Values and preferences of patients with inborn errors of immunity and their caregivers: a systematic review.

The persistence of physical restraint in human services is among the most examined and least solved problems in the field. Decades of regulatory pressure, framework adoption, and training investment have produced meaningful progress in some contexts and almost none in others, often within the same organization. That variability is the field’s most important empirical signal and has not been sufficiently theorized. The dominant explanatory frame remains individual and skill-based: restraint persists because staff lack fluency in de-escalation or have not received sufficient crisis prevention training. The frame is not wrong (skill matters), but it cannot account for why two units with comparable staff, comparable training, and comparable populations produce dramatically different restraint rates year over year. , in a survey of Swedish front-line managers in intellectual disability services, found that managers consistently reported lower restraint rates than the staff working under them, a perceptual gap the authors interpreted as evidence of organizational drift: the gradual normalization of restrictive practices within systems that nominally oppose them. , using Delphi methodology with senior managers in UK intellectual disability organizations, found that senior leadership focus remained almost entirely unstudied empirically despite being described as central to organizational functioning. Both findings point to the same conclusion: the organizational tier of the problem is real, proximate, and undertheorized.