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Quality appraisal of guidelines on physical restraints in intensive care units: A systematic review
Nianqi Cui1, Yuping Zhang1, Qian Li2
1Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China.
Background:
Guidelines concerning the use of physical restraints in medical facilities have been published and amended over the years. However, the quality and suitability of these guidelines have not been appraised.
Objectives:
This study aims to assess the suitability and quality of guidelines for the use of physical restraints in intensive care units with the AGREE-REX and AGREE Ⅱ instruments.
Methods:
A systematic search of electronic databases (e.g., EMBASE), cross-database search platforms (e.g., Clinical Key), guideline web portals (e.g., Guidelines International Network) and society websites (e.g., Society of Critical Care Medicine) was conducted from January 2011 to December 2020. The methodological quality was assessed using AGREE Ⅱ, and the recommendation quality and suitability were assessed using AGREE-REX instruments.
Results:
A total of eight guidelines were included. The criteria for overall quality and suitability of guidelines for the use of physical restraints were met by 50-72% and 59-76%, respectively. The "Values and Preferences" domain had the lowest score (38% ± 9%). The criteria for methodological quality of the guidelines were met by 50-83%. Two domains, "Applicability" and "Editorial Independence", achieved lower scores. There was a strong, positive correlation between the overall methodological quality of guidelines and the overall quality of recommendations (r = 0.968).
Conclusion:
There is a potential feasibility of guideline adaptation for the management of physical restraints. In order to implement a physical restraint guideline, the following aspects should be considered: (i) minimize the use of physical restraints, (ii) analyze barriers and facilitators relative to the local context, (iii) consider any specifications, and (iv) modify recommendations to local situation or individual conditions of the patient.
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