Doctors have been prescribing bed rest for centuries. In the last 75 years or so, it was the first line of treatment for heart attack (myocardial infarction, or MI) and acute low back pain (often called sciatica, or Hexenschusse). However, since the 1940s bed rest has been recognized as carrying certain risks - clots in the leg veins (deep venous thrombosis), bedsores, osteoporosis and even pneumonia. To make matters worse, too many patients are content to prescribe bed rest for themselves, even if their doctors would rather have them up and about. Now, Australian investigators have looked at the evidence, if any, in favor of bed rest as a part of treatment.

All available clinical studies were analyzed where the only main difference between two treatment groups was the amount of bed rest prescribed. Two main uses of bed rest were recognized - either after a medical procedure to prevent side effects, or as an actual form of therapy for a medical condition.

The analysis covered 39 randomized controlled trials, which included 5000 patients with 15 different disorders. The results of each study were examined to see if bed rest was beneficial or harmful, and the statistical significance of the finding was assessed.

In 24 trials of bed rest used to prevent side effects after various medical procedures, 7 outcomes were better with bed rest, but none significantly so, while 26 outcomes were worse after bed rest - 9 to a significant degree. When bed rest was prescribed after spinal tap (lumbar puncture), spinal anesthesia, and spinal injections to demonstrate nerve roots, headache, nausea, vomiting, or dizziness were significantly worse in 4 instances.

Older patients often undergo cardiac catheterization. Bed rest can be reduced to 4 hours or less after the procedure, without increased risk of bleeding or bruising at the catheter site.

In the 15 studies where bed rest was used as an important part of treatment, 6 outcomes were better with bed rest, but none significantly so, while 25 outcomes were worse, 9 to a significant degree. In treating low back pain, getting up and about early (in less than 2 days) was superior to bed rest lasting 2 to 7 days, 8 times out of 10.

None of the studies of heart attack showed any significant benefits of prolonged bed rest, whereas one study found that patients kept in bed for 7 days had significantly more leg vein clots than those kept in bed only 3 days.

This analysis showed that bed rest has no advantage over early mobilization, and, indeed, it may actually delay recovery or cause harm. However, one military study, not included in the main analysis, did show that bed rest for acute back pain was advantageous, largely because army drill sergeants got the patients moving! This makes the useful point that pushing patients beyond their normal level of exercise is counterproductive.

It is disturbing that as late as 1998 protocols used in spinal tap procedures showed that more than 80% of hospitals in the United Kingdom insisted on bed rest. Excessive bed rest is probably still being prescribed for medical conditions like MI or low back pain. However, health insurance schemes in the USA have reduced hospital stays to a minimum, and similar changes are occurring in other countries. Perhaps this trend has the hidden benefit of getting people moving quicker.

We may conclude that, in general, getting up and about should be practiced wherever possible, whatever your age, within your capabilities and normal limits. Not to do so is running the risk of suffering the adverse effects of bed rest.

Source

Bed rest: a potentially harmful treatment needing more careful evaluation.
C. Allen, P. Glasziou, C. Del Mar, Lancet, 1999, vol. 354, pp. 1229--1234