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September 19, 2012

Physical Restraint Use in Nursing Homes—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany (Drs Köpke and Mühlhauser) (sascha.koepke@uksh.de); and School of Nursing Science, Witten/Herdecke University, Witten, Germany (Dr Meyer).

JAMA. 2012;308(11):1091-1092. doi:10.1001/jama.2012.9403

In Reply: 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.