Study Testing Whether Music Can Replace Physical Restraints For Controlling Hospital Patients

BUFFALO, N.Y. -- If music has charms to soothe a savage beast, to soften rocks, or bend a knotted oak, as playwright William Congreve wrote, might it also have charms to calm a restless patient, or bring confused patients to their senses?

A University at Buffalo researcher is attempting to answer that question in a pilot study of patients hospitalized for standard medical or surgical procedures and subsequently confined by physical restraints.

If the answer is "yes," the sounds of Mozart, Duke Ellington or Dolly Parton eventually could replace the safety vest and wrist ties as a means of inducing restless patients to stay put.

Linda M. Janelli, Ed.D., a clinical assistant professor in the UB School of Nursing, is conducting the study with a grant from The Buffalo General Hospital Foundation. Genevieve Kanski, Ed.D, UB clinical associate professor of nursing, is co-investigator.

An expert in the use and abuse of physical restraints, Janelli says that 100 people died in 1993 and 300 patients are injured annually as a result of being physically restrained. Restraints are used most frequently on the elderly, who are apt to leave their rooms in confusion, show aggression toward staff, or fall out of bed, she says.

Janelli is looking for ways to influence patients’ behavior so that they won’t need to be tied to their hospital beds or chairs.

“Music is supposed to be a universal language,” Janelli says. "We have heard that it may be an effective substitute for restraints, but there have been no intervention studies. All we have is anecdotal evidence.

"Most studies using music have been done with psychiatric patients, the mentally retarded or newborns," she adds. "They all show that music has an impact on physiology -- it can lower blood pressure, pulse and respiration rates. We are attempting to see if music will control behavior."

Janelli’s study involves 30 patients admitted to the medical or surgical units of The Buffalo General Hospital who are at least 50 years old, alert, able to speak and understand English, and have a restraint in place.

To assess the effect of music on these patients, an investigator observes participants for 30 minutes in their restraints. The restraints are then removed, headphones are donned, and patients listen to music of their choosing -- country-western, big band, jazz or classical -- for up to 60 minutes. Investigators look for behavioral responses -- smiling, tapping, clapping, humming; also for grimacing, signs of indifference, twitching, scratching or agitated behavior.

When the music stops, the investigator replaces the restraints and observes the patients for an additional 30 minutes.

Janelli says preliminary results show some patients become so relaxed they fall asleep while the music is playing .

"Music can be relaxing," Janelli notes, "and it may help eliminate confusion and re-connect these patients to their lives. We all can remember music that was important to us at some point."

The study also will determine if participants know why they are restrained -- they usually don’t, Janelli says -- and if family members are aware that they can refuse restraints -- they usually aren’t.

Finding an alternative to physical restraints could pay large dividends in patient comfort, well-being, and lower hospitalization costs, Janelli says.

Restrained patients were eight times more likely to die during hospitalization and were more likely to have longer hospitalizations than those who weren’t restrained, a 1987 study showed. Complications caused by restraints include infection, pressure sores, constipation and loss of muscle tone.

The number of people tied to their bed or chairs in hospitals and nursing homes reached 500,000 a year in the late 1980s. That number has decreased by about 47 percent since 1990, when a federal law prohibiting the use of restraints for the convenience of staff or to discipline difficult patients went into effect in nursing homes, Janelli notes. Physical restraints now may be used only when alternatives have been tried and documented to be ineffective.

The law does not apply to hospitals, however, and Janelli says between 7 and 22 percent of hospital patients are placed in restraints at some point during their stay. The percentage will likely increase as the average age of hospitalized patients increases, she notes. Nearly 50 percent of all hospital admissions nationally involve people 65-years-of-age or older.

The pilot study is expected to be completed in a few months. If results are positive, the researchers will attempt to repeat the study, spending several days with each patient, to determine if the intervention is effective over a longer period of time.