Abstract
[Purpose] This systematic review and meta-analysis evaluated interventions for reducing the use of physical restraints in hospitalized and institutionalized older adults with neurocognitive disorder and dementia.
[Methods] We conducted a literature review according to the Cochrane Handbook. The eligibility criteria were as follows: i) intervention performed for hospitalized or institutionalized older adults with neurocognitive disorder or dementia, ii) studies that included physical restraint as outcome criterion, and iii) randomized controlled trials. Review Manager 5 was used for the data analysis. We applied a random effect model, calculated the risk ratio, and then assessed heterogeneity using I2 statistic.
[Result] Fourteen studies fulfilled the inclusion criteria. Four studies suggested a significant decrease in physical restraint by the staff education. The educational programs ranged in duration from 30 minutes to 16 hours, and the contents included the following: philosophical theory, delirium prevention, decision making of the use of physical restraint, care not to use physical restraint, dementia care, and reinforcement of the interaction with residents. Six studies on staff education involving 1,355 participants were identified in the meta-analysis. The intervention of implementing an educational program did not have a significant difference (RR = 0.88, 95% CI = 0.72-1.08 ; I2 = 70%), and blinding and case attribution biases were found.
[Conclusion] Staff education suggested an effectiveness in reducing the use of physical restraints for institutionalized older adults with neurocognitive disorder and dementia by the qualitative evaluation. However, the evidence was shown to be limited because statistically significant difference is not found in the meta-analysis.
