters were included in the intervention group (2,283 residents) and 18 in the control group (2,166 residents). The primary outcome was the percentage of residents with at least one incident of physical restraint at 6 months' follow-up. Secondary outcomes were the number of falls and fall-related fractures.

The results showed that all nursing homes completed the study, and all residents were included in the analysis. At baseline, 30.6% of control group residents had physical restraints versus 31.5% of intervention group residents. At six months, the rates were 29.1% versus 22.6%, respectively, a difference of 6.5%. All physical restraint measures were used less frequently in the intervention group, and the rates remained stable for 3-6 months. There were no statistically significant differences in falls, fall-related fractures, and psychotropic medication prescriptions. The study was published in the May 23, 2012, issue of the Journal of the American Medical Association (JAMA).

“The intervention aimed to address the three main components of the model: attitudes, subjective norms, and perceived behavioral control,” explained lead author Sascha Köpke, PhD, and colleagues. “As opposed to other guideline-based interventions, the central recommendation ... is not to apply physical restraints. The main message of the guideline and the related intervention is that it is possible to refrain from using restraints.”

The guideline- and theory-based multicomponent intervention was based on a specifically developed evidence-based guideline, and applied the theory of planned behavior. The components involved were group sessions for all nursing staff; additional training for nominated key nurses; and supportive material for nurses, residents, relatives, and legal guardians.

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