Effectiveness of a Multifactorial Intervention to Reduce Physical Restraints in Nursing Home Residents

• Published in: Journal of the American Geriatrics Society (JAGS) 2011-02, Vol.59 (2), p.333-339
• Main Authors: Koczy, Petra, Becker, Clemens, Rapp, Kilian, Klie, Thomas, Beische, Denis, Büchele, Gisela, Kleiner, Andrea, Guerra, Virginia, Rißmann, Ulrich, Kurrle, Susan, Bredthauer, Doris
• Format: Article
• Language: English
• Subjects: Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; Aged; Aged, 80 and over; Biological and medical sciences; Clinical trials; Cluster Analysis; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; dementia; Disability Evaluation; Durable Medical Equipment; elderly; Female; General aspects; Germany - epidemiology; Humans; Incidence; Intervention; Male; Medical sciences; Neurology; nursing home; Nursing Homes; Physical restraints; Prevention and actions; Prognosis; Protective Devices; Public health. Hygiene; Public health. Hygiene-occupational medicine; Restraint, Physical - adverse effects; Restraint, Physical - utilization
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2010.03278.x

OBJECTIVES: To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes. DESIGN: Cluster‐randomized controlled trial. SETTING: Forty‐five nursing homes in Germany. PARTICIPANTS: Three hundred thirty‐three residents who were being restrained at the start of the intervention. INTERVENTION: Persons responsible for the intervention in the nursing homes attended a 6‐hour training course that included education about the reasons restraints are used, the adverse effects, and alternatives to their use. Technical aids, such as hip protectors and sensor mats, were provided. The training was designed to give the change agents tools for problem‐solving to prevent behavioral symptoms and injuries from falls without using physical restraints. MEASUREMENTS: The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention. Secondary outcomes were partial reductions in restraint use, percentage of fallers, number of psychoactive drugs, and occurrence of behavioral symptoms. RESULTS: The probability of being unrestrained in the intervention group (IG) was more than twice that in the control group (CG) at the end of the study (odds ratio=2.16, 95% confidence interval=1.05–4.46). A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG. No negative effect was observed regarding medication or behavioral symptoms. The percentage of fallers was higher in the IG. CONCLUSION: The intervention reduced restraint use without a significant increase in falling, behavioral symptoms, or medication.