Mobility Decline Prevention
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Modules - Mobility Decline Prevention
The Minimum Data Set Prevalence of Restraint Quality Indicator: Does it Reflect Differences in Care?
John F. Schnelle, Barbara M. Bates-Jensen, Lené Levy-Storms, Valena Grbic, June Yoshii, Mary Cadogan, and Sandra F. Simmons, 2004, in The Gerontologist; 44(2):245-255.
Nursing homes with a high rate of physical restraint use employ more restrictive care processes, which limit their residents' movements, than facilities that use restraints less often. But findings from the first study to independently evaluate the validity of a nursing home "prevalence of restraint" quality measure also suggest that most long-stay residents spend a potentially unhealthful amount of time in bed. The authors contend that an assessment of residents' physical activity might be a more meaningful measure of care quality than restraint use. (See our press release on this study.)
The study examines whether minimal restraint use in a nursing home reflects better care practices. The researchers compared two groups of nursing homes: eight with scores among the lowest (0-5%) on a quality indicator that measures prevalence of restraint use and six with scores among the highest on this measure (28-48%). Residents were observed in bed more often in the high-restraint homes, yet there was no obvious clinical difference between these residents and those in the low-restraint homes. On all other care process measures, including those related to the management of restraints, exercise, and gait and mobility problems, the study found no differences between the two nursing home groups. In general, all facilities provided care to residents, restrained or unrestrained, less than once every two hours.
The researchers estimate that the typical resident in a high-restraint home spends between 19 and 20 hours in bed each day. That estimate drops in low-restraint homes, but by only an hour a day. These findings suggest that all residents are spending too much time in bed and not enough time engaged in activities that enhance mobility, gait, and balance.
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