With the additional fee for early rehabilitation as specific ICU management in the revision of the medical treatment fees in FY2018, physical therapy in intensive care has received renewed attention in Japan. Physical therapy in intensive care covers early mobilization, airway clearance, improvement of physical functions, and prevention of complications. In addition, it also has an important role in the prevention of post-intensive care syndrome (PICS), as the respiratory function, physical functions, cognitive functions, and quality of life of the patients often continue to decline for a long time after discharge from the ICU. We published the“Minimum standards of clinical practice for physical therapists working in ICU in Japan” in 2020. This is expected not only to promote quality assurance of physical therapists working in ICU, but also enhance the understanding of the work of the physical therapists and serve as a tool for post-graduate education of physical therapists specializing in physical therapy in intensive care. The role of physical therapists in intensive care is clear. To ensure that their role in intensive care is fulfilled, physical therapists should strive to improve the quality of their work.

Objective: To identify the views of patients or their families and medical staff regarding physical restraint and its alternatives in the ICU. Methods: We performed a systematic review of qualitative studies using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. We searched MEDLINE, CENTRAL, CINAHL, and the Central Medical Journal from inception to April 28, 2019. Results: Our search identified 16 studies for inclusion. Some patients reported that they did not remember being placed under any physical restraint, while others said that physical restraint did not pose a safety problem. However, some believed that it should not be used because it violated the human rights and dignity of patients (the certainty of the evidence was low). Patients’ families believed that the use of physical restraints could not be avoided, but felt sympathetic towards patients and felt thankful for the polite explanation provided by the medical staff in this regard and their consideration for minimizing physical restraint (very low). The medical staff was worried about the adverse events that could be caused by physical restraint, but reported that they used it for safety (high). The medical staff believed that, as alternatives to physical restraint, it was important to modify the existing system, such as by hiring adequate staff and respecting the patient as a living person (high). Conclusions: The views regarding physical restraint among stakeholders were identified. Further qualitative studies with patients and their families are needed to increase the certainty of the evidence.