Clinical Decision-Making Regarding Physical Restraint Use in Intensive Care Units : A Scoping Review

Purpose : This study aimed to map the available evidence on physical restraint-related clinical decision-making in intensive care units (ICUs) and to organize the findings according to the Ottawa Decision Support Framework (ODSF) domains of decisional needs, decision support, and decision outcomes.Methods : This scoping review followed Arksey and O’Malley’s methodology, and five databases (PubMed, Embase, Web of Science, CINAHL, and the Cochrane Library) were searched from inception to September 2025, with an update through August 2026. Original empirical studies and study protocols providing detailed information on relevant decision support interventions were eligible. Protocols were used to characterize planned interventions and were not included in the synthesis of decision outcomes. Data from the 24 included studies were analyzed using the ODSF.Results : Physical restraint decision-making was shaped by patient safety concerns, uncertainty regarding appropriate restraint use, ethical tensions between safety and autonomy, and organizational constraints such as staffing and limited resources. Decision support involved communication, repeated clinical assessment, consideration of alternatives, and multidisciplinary collaboration. Structured clinician-facing decision-support tools supported systematic assessment of restraint necessity. Several studies reported reductions in restraint use, although intervention effects were inconsistent, and major safety outcomes did not show clear deterioration.Conclusion : Physical restraint decision-making in the ICU is influenced by interacting clinical, organizational, and ethical factors. Structured decision support and supportive organizational and multidisciplinary environments may facilitate more systematic restraint-related decision-making. Further research should evaluate these approaches using clearly defined decision and clinical outcomes and greater representation of patient and family perspectives.