School of Primary and Allied Health Care & National Centre for Healthy Ageing, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Royal Parade, Parkville, VIC 3052, Australia.
Int J Environ Res Public Health. 2021 Mar 31;18(7):3639. doi: 10.3390/ijerph18073639.
This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of physical and/or chemical restraint use, or evaluated an intervention to reduce restraint use in long-term care. 86 papers were included in this review, all discussed physical restraint use and 20 also discussed chemical restraint use. Seven themes were generated from definitions including: restraint method, setting resident is restrained in, stated intent, resident capacity to remove/control, caveats and exclusions, duration, frequency or number, and consent and resistance. None of the studies reported validity of measurement approaches. Inter-rater reliability was reported in 27 studies examining physical restraint use, and only one study of chemical restraint. Results were compared to an existing consensus definition of physical restraint, which was found to encompass many of the thematic domains found within explicit definitions. However, studies rarely applied measurement approaches that reflected all of the identified themes of definitions. It is necessary for a consensus definition of chemical restraint to be established and for measurement approaches to reflect the elements of definitions.
本次系统评价旨在确定物理和化学约束定义中的主题要素，比较明确和隐含的定义，并综合研究物理和/或化学约束在长期护理中使用的可靠性和有效性。研究包括测量物理和/或化学约束使用的流行率，或评估减少长期护理中约束使用的干预措施。本综述共纳入 86 篇论文，均讨论了物理约束的使用，其中 20 篇还讨论了化学约束的使用。从定义中生成了 7 个主题，包括：约束方法、约束居民所在的环境、规定的意图、居民去除/控制的能力、警告和排除、持续时间、频率或次数以及同意和抵抗。没有研究报告测量方法的有效性。在 27 项关于物理约束使用的研究中报告了组内一致性，在一项关于化学约束的研究中报告了组内一致性。结果与现有的物理约束共识定义进行了比较，该共识定义包含了明确定义中许多主题领域。然而，研究很少采用反映定义中所有已确定主题的测量方法。有必要建立化学约束的共识定义，并使测量方法反映定义的要素。
