Important Topic, Unsatisfactorily Reported

Abstract

The article by Berzlanovich et al. (1) has been widely reported in Germany. The media rightly focus on the reported fatal consequences of using physical restraints (PR). Unfortunately, reporting in the article does not reflect current scientific standards and ignores the current state of research. The appropriateness and validity of the study cannot be assessed; a methods section and critique of methods are lacking, although the limitations of a retrospective analysis of postmortem reports are obvious. Recent research literature is not included. The given prevalence data, for example, are based on outdated or inappropriate sources. The statement that the authors' own survey study was the first to assess data on type and prevalence of PR is incorrect. Among others, our own observational study with 2367 nursing home residents in Hamburg provides reliable data on prevalence and type of PR, and the characteristics associated with their use (2). The authors also omit the latest developments regarding PR prevention strategies. The recent Cochrane review on the topic (3) is not included. After publication of the review, further randomized trials have been published, evaluating intervention programs to reduce PR—for example, Redufix (www.redufix.com) or a PR guideline (www.leitlinie-fem.de). The authors mention merely a brochure and a DVD issued by the Bavarian State Ministry. These are certainly ambitious, but were not evaluated. This also applies to assumed alternatives to PR described by the authors, such as hip protectors or strength and balance training. The concluding plea for the correct use of PR is counterproductive since the evidence implies that PR always do more harm than good.