Gilbert J R, Taylor D W, Hildebrand A, Evans C
Br Med J (Clin Res Ed). 1985 Sep 21;291(6498):791-4. doi: 10.1136/bmj.291.6498.791.
The results of a multicentered randomised clinical trial are reported of bed rest and of a physiotherapy and education programme for patients who presented in family practice with an acute episode of low back pain. No beneficial effect of either treatment was observed on several clinical outcome measures, including straight leg raising, lumbar flexion, activities of daily living, and pain. In fact the results favoured early mobilisation over bed rest and suggested that the physiotherapy and education programme was doing more harm than good. Moreover, additional analyses, which focused on clinically interesting patient subgroups, discovered no subset of patients who benefited from either of the treatments under study. Having failed to identify any clinically important benefits, or other explanations for these negative results, we can only conclude that family doctors have little reason to prescribe either bed rest or isometric exercises to patients who suffer from low back pain.
本文报告了一项多中心随机临床试验的结果，该试验针对在家庭医疗中出现急性腰痛发作的患者，比较了卧床休息与物理治疗及教育计划的效果。在包括直腿抬高、腰椎前屈、日常生活活动及疼痛等多项临床结局指标上，未观察到两种治疗方法有任何有益效果。事实上，结果显示早期活动优于卧床休息，且物理治疗及教育计划弊大于利。此外，针对临床上有意义的患者亚组进行的额外分析发现，在所研究的两种治疗方法中，没有任何一个患者亚组从中受益。由于未能确定任何具有临床重要意义的益处，或对这些阴性结果的其他解释，我们只能得出结论：对于患有腰痛的患者，家庭医生几乎没有理由开具卧床休息或等长运动的处方。
