Physicians have used these devices almost reflexively, believing that they provided safety for patients. So, the controversy and regulations regarding use of physical restraints may be perplexing to many physicians. In this age of dazzling high-tech innovations in healthcare, it is difficult to understand how cloth belts and vests can command serious attention. Many physicians may consider restraints to be a nursing intervention. These commonplace, low-tech devices are responsible for serious morbidity, including increased behavioral problems, increased physical debility, pressure sores, incontinence, and direct trauma.
Restraints also are underrecognized causes of death, usually by strangulation or entrapment.
Notably, there are no corresponding data to support the efficacy of physical restraints. Their use has become a standard based on past practice rather than on research demonstrating clinical benefits. The federal restraint regulations have evolved from a combination of the medical research and a trend toward overall improvement in the quality of life and quality of care in nursing homes. Healthcare professionals, advocates, providers, and regulators have collaborated on the development of regulations that reflect current concepts of care and a commitment to an acceptable quality of life for nursing home residents. The regulations are not the product of idealists detached from clinical practice.