Effectiveness of a Multifactorial Intervention to Reduce Physical Restraints in Nursing Home Residents

Authors

  • Petra Koczy Dr,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Clemens Becker Dr PD,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Kilian Rapp MPH, Dr,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Thomas Klie Dr Prof,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Denis Beische,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Gisela Büchele MPH,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Andrea Kleiner,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Virginia Guerra,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Ulrich Rißmann,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Susan Kurrle Dr Prof,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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  • Doris Bredthauer Dr Prof 

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Protestant University of Applied Sciences, Age Society Participation, Freiburg, Germany; §Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; and #Faculty of Health and Social Work, University of Applied Sciences, Frankfurt am Main, Germany.
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Address correspondence to Dr. Petra Koczy, Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany. E-mail: petra.koczy@rbk.de

Abstract

OBJECTIVES: To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes.

DESIGN: Cluster-randomized controlled trial.

SETTING: Forty-five nursing homes in Germany.

PARTICIPANTS: Three hundred thirty-three residents who were being restrained at the start of the intervention.

INTERVENTION: Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used, the adverse effects, and alternatives to their use. Technical aids, such as hip protectors and sensor mats, were provided. The training was designed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints.

MEASUREMENTS: The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention. Secondary outcomes were partial reductions in restraint use, percentage of fallers, number of psychoactive drugs, and occurrence of behavioral symptoms.

RESULTS: The probability of being unrestrained in the intervention group (IG) was more than twice that in the control group (CG) at the end of the study (odds ratio=2.16, 95% confidence interval=1.05–4.46). A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG. No negative effect was observed regarding medication or behavioral symptoms. The percentage of fallers was higher in the IG.

CONCLUSION: The intervention reduced restraint use without a significant increase in falling, behavioral symptoms, or medication.

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