Wilkinson M J
Department of General Practice, University of Birmingham.
Br J Gen Pract. 1995 Sep;45(398):481-4.
Bed rest is a traditional treatment for back pain, yet only in recent years has the therapeutic benefit of this been questioned.
The aim of this pilot study was to ascertain whether or not 48 hours' bed rest had an effect on the outcome of acute low back pain.
The study was conducted as a randomized controlled trial to compare a prescription of 48 hours' strict bed rest with controls; the control subjects were encouraged to remain mobile and to have no daytime rest. Nine general practitioners from practices in the West Midlands recruited patients in the age range 16-60 years who presented with low back pain of less than seven days' duration, with or without pain radiation. The outcome measures assessed were: change in straight leg raise and lumbar flexion after seven days, Oswestry and Roland-Morris disability scores after seven days and 28 days, and time taken from work.
Forty two patients were recruited: 20 were allocated to bed rest and 22 as controls. Compared with the bed rest group the control group had statistically better Roland-Morris scores at day seven (P < 0.05) but not at day 28. At day seven, there were no statistically significant differences between groups in straight leg raise or lumbar flexion measurements although the control group had a better mean lumbar flexion than the bed rest group. The improvement in disability scores at day seven compared with day one was similar for the two groups but more of the control group had fully recovered (defined as scores of one or zero on the Roland-Morris disability scale and five or less on the Oswestry disability scale) by day seven. Remaining mobile did not appear to cause any adverse effects. The number of days lost from work in both groups was equal. A large number of self-remedies and physical therapies were recorded by subjects from both groups.
The results of this pilot study did not indicate whether bed rest or remaining mobile was superior for the treatment of acute low back pain; however, the study sample was small. Subjects in the control group possibly fared better as they appeared to have better lumbar flexion at day seven. It appears that 48 hours' bed rest cannot be recommended for the treatment of acute low back pain on the basis of this small study. Large-scale definitive trials are required to detect clinically significant differences.
卧床休息是治疗背痛的传统方法，但直到近年来，其治疗效果才受到质疑。
本初步研究的目的是确定48小时卧床休息对急性下背痛的治疗效果是否有影响。
本研究采用随机对照试验，将48小时严格卧床休息的处方与对照组进行比较；对照组受试者被鼓励保持活动，白天不休息。西米德兰兹郡的9名全科医生招募了年龄在16至60岁之间、出现持续时间少于7天的下背痛（无论是否伴有疼痛放射）的患者。评估的结果指标包括：7天后直腿抬高和腰椎前屈的变化、7天和28天后的Oswestry和Roland-Morris残疾评分，以及误工时间。
招募了42名患者：20名被分配到卧床休息组，22名作为对照组。与卧床休息组相比，对照组在第7天的Roland-Morris评分在统计学上更好（P < 0.05），但在第28天并非如此。在第7天，两组之间在直腿抬高或腰椎前屈测量方面没有统计学上的显著差异，尽管对照组的平均腰椎前屈比卧床休息组更好。两组在第7天与第1天相比，残疾评分的改善相似，但到第7天，更多的对照组患者已完全康复（定义为Roland-Morris残疾量表评分为1或0，Oswestry残疾量表评分为5或更低）。保持活动似乎没有引起任何不良影响。两组的误工天数相等。两组受试者都记录了大量的自我治疗方法和物理治疗方法。
本初步研究的结果并未表明卧床休息或保持活动对急性下背痛的治疗哪个更优；然而，研究样本较小。对照组的受试者可能情况更好，因为他们在第7天的腰椎前屈似乎更好。基于这项小型研究，似乎不推荐48小时卧床休息用于治疗急性下背痛。需要进行大规模的确定性试验来发现临床上的显著差异。
