The cardiopulmonary effects of physical restraint in subjects with chronic obstructive pulmonary disease

Police officers commonly encounter violent individuals in their line of duty, with the use of physical restraint sometimes being necessary. A major criticism of previous studies of the effect of restraint on cardiac and pulmonary function has been that they have only recruited young healthy adults. This study aims to assess the cardiopulmonary effects of restraint positioning in individuals with chronic obstructive pulmonary disease (COPD). Eight patients with stable COPD were recruited. Subjects were randomly allocated to the following five positions: Wrist restraint behind the body whilst seated; wrist restraint in front of the body whilst seated; lying prone with wrists restrained behind back; lying prone with arms free; lying supine with wrists restrained in front. The outcomes measures studied were pulmonary function at 10 min. There was no significant difference in FEV1 or FVC between groups, (one way ANOVA p=0.94 and 0.99, respectively). The difference in FEV1 between the seated position and seated position with wrists restrained behind the back were also compared (p=0.8) as was the effect of wrist restraint in the prone position compared to no restraint prone (p=0.69). However, three subjects could not tolerate the prone position due to a clinical deterioration in symptoms. The response to the prone position with or without wrist restraint appears highly individual, with some individuals tolerating the prone position with no measurable clinical effects and others suffering a clinical deterioration in symptoms. The reasons for this individual variation remain unclear.