What factors contribute to the need for physical restraint in institutionalized residents in Taiwan?

PLoS ONE, 2022 · DOI: https://doi.org/10.1371/journal.pone.0276058 · Published: November 17, 2022

Simple Explanation

This study investigates the use of physical restraints in Taiwanese institutions and identifies factors contributing to their use. Physical restraints are used to prevent falls or injuries but can have negative side effects. The goal is to understand the prevalence and risk factors associated with physical restraint in this population. The study surveyed over 5,700 residents in 266 residential institutions in Taiwan. Researchers collected data on demographics, cognitive abilities, disabilities, medical history, nursing care needs, and behavioral symptoms. This information was used to determine which factors increase the likelihood of physical restraint. The study found that older age, lower education, cognitive impairment, higher dependence, cerebrovascular disease, pulmonary disease, dementia, and intractable epilepsy were associated with a higher rate of physical restraint. Orthopedic disease and spinal cord injury were associated with a lower rate. The study concludes that the benefits and risks of physical restraint should be carefully evaluated.

Study Duration

July 2019 to February 2020

Participants

5,752 institutionalized residents in Taiwan

Evidence Level

Not specified

Key Findings

1
30.2% of the 5,752 institutionalized residents had been previously restrained.
2
Older age, lower education level, lower cognitive function, and higher dependence were associated with an increased physical restraint rate.
3
Cerebrovascular disease, pulmonary disease, dementia, and intractable epilepsy contributed to a higher physical restraint rate.

Research Summary

This study aimed to identify the rate of physical restraint and associated risk factors among institutionalized residents in Taiwan. Data was collected from 5,752 residents across 266 institutions, focusing on demographics, cognition, disability, medical history, and behavioral symptoms. The study revealed that 30.2% of residents had been previously restrained. Factors significantly associated with higher restraint rates included older age, lower education, cognitive impairment, higher dependence, cerebrovascular disease, pulmonary disease, dementia, and intractable epilepsy. The authors conclude that a careful evaluation of the benefits and risks of physical restraint is necessary, and its application should be adjusted based on individual clinical situations. They suggest exploring alternative methods to reduce restraint use and improve the quality of life for institutionalized residents.

Practical Implications

Informed Decision-Making

Healthcare providers should carefully evaluate the risks and benefits of physical restraint on a case-by-case basis.

Targeted Interventions

Institutions should focus on addressing modifiable risk factors such as cognitive decline and dependence through tailored interventions.

Staff Training

Enhance staff education and resources to promote best practices in restraint reduction and alternative care strategies.

Study Limitations

1
The study did not include other forms of restraint than physical restraint of the limbs.
2
The cross-sectional design limits the ability to understand the impact of physical restraint over time.
3
A 12.2% failure to complete the survey may introduce bias in the estimation of physical restraint rates and causes.

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