Definition and Measurement of Physical and Chemical Restraint in Long-Term Care: A Systematic Review.

Lauren M Robins,J Simon Bell,Velandai Srikanth,Terry P Haines,Den-Ching A Lee,Ralph Möhler,Keith D Hill

doi:10.3390/ijerph18073639

Abstract

This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of physical and/or chemical restraint use, or evaluated an intervention to reduce restraint use in long-term care. 86 papers were included in this review, all discussed physical restraint use and 20 also discussed chemical restraint use. Seven themes were generated from definitions including: restraint method, setting resident is restrained in, stated intent, resident capacity to remove/control, caveats and exclusions, duration, frequency or number, and consent and resistance. None of the studies reported validity of measurement approaches. Inter-rater reliability was reported in 27 studies examining physical restraint use, and only one study of chemical restraint. Results were compared to an existing consensus definition of physical restraint, which was found to encompass many of the thematic domains found within explicit definitions. However, studies rarely applied measurement approaches that reflected all of the identified themes of definitions. It is necessary for a consensus definition of chemical restraint to be established and for measurement approaches to reflect the elements of definitions.

Highlights

IntroductionFrequent use of physical and chemical restraint remains a concern in long-term care facilities internationally [1,2,3,4]
None of the studies in this review reported validity data for their measurement approach of either physical or chemical restraint use. 46 of the 73 physical restraint studies did not report any reliability of their measurement approach
This review identified a range of domains for the construct of physical restraint applied in the literature that largely overlapped with the consensus definition

Summary

Introduction

Frequent use of physical and chemical restraint remains a concern in long-term care facilities internationally [1,2,3,4]. Use of restraint has been justified on the basis of preventing harm to the individual [5,6,7,8] or to others [5,8]. Adverse consequences of physical restraint include injury, lower cognitive performance, lower performance in activities of daily living (ADLs), higher walking dependence, increased falls, pressure injuries, urinary and faecal incontinence, and death [9,10,11]. Chemical restraint use can lead to decrease in functional and cognitive performance, falls and fractures, excess sedation, and respiratory depression [12,13,14]. Prescribing of antipsychotics has been linked to an increased risk of

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