Bed Rest Ineffective as Therapy

CLINICAL QUESTION: Should bed rest be prescribed for any condition?

BACKGROUND: Bed rest is a traditional and frequently prescribed treatment for various medical conditions. Its therapeutic value should be critically assessed just as any other treatment modality.

POPULATION STUDIED: The authors identified a total of 39 randomized controlled trials of bed rest as a therapeutic intervention published between January 1966 and June 1998. The studies represented 17 conditions and a total of 5777 patients. Therapeutic uses of bed rest were used as prophylactic treatment after medical procedures and as primary treatment. Procedures included lumbar puncture (2 studies), spinal anesthesia (4), radiculography (4), cardiac catheterization (9), skin graft of burn (1), liver biopsy (1), fixation of femoral fracture (1), pressure sore surgery (1), and gastric surgery (1). The conditions for primary treatment included acute low back pain (5), spontaneous labor (1), proteinuric hypertension during pregnancy (2), early threatened abortion (1), uncomplicated myocardial infarction (4), pulmonary tuberculosis (1), rheumatoid arthritis (1), and acute infectious hepatitis (1). Control groups had to receive the same treatment other than bed rest and in the same environment (eg, hospital, home).

STUDY DESIGN AND VALIDITY: This was a systematic review of the literature with well-described methodology regarding search strategy and selection criteria. The authors did not present an assessment of the methodologic quality of the included studies. They determined that no pooled analyses were possible and presented their results appropriately in tables.

OUTCOMES MEASURED: The measure of interest for this review was presence or absence of statistically significant differences between treatment groups in the studies identified.

RESULTS: There were a total of 64 outcomes reported in the included studies. These were classified as better or worse with bed rest. In the 24 trials of bed rest as prophylaxis after procedures, there were 7 outcomes that were better with bed rest, none significantly. There were 26 outcomes worse with bed rest, 9 significantly. The significantly worse outcomes included nausea after lumbar puncture, headache after spinal anesthesia, dizziness after radiculography, hematoma, pain, back pain after cardiac catheterization, and time to normal bowel function after gastric surgery. In the 15 trials of bed rest as primary treatment, 6 outcomes were better with treatment (none significantly) and 25 outcomes were worse with treatment (8 significantly). The significantly worse outcomes included disability index at day 1 for acute low back pain, length of first stage of labor, contraction strength, assisted delivery, analgesia required during labor, 5-minute Apgar score, venous thrombosis after myocardial infarction, and time for recovery from acute infectious hepatitis.

CLINICAL QUESTION: Should bed rest be prescribed for any condition?

BACKGROUND: Bed rest is a traditional and frequently prescribed treatment for various medical conditions. Its therapeutic value should be critically assessed just as any other treatment modality.

POPULATION STUDIED: The authors identified a total of 39 randomized controlled trials of bed rest as a therapeutic intervention published between January 1966 and June 1998. The studies represented 17 conditions and a total of 5777 patients. Therapeutic uses of bed rest were used as prophylactic treatment after medical procedures and as primary treatment. Procedures included lumbar puncture (2 studies), spinal anesthesia (4), radiculography (4), cardiac catheterization (9), skin graft of burn (1), liver biopsy (1), fixation of femoral fracture (1), pressure sore surgery (1), and gastric surgery (1). The conditions for primary treatment included acute low back pain (5), spontaneous labor (1), proteinuric hypertension during pregnancy (2), early threatened abortion (1), uncomplicated myocardial infarction (4), pulmonary tuberculosis (1), rheumatoid arthritis (1), and acute infectious hepatitis (1). Control groups had to receive the same treatment other than bed rest and in the same environment (eg, hospital, home).

STUDY DESIGN AND VALIDITY: This was a systematic review of the literature with well-described methodology regarding search strategy and selection criteria. The authors did not present an assessment of the methodologic quality of the included studies. They determined that no pooled analyses were possible and presented their results appropriately in tables.

OUTCOMES MEASURED: The measure of interest for this review was presence or absence of statistically significant differences between treatment groups in the studies identified.

RESULTS: There were a total of 64 outcomes reported in the included studies. These were classified as better or worse with bed rest. In the 24 trials of bed rest as prophylaxis after procedures, there were 7 outcomes that were better with bed rest, none significantly. There were 26 outcomes worse with bed rest, 9 significantly. The significantly worse outcomes included nausea after lumbar puncture, headache after spinal anesthesia, dizziness after radiculography, hematoma, pain, back pain after cardiac catheterization, and time to normal bowel function after gastric surgery. In the 15 trials of bed rest as primary treatment, 6 outcomes were better with treatment (none significantly) and 25 outcomes were worse with treatment (8 significantly). The significantly worse outcomes included disability index at day 1 for acute low back pain, length of first stage of labor, contraction strength, assisted delivery, analgesia required during labor, 5-minute Apgar score, venous thrombosis after myocardial infarction, and time for recovery from acute infectious hepatitis.

CLINICAL QUESTION: Should bed rest be prescribed for any condition?

BACKGROUND: Bed rest is a traditional and frequently prescribed treatment for various medical conditions. Its therapeutic value should be critically assessed just as any other treatment modality.

POPULATION STUDIED: The authors identified a total of 39 randomized controlled trials of bed rest as a therapeutic intervention published between January 1966 and June 1998. The studies represented 17 conditions and a total of 5777 patients. Therapeutic uses of bed rest were used as prophylactic treatment after medical procedures and as primary treatment. Procedures included lumbar puncture (2 studies), spinal anesthesia (4), radiculography (4), cardiac catheterization (9), skin graft of burn (1), liver biopsy (1), fixation of femoral fracture (1), pressure sore surgery (1), and gastric surgery (1). The conditions for primary treatment included acute low back pain (5), spontaneous labor (1), proteinuric hypertension during pregnancy (2), early threatened abortion (1), uncomplicated myocardial infarction (4), pulmonary tuberculosis (1), rheumatoid arthritis (1), and acute infectious hepatitis (1). Control groups had to receive the same treatment other than bed rest and in the same environment (eg, hospital, home).

STUDY DESIGN AND VALIDITY: This was a systematic review of the literature with well-described methodology regarding search strategy and selection criteria. The authors did not present an assessment of the methodologic quality of the included studies. They determined that no pooled analyses were possible and presented their results appropriately in tables.

OUTCOMES MEASURED: The measure of interest for this review was presence or absence of statistically significant differences between treatment groups in the studies identified.

RESULTS: There were a total of 64 outcomes reported in the included studies. These were classified as better or worse with bed rest. In the 24 trials of bed rest as prophylaxis after procedures, there were 7 outcomes that were better with bed rest, none significantly. There were 26 outcomes worse with bed rest, 9 significantly. The significantly worse outcomes included nausea after lumbar puncture, headache after spinal anesthesia, dizziness after radiculography, hematoma, pain, back pain after cardiac catheterization, and time to normal bowel function after gastric surgery. In the 15 trials of bed rest as primary treatment, 6 outcomes were better with treatment (none significantly) and 25 outcomes were worse with treatment (8 significantly). The significantly worse outcomes included disability index at day 1 for acute low back pain, length of first stage of labor, contraction strength, assisted delivery, analgesia required during labor, 5-minute Apgar score, venous thrombosis after myocardial infarction, and time for recovery from acute infectious hepatitis.