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Prevalence and variability in use of physical restraints in intensive care units: A systematic review and
Akbar Zare-Kaseb1, Sogand Sarmadi1, Neda Sanaie2
1Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Background:
Given the varying perspectives on the use of physical restraint (PR) over the past decades and the provided protocols to minimise its occurrence in intensive care units (ICUs), a comprehensive study was deemed necessary to examine the prevalence and variation of PR use in ICUs.
Objective:
The aim of this study was to estimate the overall proportions of PR utilised in adult ICUs whilst examining the various factors contributing to the variability of these estimates.
Methods:
A search of five databases (PubMed, Cochrane Library, Scopus, Embase, and Web of Science) was performed. Studies published in English and available online from inception to December 18, 2024, were included. A pooled estimate with a 95% confidence interval was calculated, and the data were represented by the random-effect model. Analysis was performed using the STATA statistical software (version 17).
Results:
The meta-analysis included 39 studies, with a sample size of 21 665 patients. The overall prevalence of patients exposed to PRs was 41.6% (95% confidence interval: 33.8%-49.5%). The heterogeneity was significantly high (I2 = 99.61%), and the Q Cochrane test for homogeneity was significant (p value < 0.001), indicating substantial variability between studies. Subgroup analysis regarding the continent and restraint method contributed to a lowered heterogeneity.
Conclusions:
There was considerable variation in reported estimates of PR prevalence in adult ICUs. Despite valid guidelines and recommendations supporting the reduction of PR, the results of our study show its significant prevalence. Additionally, our study demonstrated a relationship between PR use and delirium, sedation use, and mechanical ventilation. This study emphasises the importance of managing and focussing on PRs in ICUs. Also, it is crucial to evaluate barriers to guideline implementation.
Registration:
The systematic review protocol has been prospectively registered in the International Prospective Register of Systematic Reviews: CRD42024566480.
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