SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1606359
This article is part of the Research TopicState of the Art in Acute Care Surgery: Application, Innovation, and Future PerspectivesView all 11 articles
Guide-based interventions aimed at reducing physical restraints in intensive care unit: A systematic review and meta-analysis of randomized controlled trials
Provisionally accepted
Yueli Ping1,2Jianyan Yang1,2Yanming Zheng1,2Wanting Feng1Zexi Huang1,2Ruiqin Sha3
Nianqi Cui1*Ying Tian4*- 1Kunming Medical University, Kunming, China
- 2The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
- 3Department of diabetes, The First Affiliated Hospital of Kunming Medical University, Kunming, China, Kunming/Yunnan, China
- 4Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China, Kunming/Yunnan, China
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Objective: Despite widespread advocacy and organizational support for reducing the utilization of physical restraint (PR) in clinical settings, its application remains prevalent on a global scale. This study aims to identify and evaluate guide-based, high-quality interventions that can be effectively integrated into clinical practice to substantially reduce PR utilization rates. Methods: A comprehensive search of relevant databases was covered all available records from their establishment through November 10, 2024, including PubMed, the Cochrane library, Web of Science, CINAHL, EMBASE, the Joanna Briggs Institute (JBI), China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (VIP) and Chinese BioMedical Literature Service System (SinoMed). The search specifically targeted randomized controlled trials (RCTs) that focused on guide-based interventions designed to reduce the utilization of PR in the intensive care unit (ICU). Two independent researchers systematically reviewed the literature, with each investigator independently extracting relevant data and assessing the methodological quality of included studies using standardized criteria. The subsequent meta-analysis was conducted using Review Manager software version 5.2. Results: A total of 14 RCTs, involving 4,338 participants, were included in the analysis. The results indicated that guide-based interventions significantly reduced the PR rate (RR=0.72, P<0.001), PR time (WMD = -248.5, P = 0.002), delirium incidence (RR=0.53, P<0.001), duration of delirium (WMD=-11.94, P=0.008), unplanned extubation rate (RR=0.36, P<0.001), the other complications rate ((RR=0.36, P<0.001), and duration of mechanical ventilation (WMD=-31.84, P=0.005). Additionally, Notably, in contrast to other outcomes, these interventions were associated with increased patient satisfaction (RR=1.16, P<0.001). However, there was no evidence to suggest that guide-based interventions reduced the length of ICU stay or patient agitated or anxiety rate (P > 0.05). Conclusion: Guide-based interventions can effectively reduce the utilization of PR with patients in ICU. Employing a multidisciplinary team, adjusting patient assessment frequency by PR type and standardizing the PR assessment scale are possible to reduce the utilization of PR.
Keywords: Restraint, physica1, intensive care units2, critical care nursing3, guidelines as topic4, evidence-based practice5
Received: 05 Apr 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 Ping, Yang, Zheng, Feng, Huang, Sha, Cui and Tian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Nianqi Cui, Kunming Medical University, Kunming, China
Ying Tian, Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China, Kunming/Yunnan, China
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