An Investigation into the Range of Movement and Forces Involved by the Application of Wrist Flexion Restraint Techniques - Pain Inducing or Not?

Abstract

Although the use of physical restraint (PR) is accepted, it remains controversial as staff are required to balance professional, ethical and legal tensions between maintaining everyone’s safety, upholding human rights, and minimising harm. One such tension relates to the use of Wrist Flexion Techniques (WFT) used in some health, social care and custodial settings. WFT impose load onto the musculoskeletal structures of the wrist to gain control or compliance from a restrained person, and can result in discomfort, pain, injury, psychological trauma and be detrimental to therapeutic relationships. Current evidence and guidance on WFT are absent with debate existing as to whether WFT can be used without inducing pain. Twenty adults participated in the study. The mean discomfort angle was 90.1° (± 8.6) of flexion with 2.8 Kg (± 1.1) of force, and the mean pain angle was and 98.4° (± 7.9) of flexion with 4.4 Kg (± 1.8) of force, therefore only 8.3° of movement and 1.6 Kg of force separate pain free from pain inducing WFT. Genders did not differ in relation to angle of discomfort or pain. Females experienced discomfort with 1.1Kg less force (p = 0.021) and experienced pain with 1.7Kg less force (p = 0.023). This research challenges the assertion that WFT can exist as non-pain inducing and pain inducing PR techniques since the margin between them may be too small for practitioners to discriminate, particularly during the struggle of real world restraint. Further research may consider other potential pain inducing techniques, and the role and use of PIT during restraint.