The purpose of this article was to review current evidence regarding the use and efficacy of physical restraints in inpatient settings and to discuss the regulations, ethical implications, and legal considerations surrounding their use. This study provides an update to a previous report published over a decade ago.
The rate of physical restraint use has declined significantly over the past few decades, largely because of a lack of support for their efficacy in keeping patients safe, coupled with evidence of negative outcomes associated with their use. Many studies have shown that restraint use can actually increase the risk of falls, injury, negative events like self-extubation, and even death.
While restraints are less prevalent, their use in acute, critical, and long-term care environments continues into the 21st century. The historical rationale that restraints should be used to prevent falls, keep patients safe, and limit interference with medical treatment is not supported by the literature. Continuing to reduce their use in all inpatient health care settings appears to be the most appropriate, patient-centered course of action. Physical therapists are experts at assessing and improving patient safety, mobility, and functional independence and are in an excellent position to encourage the use of restraint alternatives to maximize patient safety.