Quality appraisal of clinical practice guidelines on physical restraints in ICU: a systematic review

Physical restraint has been regarded as a protective measure in the intensive care unit (ICU) in order to avoid unexpected events. But a great number of researches have proven that physical restraints can cause bad influences on patients' mental health, such as language delays of children, sense of uncertainty, loss of trust, etc. However, it is unclear whether there are currently high-quality clinical practice guidelines (CPGs) to guide clinical practice in physical restraints. So we aim to analyze available CPGs on physical restraints in ICU with Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluating methodological quality and Reporting Items for Practice Guidelines in Healthcare (RIGHT) evaluating reporting quality.

We systematically searched PubMed, Embase, Web of Science, CINAHL, CNKI (Chinese database), Wanfang data (Chinese database), relevant websites (GIN, NICE, SIGN, RNAO, AHRQ, AACN), and Google from their inception to Nov 21, 2021. Two reviewers independently use the AGREE II tool and RIGHT checklist to evaluate methodological and reporting quality of included guidelines on physical restraints in ICU. The number and proportion of reported items of RIGHT checklist and the scores of each domain of AGREE II were calculated. We also evaluated the consistency among the reviewers via use of the intragroup correlation coefficient.

A total of six guidelines were included. The mean AGREE II score for the included guidelines was 39.56% with a range of 30.27-69.85%. No guideline was "high quality", and only one guideline was "moderate quality" with 69.85% mean AGREE II score. The mean RIGHT reporting score for guidelines was 41.0% with a range of 24.7-77.7%. Only one guideline was "moderate-reported" with a mean reporting score of 77.7%.

In general, the methodological and reporting quality of physical restraints guidelines is low, and future development or updating of high-quality guidelines to guide clinical practice is needed.