SAFETY AND EFFICACY OF PHYSICAL RESTRAINTS FOR THE ELDERLY - REVIEW OF THE EVIDENCE

OBJECTIVE To critically review evidence on the safety and efficacy of physical restraints for the elderly and to provide family physicians w ith guidelines for rational use of restraints. DATA SOURCES Articles c ited on MEDLINE (from 1989 to November 1994) and Cinahl (from 1982 to 1994) under the MeSH heading ''physical restraints.'' STUDY SELECTION Articles that specifically dealt with the safety and efficacy ofmstrai nts and current patterns of use, including prevalence, risk factors, a nd indications, were selected. Eight original research articles were i dentified and critically appraised. DATE EXTRACTION Data extracted con cerned the negative sequelae of restraints and the association between restraint use and fall and injury rates. General data about current p atterns of restraint use were related to safety and efficacy findings. DATE SYNTHESIS No randomized, controlled trials of physical restraint use were found in the literature. A variety of study designs, includi ng retrospective chart review, prospective cohort studies, and case re ports, found little evidence that restraints prevent injury. Some evid ence suggested that restraints might increase risk of falls and injury . Restraint-reduction programs have not been shown to increase fall or injury rates. Numerous case reports document injuries or deaths resul ting from restraint use or misuse. CONCLUSIONS Although current eviden ce does not support the belief that restraints prevent falls and injur ies and questions their safety, further prospective and controlled stu dies are needed to clarify these issues. Information from review and r esearch articles was synthesized in this paper to produce guidelines f or the safe and rational use of restraints.