Zare-Kaseb A, Sarmadi S, Sanaie N, Emami Zeydi A. Prevalence and variability in use of physical restraints in intensive care units: A systematic review and meta-analysis.
Aust Crit Care 2025;
38:101210. [PMID:
40101313 DOI:
10.1016/j.aucc.2025.101210]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 02/09/2025] [Accepted: 02/11/2025] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND
Given the varying perspectives on the use of physical restraint (PR) over the past decades and the provided protocols to minimise its occurrence in intensive care units (ICUs), a comprehensive study was deemed necessary to examine the prevalence and variation of PR use in ICUs.
OBJECTIVE
The aim of this study was to estimate the overall proportions of PR utilised in adult ICUs whilst examining the various factors contributing to the variability of these estimates.
METHODS
A search of five databases (PubMed, Cochrane Library, Scopus, Embase, and Web of Science) was performed. Studies published in English and available online from inception to December 18, 2024, were included. A pooled estimate with a 95% confidence interval was calculated, and the data were represented by the random-effect model. Analysis was performed using the STATA statistical software (version 17).
RESULTS
The meta-analysis included 39 studies, with a sample size of 21 665 patients. The overall prevalence of patients exposed to PRs was 41.6% (95% confidence interval: 33.8%-49.5%). The heterogeneity was significantly high (I2 = 99.61%), and the Q Cochrane test for homogeneity was significant (p value < 0.001), indicating substantial variability between studies. Subgroup analysis regarding the continent and restraint method contributed to a lowered heterogeneity.
CONCLUSIONS
There was considerable variation in reported estimates of PR prevalence in adult ICUs. Despite valid guidelines and recommendations supporting the reduction of PR, the results of our study show its significant prevalence. Additionally, our study demonstrated a relationship between PR use and delirium, sedation use, and mechanical ventilation. This study emphasises the importance of managing and focussing on PRs in ICUs. Also, it is crucial to evaluate barriers to guideline implementation.
REGISTRATION
The systematic review protocol has been prospectively registered in the International Prospective Register of Systematic Reviews: CRD42024566480.
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