Comparison of restraint data from four countries

Background Previous studies comparing restraint data
from different countries had to rely on randomly published
data and showed wide variance in the prevalence of
restraint between countries.
Aim To systematically compare datasets from four similar
European countries with regard to restraint prevalence.
Methods We analysed whole country or area datasets on
restraint from Wales, Ireland, Germany and the Netherlands
systematically, thus excluding selection, patient and
setting bias. Learning disability (LD) and forensic settings
were analysed separately. Differences in proportions
between countries were tested by means of Chi square,
with number of admissions, admission days and catchment
area as denominator and counts of restraint as numerators.
Results Full datasets were obtained allowing calculations
of total admissions, total restraint numbers, numbers of
patients involved and total occupied bed days. Data for
Ireland is from 2012 and from 2013 for the other three
countries. The percentage of patients exposed to restraint
varies between 4.5 and 9.4 %. The average number of
restraints per patient is stable at around 3 in all countries.
Patient numbers affected by restraint per 100 occupied bed
days per month vary between 0.095 and 0.200. The
Netherlands have the highest use of seclusion (79 %), the
longest restraint times and low use of enforced medication.
Wales the lowest use of seclusion (2 %), followed by Ireland
(29 %) and Germany (49 %). Events per 100 admissions
per month vary between 17 and 21. Patients affected
by restraint per 100 admissions per month vary between 5.4
and 7.5. LD services account for a disproportionately high
number of restraint events.
Conclusion Patient related restraint data are remarkably
similar between countries. Type and length of restraint still
vary significantly.