Bed rest: a potentially harmful treatment needing more careful evaluation.

BACKGROUND

Bed rest is not only used in the management of patients who are not able to mobilise, but is also prescribed as a treatment for a large number of medical conditions, a procedure that has been challenged. We searched the literature for evidence of benefit or harm of bed rest for any condition.

METHODS

We systematically searched MEDLINE and the Cochrane library, and retrieved reports on randomised controlled trials of bed rest versus early mobilisation for any medical condition, including medical procedures.

FINDINGS

39 trials of bed rest for 15 different conditions (total patients 5777) were found. In 24 trials investigating bed rest following a medical procedure, no outcomes improved significantly and eight worsened significantly in some procedures (lumbar puncture, spinal anaesthesia, radiculography, and cardiac catheterisation). In 15 trials investigating bed rest as a primary treatment, no outcomes improved significantly and nine worsened significantly for some conditions (acute low back pain, labour, proteinuric hypertension during pregnancy, myocardial infarction, and acute infectious hepatitis).

INTERPRETATION

We should not assume any efficacy for bed rest. Further studies need to be done to establish evidence for the benefit or harm of bed rest as a treatment.