Restrictive practice use in people with neurodevelopmental disorders: a systematic review

Objectives: Restrictive practices (RP) include any practice or intervention that infringes on the rights and freedom of movement of people with disability, including those with neurodevelopmental disorders (NDD). The use of RP is inconsistent with the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The objective of this systematic review was to estimate the use of RP internationally and identify factors associated with RP use. Methods: Six electronic databases alongside a comprehensive online search were conducted for literature up to 12th December 2022. This systematic review included any publication published within the past 18 years that reported the rate of RP in at least 250 people in residential, community, and hospital settings who had a NDD. Results: Twenty publications reporting thirty datasets were included in this review. Sample sizes ranged from 268 to 107,392. Overall rates of RP ranged from 6% to 78% across different timeframes and populations. Chemical restraint was the most commonly reported RP, with 12 of 20 publications (60%) reporting rates across one or more timeframes. Higher prevalence of RP were found in populations with higher reported mental illness and behaviors of concern. Conclusion: The very considerable differences between publications and limited data means that the rates of RP are variable. The high variability appears to be attributable to methodological differences. Requiring the reporting of RP through legislation is one mechanism that can support better monitoring of RP and ultimately ensure progress is being made towards CRPD obligations to uphold human rights.