In reply

Abstract

Editors note: The above letter was referred to the authors of the original paper, and their reply follows In reply: We are grateful to Levine and Hammond for their interest in our paper. They are right to chide us for not making clear that bedrails were not among the restraints studied in the two American studies quoted. Nevertheless, bedrails are often used as a form of restraint, and we feel it is useful to point out that similar factors are associated with the use of restraints in America and Britain, even if the types of restraints used are very different. Our comments opposing the use of bedrails as ‘enablers'referred specifically to their use in stroke patients in an acute hospital. Most modern approaches to stroke physiotherapy aim to promote recovery of the affected side and more normal movement of the whole body rather than encouraging early compensatory use of the unaffected side.1 Stroke physiotherapy in our hospital is based on the Bobath approach in which considerable emphasis is placed on inhibition of spastic movement patterns.2 Notwithstanding the continuing controversy regarding the relative benefits of different physiotherapy practices, it is clearly illogical to encourage a different pattern of movement at night to that advised by the therapists during the day. We accept that bedrails may be useful to assist bed transfers in individual patients in other settings. It is certainly possible that half-length bedrails are safer for frail older people than full-length bedrails. However, even half-length rails are likely to present a hazard to confused patients who may be unable to reason that they would be better off shuffling down the bed before trying to get out of it.