Our study provided convincing evidence that nursing home care can be conducted safely with fewer physical restraints. Because the study was powered to detect a relevant reduction of any physical restraint (primary outcome), it cannot be concluded that the intervention had no effect on the use of waist belts in beds because this would have required a much larger sample size.
A strength of our study was the preplanned process evaluation, which explored factors influencing successful reduction of physical restraints. The main results presented in the article are preferable to the single-center analyses suggested by Drs Riese and Hock. A more detailed process analysis is being conducted.
In Germany, nursing homes provide care for all kinds of residents, including residents with behavioral and psychological symptoms related to dementia. Geriatric psychiatry wards are seldom used for such persons. A post hoc analysis of residents who were transferred during the study period revealed a low prevalence of physical restraint use with no difference between study groups. In the intervention group, 20 of 125 residents (16%) who transferred had been restrained at least once during the study period compared with 15 of 94 in the control group (16%). Therefore, there is no reason to assume that selective transfer of residents influenced the study results.