Effect of a Guideline-Based Multicomponent Intervention on Use of Physical Restraints in Nursing Homes A Randomized Controlled Trial
Effect of a Guideline-Based Multicomponent Intervention on Use of Physical Restraints in Nursing Homes A Randomized Controlled Trial
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DOI：
10.1001/jama.2012.4517
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发表时间：
2012-05-23
影响因子：
120.7
通讯作者：
Meyer, Gabriele
中科院分区：
文献类型：
--
作者：
Koepke, Sascha;Muehlhauser, Ingrid;Meyer, Gabriele
背景尽管明确的法律的规定和证据缺乏有效性和安全性，身体约束仍然经常在nursinghomes.Objective减少身体约束的患病率在疗养院使用指南和理论为基础的多组分干预。2009年2月至2010年4月在德国2个城市进行的为期6个月的整群随机对照试验。疗养院如果有20%或更多的居民有身体限制，就有资格。采用外部隐蔽随机化方法，将18个养老院集群（2283名居民）纳入干预组，18个养老院集群（2166名居民）纳入对照组。干预基于专门制定的循证指南，并应用计划行为理论。组成部分是所有护理人员的小组会议;提名的关键护士的额外培训;和护士，居民，亲属和法律的监护人的支持材料。控制组集群收到的标准information.Main结局措施主要结局是居民的身体限制（双边床栏杆，皮带，固定表，和其他措施限制自由的身体运动）在6个月的百分比，通过直接突击观察由盲调查人员在1天内3次进行评估。次要结果包括约束使用3个月，福尔斯，跌倒相关的骨折，精神药物prescription.Results所有疗养院完成了研究，所有居民被纳入分析。在基线时，30.6%的对照组居民有身体限制，而干预组居民有31.5%。6个月时，发生率分别为29.1%和22.6%，差异为6.5%（95% CI，0.6%至12.4%;聚类调整比值比，0.71; 95% CI，0.52至0.97; P = 0.03）。在干预组中，所有身体约束措施的使用频率都较低。术后3 ~ 6个月内发生率稳定。有没有统计学上的显着差异，在福尔斯，下跌相关的骨折，精神药物prescriptions.Conclusion指南和理论为基础的多组分干预与标准的信息相比，减少了身体约束的使用在养老院。
Context Despite unambiguous legal regulation and evidence for lack of effectiveness and safety, physical restraints are still frequently administered in nursing homes.Objective To reduce physical restraint prevalence in nursing homes using a guideline- and theory-based multicomponent intervention.Design, Setting, and Participants Cluster randomized controlled trial of 6 months' duration conducted in 2 German cities between February 2009 and April 2010. Nursing homes were eligible if they had 20% or more residents with physical restraints. Using external concealed randomization, 18 nursing home clusters were included in the intervention group (2283 residents) and 18 in the control group (2166 residents).Intervention The intervention was based on a specifically developed evidence-based guideline and applied the theory of planned behavior. Components were group sessions for all nursing staff; additional training for nominated key nurses; and supportive material for nurses, residents, relatives, and legal guardians. Control group clusters received standard information.Main Outcomes Measures Primary outcome was percentage of residents with physical restraints (bilateral bed rails, belts, fixed tables, and other measures limiting free body movement) at 6 months, assessed through direct unannounced observation by blinded investigators on 3 occasions during 1 day. Secondary outcomes included restraint use at 3 months, falls, fall-related fractures, and psychotropic medication prescriptions.Results All nursing homes completed the study and all residents were included in the analysis. At baseline, 30.6% of control group residents had physical restraints vs 31.5% of intervention group residents. At 6 months, rates were 29.1% vs 22.6%, respectively, a difference of 6.5% (95% CI, 0.6% to 12.4%; cluster-adjusted odds ratio, 0.71; 95% CI, 0.52 to 0.97; P = .03). All physical restraint measures were used less frequently in the intervention group. Rates were stable from 3 to 6 months. There were no statistically significant differences in falls, fall-related fractures, and psychotropic medication prescriptions.Conclusion A guideline- and theory-based multicomponent intervention compared with standard information reduced physical restraint use in nursing homes.