Exploring differences in reported mental health outcomes and quality of life between physically restrained and non-physically restrained ICU patients; a prospective cohort study

Abstract

Background

Physical restraints are frequently used in ICU patients, while their effects are unclear.

Objective

To explore differences in patient reported mental health outcomes and quality of life between physical restrained and non-physical restrained ICU patients at 3- and 12-months post ICU admission, compared to pre-ICU health status.

Research Methodology/Design

Prospective cohort study. Patients were included when 16 years or older, admitted for at least 12 h and provided informed consent. Differences between groups were analysed using linear mixed model analyses.

Setting

Two ICUs, a 35 bed academic ICU and a 12 bed ICU in a teaching hospital in the Netherlands.

Main Outcome Measures

Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, post-traumatic stress disorder using the Impact of Event Scale-Revised, and Quality of life using the Short Form-36 scores.

Results

2,764 patients were included, of which 486 (17.6 %) were physically restrained for median 2 [IQR 1–6] days. Significantly worse outcomes were reported at 3-months by physically restrained patients (symptoms of depression 0.89, 95 %CI 0.37 to 1.41, p < 0.001; PCS −2.82, 95 %CI −4.47 to −1,17p < 0.001; MCS −2.67, 95 %CI −4.39 to −0.96, p < 0.01). At 12-months, only the PCS scores remained significantly lower (−1.71, 95 %CI −3.42 to −0.004, p < 0.05).

Conclusion

Use of physical restraints is associated with worse self-reported symptoms of depression and decreased quality of life 3-months post ICU, and lower physical quality of life after 12-months.

Implications for Clinical Practice

Use of physical restraints is associated with statistical significant worse mental and physical outcomes.