The effect of non-pharmacological interventions on physical restraint reduction in intensive care units: a protocol for an umbrella review of systematic reviews and meta-analysis

Background: As the last resort in intensive care units, physical restraint reduction is affected by various interventions. Several non-pharmacological interventions may directly reduce physical restraints, such as staff education, or indirectly reduce physical restraint, such as delirium prevention; however, their effectiveness has remained inconclusive. Therefore, we devised a protocol for umbrella reviews to summarize the evidence integrating data of different non-pharmacological interventions that may reduce physical restraint use. Methods: The umbrella review will be conducted following the methodology formulated by the Joanna Briggs Institute (JBI). Electronic databases, including Web of Science, PubMed, EMBASE, PsycInfo, Psyc Articles, Psychology and Behavioral Science Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), JBISRIS (JBI Database of Systematic Reviews and Implementation Reports), Cochrane Database of Systematic Reviews, China National Knowledge Infrastructure (CNKI, for Chinese literature), SinoMed (for Chinese literature), and WANFANG DATA (for Chinese literature), will be searched to identify articles published from January 2016 to December 2020. A systematic review and meta-analysis quality will be critically assessed by AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews). According to the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) guidelines, the evidence quality of each intervention will be assessed. Overlapping studies and the excess significance test will be performed to assess whether previous evidences are bias. Discussion: This protocol was devised according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Umbrella reviews will be an excellent supplement to the evidence of the guideline adaptation and provide a broader picture of non-pharmacological interventions that may reduce the use of physical restraint, which can provide critical care nurses in intensive care units with the evidence they need.