Deyo R A, Diehl A K, Rosenthal M
N Engl J Med. 1986 Oct 23;315(17):1064-70. doi: 10.1056/NEJM198610233151705.
Bed rest is usually recommended for acute low back pain. Although the optimal duration of bed rest is uncertain, a given prescription may directly affect the number of days lost from work or other activities. In a randomized trial, we compared the consequences of recommending two days of bed rest (Group I) with those of recommending seven days (Group II). The subjects were 203 walk-in patients with mechanical low back pain; 78 percent had acute pain (less than or equal to 30 days), and none had marked neurologic deficits. Follow-up data were obtained at three weeks (93 percent) and three months (88 percent). Although compliance with the recommendation of bed rest was variable, patients randomly assigned to Group I missed 45 percent fewer days of work than those assigned to Group II (3.1 vs. 5.6 days, P = 0.01), and no differences were observed in other functional, physiologic, or perceived outcomes. For many patients without neuromotor deficits, clinicians may be able to recommend two days of bed rest rather than longer periods, without any perceptible difference in clinical outcome. If widely applied, this policy might substantially reduce absenteeism from work and the resulting indirect costs of low back pain for both patients and employers.
对于急性下腰痛通常建议卧床休息。虽然卧床休息的最佳时长尚无定论，但特定的医嘱可能会直接影响因工作或其他活动而损失的天数。在一项随机试验中，我们比较了建议卧床休息两天（第一组）与建议卧床休息七天（第二组）的结果。受试者为203名因机械性下腰痛前来就诊的患者；78%的患者有急性疼痛（小于或等于30天），且无一例有明显的神经功能缺损。在三周（93%）和三个月（88%）时获取了随访数据。尽管对卧床休息建议的依从性各不相同，但随机分配到第一组的患者比分配到第二组的患者少误工45%（3.1天对5.6天，P = 0.01），且在其他功能、生理或自我感觉的结果方面未观察到差异。对于许多没有神经运动功能缺损的患者，临床医生或许可以建议卧床休息两天而非更长时间，而临床结果并无明显差异。如果广泛应用这一策略，可能会大幅减少患者和雇主因下腰痛导致的旷工情况及由此产生的间接成本。
