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Open Access Highly Accessed Study protocol

Belt restraint reduction in nursing homes: design of a quasi-experimental study

Math JM Gulpers1*, Michel HC Bleijlevens1, Erik van Rossum12, Elizabeth Capezuti3 and Jan PH Hamers1

Author Affiliations

1 School for Public Health and Primary Care (Caphri), Department of Health Care and Nursing Science, Maastricht University, Maastricht, the Netherlands

2 Zuyd University of Applied Sciences, Research Centre on Autonomy and Participation of chronically ill patients, Heerlen, the Netherlands

3 New York University, Hartford Institute for Geriatric Nursing, New York, USA

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BMC Geriatrics 2010, 10:11  doi:10.1186/1471-2318-10-11

Published: 25 February 2010



The use of physical restraints still is common practice in the nursing home care. Since physical restraints have been shown to be an ineffective and sometimes even hazardous measure, interventions are needed to reduce their usage. Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. However, the success rate of these interventions has been inconsistent. We developed a new multi-component intervention (EXBELT) comprising an educational intervention for nursing home staff in combination with a policy change (belt use is prohibited by the nursing home management), availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes. However, the reduction of belts should not result in an increase of other restrictive restraints (such as a chair with locked tray table) or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes.

Methods and design

Effects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement. Furthermore, changing attitudes will become an important addition to the educational part of EXBELT.


A quasi-experimental study is presented to investigate the effects of EXBELT on the use of belts on wards in psychogeriatric nursing homes. The study will be conducted in 26 wards in 13 psychogeriatric nursing homes. We selected the wards in a manner that contamination between control- and intervention group is prevented.

Trial registration