Physical restraints, such as bed rails or wheelchair belts, were once regarded as necessary to improve safety, to keep patients from falling or wandering off.

That mind-set has changed during the last two decades. Repeated use of restraints on long-term nursing home patients declined nearly 40 percent between 2002 and 2006 alone, as states and most nursing homes placed greater emphasis on eliminating the practice.

Nationwide, about 5.9 percent of patients were restrained in 2006. That's a drop from 9.7 percent in 2002. Locally, all three states reported lower numbers for both years.

In Pennsylvania, 3.7 percent of nursing home residents were repeatedly restrained in 2006, down from 6.4 percent in 2002.

New Jersey restrained 4.8 percent of patients in 2006 compared with 5.6 percent four years earlier.

And Delaware restrained 2.1 percent of patients in 2006, down from 4.0 percent.

By comparison, in 2006 physical restraints were used most frequently in California (13.4 percent) and least frequently in Nebraska (1.3 percent).

The numbers were part of an Agency for Healthcare Research and Quality report that compares states on numerous health issues.

Mary Jean Koren, assistant vice president at the Commonwealth Fund, a research group, said that changes to federal law in 1987 made it illegal for nursing homes to use restraints to discipline residents or as a matter of convenience. The restraints can only be used for medical reasons, such as to prevent a resident from tearing out an IV. Until the change in law, restraints were standard procedure in many homes.