Development methods of guidelines and documents with recommendations on physical restraint reduction in nursing homes: a systematic review
Bibliographic record
Abstract
BACKGROUND: Physical restraint, e.g. bedrails or belts in beds or chairs, are commonly used in nursing homes. However, there have been reports of pronounced differences in the prevalence between different facilities. Guidelines or other documents with recommendations for clinical practice are one approach to overcome centre variation and improve the quality of care. Rigorous development methods are deemed to ensure the validity, clarity and clinical applicability of practice recommendations. This study aims at describing the development methods of documents offering recommendations on physical restraint reduction in geriatric long-term care. METHODS: We performed a systematic search (February 2014) in electronic databases (PubMed, CINAHL, Gerolit, Carelit), the World Wide Web (via google.de) and on the homepages of 34 international scientific or healthcare organisations, using various terms related to documents offering guidance for clinical practice and physical restraints. All German and English language documents with recommendations for clinical practice aimed at reducing physical restraints' in nursing homes were included. Documents targeting mental health or acute care settings were excluded. Two reviewers independently selected the documents and extracted data, using a self-developed and piloted data extraction form. RESULTS: We identified 28 documents from Germany, USA, Australia, Switzerland, Canada and UK, published between 2002 and 2014. The documents were developed or published by governmental organisations, nursing or healthcare organisations, non-profit organisation, research institutions and private organisations. Two documents were developed mono-disciplinary (nursing) and eight documents interdisciplinary (including different healthcare professionals, lawyers or other stakeholders). In 18 documents the composition of the development group was not described. Two documents described the methods used for developing the recommendations. In both documents, the recommendations were based on a systematic literature search, critical appraisal of the evidence and developed in a consensus process. Materials or tools supporting the implementation were mentioned in 18 documents. CONCLUSIONS: This review shows that most of the identified documents with recommendations to reduce physical restraints in nursing homes did not adhere to rigorous scientific development methods. Only two documents comprised a systematic literature search and critical appraisal. Guidance aimed to inform clinical practice should rely on transparent and evidence-based methodologically with sound developed recommendations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.156 | 0.368 |
| Meta-epidemiology (narrow) | 0.004 | 0.004 |
| Meta-epidemiology (broad) | 0.013 | 0.010 |
| Bibliometrics | 0.060 | 0.042 |
| Science and technology studies | 0.003 | 0.004 |
| Scholarly communication | 0.008 | 0.013 |
| Open science | 0.009 | 0.008 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.009 | 0.002 |
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 source (direct Gemma or distilled Codex), 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".