Marques Paulo, Queirós Carmen, Apóstolo João, Cardoso Daniela
1Center for Health Technology and Services Research (CINTESIS), Escola Superior de Enfermagem do Porto, Porto, Portugal 2Centro Hospitalar do Porto, Escola Superior de Enfermagem do Porto, ICBAS - UP, Porto, Portugal 3Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal 4Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence, Coimbra, Portugal.
JBI Database System Rev Implement Rep. 2017 Oct;15(10):2527-2554. doi: 10.11124/JBISRIR-2017-003362.
Falls are a major problem today affecting adults of any age, but the elderly are a population that is more susceptible to falls. Falls are the leading cause of injury or death among older adults. Hospitalized older people are particularly vulnerable to falls. Falls cause direct injuries (minor injuries, severe wounds of the soft tissues and bone fractures) to patients and increased length of stay. The prevention of falls is commonly considered an indicator of the quality of care. Therefore, health institutions and professionals treat the identification and implementation of strategies to prevent or minimize their effects as a high priority. Fall prevention interventions involving physical restraints are still common and considered a primary preventative measure, despite controversy in their use. One of the most frequently used restraint interventions is bedrails. The question of the effectiveness of bedrails in preventing falls cuts across all societies and cultures and has with significant implications for the clinical practice of nurses.
The objective of this review was to identify the effectiveness of the use of bedrails in preventing falls among hospitalized older adults when compared with no use of bedrails or any type of physical restraints.
The current review considered studies that included hospitalized adults (female and male), 65 years and over with any clinical condition in a non-intensive care unit (ICU).
TYPES OF INTERVENTION(S): The current review considered studies that evaluated the use of bedrails as a restraint to prevent falls among older adults in non-ICUs compared to no use of bedrails or any type of physical restraints, for example, bedrails versus no bedrails, and bedrails versus no wrist or ankle ties.
The current review considered any randomized controlled trials (RCTs). In the absence of RCTs, other research designs such as non-RCTs, before and after studies, cohort studies, case-control studies, descriptive studies, case series/reports and expert-opinion were considered.
The current review considered studies that included primary outcomes (number of patients who fell or the number of falls per patient) and secondary outcomes (number of head trauma, bone fractures or soft tissue injuries).
The search strategy aimed to find both published and unpublished articles. A three-step search strategy was utilized in 13 databases. Articles published in Portuguese, English and Spanish beginning from 1980 were considered for inclusion.
Assessment of methodological quality was not conducted as no articles were identified that met the inclusion criteria.
Data extraction and synthesis was not performed, because no articles were included in this systematic review.
The search identified a total of 875 potentially relevant articles. Sixteen articles were identified through the reference lists of all identified articles. One hundred and thirteen full-text papers were assessed by two independent reviewers to determine eligibility. However, 11 articles were not found (despite all the efforts), and 102 articles did not meet the inclusion criteria.
There is no scientific evidence comparing the use of bedrails in preventing falls among hospitalized older adults to no use of bedrails or any type of physical restraints.
跌倒是当今影响任何年龄段成年人的一个主要问题，但老年人更容易跌倒。跌倒是老年人受伤或死亡的主要原因。住院老年人尤其容易跌倒。跌倒会给患者造成直接伤害（轻伤、软组织严重创伤和骨折），并延长住院时间。预防跌倒通常被视为护理质量的一个指标。因此，卫生机构和专业人员将识别和实施预防跌倒或尽量减少其影响的策略作为高度优先事项。尽管使用身体约束措施存在争议，但涉及身体约束的预防跌倒干预措施仍然很常见，并被视为主要的预防措施。最常用的约束干预措施之一是床栏。床栏在预防跌倒方面的有效性问题跨越所有社会和文化，对护士的临床实践具有重大影响。
本综述的目的是确定与不使用床栏或任何类型的身体约束措施相比，使用床栏预防住院老年人跌倒的有效性。
纳入标准 参与者类型：本综述考虑了纳入65岁及以上、患有任何临床疾病、在非重症监护病房（ICU）的住院成年人（男性和女性）的研究。
本综述考虑了评估在非ICU中使用床栏作为约束措施以预防老年人跌倒的研究，与不使用床栏或任何类型的身体约束措施相比，例如，使用床栏与不使用床栏，以及使用床栏与不使用手腕或脚踝约束带。
本综述考虑了任何随机对照试验（RCT）。在没有RCT的情况下，也考虑其他研究设计，如非RCTs、前后研究、队列研究、病例对照研究、描述性研究、病例系列/报告和专家意见。
本综述考虑了纳入主要结果（跌倒患者数量或每位患者的跌倒次数）和次要结果（头部创伤、骨折或软组织损伤数量）的研究。
检索策略旨在找到已发表和未发表的文章。在13个数据库中采用了三步检索策略。考虑纳入1980年以来以葡萄牙语、英语和西班牙语发表的文章。
由于未识别出符合纳入标准的文章，因此未进行方法学质量评估。
未进行数据提取和综合，因为本系统综述未纳入任何文章。
检索共识别出875篇潜在相关文章。通过所有已识别文章的参考文献列表又识别出16篇文章。由两名独立评审员评估了113篇全文论文以确定其是否符合纳入标准。然而，尽管竭尽全力仍未找到11篇文章，102篇文章不符合纳入标准。
没有科学证据比较使用床栏与不使用床栏或任何类型的身体约束措施在预防住院老年人跌倒方面的效果。
