El-Abidi Khadija, Moreno-Poyato Antonio R, Toll Privat Alba, Corcoles Martinez David, Aceña-Domínguez Rosa, Pérez-Solà Victor, Mané Anna
Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain.
Public Health, Mental and Maternal and Child Health, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona 08907, Spain.
World J Psychiatry. 2021 Oct 19;11(10):854-863. doi: 10.5498/wjp.v11.i10.854.
Despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential.
To determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR.
Descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration.
Of the 464 patients, 119 25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; = 0.05).
The presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.
尽管人们多次尝试减少机械约束（MR）的使用，但该技术仍在许多急性精神科护理环境中广泛应用。为了减少MR的使用，更好地了解不同临床环境中与其使用及持续时间相关的变量至关重要。
确定两家急性护理精神科病房中接受MR治疗的患者比例及其持续时间；并识别与MR使用及持续时间相关的变量。
对2018年在西班牙巴塞罗那圣萨尔瓦多公园急性精神科病房住院的所有患者进行描述性研究。评估接受MR治疗的患者数量及百分比，以及每次发作的持续时间。还记录了以下数据：社会人口学特征、精神科诊断以及文化和/或语言障碍的存在情况。进行多变量分析以评估MR及其持续时间的决定因素。
在464名患者中，119名（25.6%）需要MR治疗，每次MR治疗的中位时间为16.4小时。两个因素——精神病性障碍诊断[比值比（OR）=0.22；95%置信区间：0.06 - 0.62；P = 0.005]和语言障碍的存在（OR = 2.13；95%置信区间：1.2 - 3.7；P = 0.007）——与MR治疗的显著更高风险相关。男性与MR治疗持续时间更长相关（B = -19.03；95%置信区间：-38.06 - 0.008；P = 0.05）。
语言障碍的存在和精神病性障碍诊断与MR治疗的显著更高风险相关。此外，男性与MR治疗持续时间更长相关。最终限制机械约束的使用需要包括所需工具的个性化约束方案。
