Development and Testing of Tools to Assess Physical Restraint Use
Bibliographic record
Abstract
BACKGROUND: To implement best practice in restraint use, healthcare providers and decision makers require current, accurate, and easily accessible information about restraint practices in their setting. There is a need for a reliable and valid instrument that is feasible for use in these settings to rapidly assess physical restraint use. METHOD: Two instruments to assess physical restraint use were developed and tested: an observation tool and a chart audit. The instruments were tested in complex continuing care units and rehabilitation units at two healthcare organizations. The restraint use observation tool was administered by trained observers in a series of five observations over a 2-week period. Chart audits were conducted for a sample of residents. Inter-rater agreement of the observation tool and chart audit was assessed. Point prevalence estimates were obtained for each site. The time required to use the observation tool and complete chart audits as well as the comparability of findings from the two data sources were described. FINDINGS: Restraint use observations were completed for 289 patients and chart audits were completed for 207 patients. Prevalence and patterns of restraint use varied between sites and across time periods. Observations took an average of 2.6 (Site A) and 0.6 (Site B) minutes per patient. There was excellent inter-rater agreement for most items on the observation tool with the exception of whether or not the patient was able to release or loosen the restraint. There was significant concordance but as expected, not complete agreement between paired estimates of prevalence using the observational tool and the chart audit. CONCLUSION: The observation and chart audit tools are feasible to use and reliably assess physical restraint use in healthcare organizations. The patient's physical capacity to move independently, the patient's waking status, and the restraint's restriction of mobility are items that should be added to the observation tool. The tools are complementary and should be used in tandem to capture the multifaceted complexity of restraint use in health service organizations.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".