ArticlesBed rest: a potentially harmful treatment needing more careful evaluation
Introduction
Sleep is a daily requirement for normal function. People who are very weak from illness can not do much more than to go to bed. Perhaps this general knowledge led to the little-challenged assumption that bed rest will be good for most illnesses. Hippocrates suggested that “In every movement of the body, whenever one begins to endure pain, it will be relieved by rest”.1 The value of rest was emphasised in the 19th century as the primary treatment of many disorders and after surgical procedures.2 Bed rest has been specifically advocated for myocardial infarction,3 psychiatric diseases,4 and after orthopaedic surgery.5
The association between patients and beds continues in medical thinking; until recently, the size of hospitals was measured by bed numbers. The fact that bed rest is a treatment has almost been forgotten. However, like any other treatment, its therapeutic value should be assessed critically.
There have been challenges. Studies of large series of patients in the 1940s showed no advantages for complete bed rest after surgery;6 instead dangers such as deep-vein thrombosis, bedsores, osteoporosis, and pneumonia were identified. Such critical analyses gradually led to a shortening of prescribed postoperative periods of bed rest from weeks to days.
We systematically searched published studies to find evidence of benefit or harm for bed rest for any indication.
Section snippets
Methods
We searched MEDLINE and the Cochrane Library between January 1966, and June 1998, for published studies, and checked the references of relevant studies. The search strategy used terms associated with bed rest (bed rest, bedrest, recumben*, expectant, rest as subject headings), or its opposite (early ambulat*, early activation, early discharge) and randomised controlled trials (randomised-controlled-trial or controlled-clinical-trial or random*). Relevant articles from this search, review
Results
We found more than 2000 abstracts by the initial search and retrieval of promising-looking citations, of which 90% could be discarded from examination of the title or abstract. Of the remaining 200, for which we retrieved the full texts, 39 were randomised controlled trials (excluding duplicate publications) that examined the effect of bed rest on 15 different disorders. 5777 patients were studied. We report all outcome measures that showed a significant difference between mobilised patients
Discussion
Published results give little support for bed rest as a form of management in a wide range of settings, and suggest that it may actually delay recovery and even harm the patient. Perhaps only contentious uses of bed rest have been investigated in trials. This use might have selected out those returning a negative result, in which case fewer trials have been done than required. If bed rest is to be regarded as a treatment, it must be subject to the same assessment as any other.
In attempting to
References (61)
- et al.
Posture and post-spinal headache. A controlled trial in 80 obstetric patients
Br J Anaesth
(1988) - et al.
Radiculography: is routine bed rest really necessary?
Clin Radial
(1983) - et al.
Radiculography with non-ionic contrast medium: routine bed rest is unnecessary
Clin Radial
(1984) - et al.
Ambulation after sheath removal: a comparison of 6 and 8 hours of bedrest after sheath removal in patients following a PTCA procedure
Heart Lung
(1995) - et al.
Postcardiac catheterization time-in-bed study: enhancing patient comfort through nursing research
Appl Nurs Res
(1994) - et al.
Effects of modified positioning and mobilization of back pain and delayed bleeding in patients who had received heparin and undergone angiography: a pilot study
Heart Lung
(1996) - et al.
Femoral complications and bed rest duration after coronary arteriography
Am J Cardiol
(1997) - et al.
Prospective study of the incidence of ultrasound-detected intrahepatic and subcapsular hematomas in patients randomized to 6 or 24 hours of bed rest after percutaneous liver biopsy
Gastroenterology
(1987) - et al.
Is cavity closure in pulmonary tuberculosis influenced by bed-rest?
Tubercle
(1960) - et al.
How emergency physicians approach low back pain: choosing costly options
J Emerg Med
(1995)
Cause of death in patients with congestive heart failure
Am Heart J
The genuine works of Hippocrates
On the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases and the diagnostic value of pain
Rest and exercise in the treatment of heart diseases
South Med J
The abuse of rest in psychiatry
JAMA
The abuse of rest in bed in orthopedic surgery
JAMA
The evil sequelae of complete bed rest
JAMA
Early ambulation following 6 French diagnostic left heart catheterization: a prospective randomized trial
Cathet Cardiovasc Diagn
Safety of decreasing bedrest after coronary angiography
Cathet Cardovasc Diagn
Ambulation in labour
BMJ
Is bed rest useful after diagnostic lumbar puncture?
Postgrad Med J
Post-lumbar-puncture headache—the significance of body posture: a controlled study of 300 patients
Cephalalgia
Is early mobilization associated with lower incidence of postspinal headache?: a controlled trial in 69 urologic patients
Anestheziol Reamin
Post spinal headache: is 24 hour flat bed-rest a preventable measure?
Regional Anaesthesia
Bed rest and postlumbar puncture headache: the effectiveness of 24 hours' recumbency in reducing the incidence of postlumbar puncture headache
Anaesthesia
Incidence of side effects following direct puncture cervical myelography: bed rest versus normal mobility
Neuroradiology
Routine bed rest is unnecessary after cervical myelography
Neuroradiology
Reducing time in bed after cardiac catheterization (TIBS II)
Am J Crit Care
Early ambulation following diagnostic 7-French cardiac catheterization: a prospective randomized trial
Cathet Cardiovasc Diagn
The effect of early ambulation on patient comfort and delayed bleeding after cardiac angiogram: a pilot study
Heart Lung
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