Vroomen P C, de Krom M C, Wilmink J T, Kester A D, Knottnerus J A
Department of Neurology, Maastricht University Hospital, The Netherlands.
N Engl J Med. 1999 Feb 11;340(6):418-23. doi: 10.1056/NEJM199902113400602.
Bed rest is widely advocated for sciatica, but its effectiveness has not been established. To study the effectiveness of bed rest in patients with a lumbosacral radicular syndrome of sufficient severity to justify treatment with bed rest for two weeks, we randomly assigned 183 subjects to either bed rest or watchful waiting for this period. The primary outcome measures were the investigator's and patient's global assessments of improvement after 2 and 12 weeks, and the secondary outcome measures were changes in functional status and in pain scores (after 2, 3, and 12 weeks), absenteeism from work, and the need for surgical intervention. Neither the investigators who assessed the outcomes nor those involved in data entry and analysis were aware of the patients' treatment assignments.
After two weeks, 64 of the 92 patients in the bed-rest group (70 percent) reported improvement, as compared with 59 of the 91 patients in the control (watchful-waiting) group (65 percent) (adjusted odds ratio for improvement in the bed-rest group, 1.2; 95 percent confidence interval, 0.6 to 2.3). After 12 weeks, 87 percent of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the bothersomeness of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.
Among patients with symptoms and signs of a lumbosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting.
卧床休息被广泛推荐用于治疗坐骨神经痛，但其有效性尚未得到证实。为研究卧床休息对病情严重程度足以证明需卧床休息两周进行治疗的腰骶神经根综合征患者的有效性，我们将183名受试者随机分为卧床休息组或在此期间进行观察等待组。主要结局指标为研究者和患者在2周及12周后对改善情况的整体评估，次要结局指标为功能状态和疼痛评分的变化（在2周、3周和12周后）、缺勤情况以及手术干预需求。评估结局的研究者以及参与数据录入和分析的人员均不知患者的治疗分组情况。
两周后，卧床休息组92例患者中有64例（70%）报告病情改善，而对照组（观察等待组）91例患者中有59例（65%）报告病情改善（卧床休息组改善的调整优势比为1.2；95%置信区间为0.6至2.3）。12周后，两组中87%的患者报告病情改善。对疼痛强度、症状困扰程度和功能状态的评估结果显示两组之间无显著差异。两组的缺勤程度和手术干预率相似。
在有腰骶神经根综合征症状和体征的患者中，卧床休息并不比观察等待更有效。
