Factors associated with long-term use of restrictive interventions

ABSTRACT

Background

Despite agreement that restrictive intervention (RI) should only be used as a last resort and for as long as required, little is known about long-term RI among individuals with a disability. This study examines long-term RI use.

Method

From the Restrictive Intervention Data System dataset from Victoria, Australia, a cohort of 1,414 people reported to be restrained or secluded between July 2008 and June 2010 were identified. The primary outcome was restraint during the follow-up period (July 2013–June 2015). Measures of the secondary outcome, reasons for restraint cessation, were assessed via a self-report survey completed by 54 service providers.

Results

At follow up, 74% of the cohort was still subject to RI. Antipsychotic medication use, a diagnosis of autism, and communication difficulties were associated with the use of restrictive interventions at follow up.

Conclusions

Long-term RI is prevalent, but can be minimised by positive behaviour support.

KEYWORDS:

• Intellectual disability
• restraint
• seclusion
• challenging behaviour
• autism
• antipsychotic medications

Acknowledgements

The authors thank Robin Dale and Anthony La Sala for the collation of the data sets analysed in this study.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Notes

1 It is worth noting that the effect size for baseline mechanical restraint was similar to that for baseline chemical routine restraint; that is, individuals who were mechanically restrained at baseline were 1.86 times more likely. However, given there were far fewer individuals mechanically restrained at baseline, there was less statistical power available to detect the effect. Thus, the current results should not be interpreted as conclusively showing that mechanical restraint is not predictive of persistent restraint.

2 For an overview of decision tree modelling and its application: https://www.researchgate.net/profile/Vili_Podgorelec/publication/11205595_Decision_Trees_An_Overview_and_Their_Use_in_Medicine/links/0912f506e77f1e9d1d000000.pdf

Additional information

Funding

This work was supported by the Victorian Department of Health and Human Services.