Authors' objectives

To assess the efficacy or adverse effects of bed rest for any condition.

Searching

The authors searched the electronic databases of MEDLINE and the Cochrane Library (January 1966 to June 1998) using the terms: 'bed rest', 'bedrest', 'recumben*', 'expectant', 'rest', 'early ambulat*', 'early activation', 'early discharge', 'randomised-controlled-trial', 'controlled-clinical-trial', or 'random'. The authors also searched relevant articles from this review, review articles with citation tracking, and personal bibliographies for additional relevant studies.

Study selection

Assessment of study quality

The authors do not state that they assessed validity.

Data extraction

One author performed the data extraction.

Data were extracted for the categories of: Study identification, intervention, number of participants, outcome measures, condition being treated, direction of effect and individual odds ratios (ORs) with 95% confidence intervals (CIs).

Methods of synthesis

Results of the review

Thirty-nine RCTs were included in the review with 5,777 participants.

In twenty-four trials investigating bed rest following a medical procedure, seven outcomes were better with bed rest but none significantly so, whereas twenty-six outcomes were worse with bed rest; and nine of which were significantly worse. No significant benefit was shown in ten trials examining the frequency of headache after spinal puncture with different protocols of bed rest. Nine studies examined the effect of different periods of bed rest after cardiac catheterisation, with the early ambulation times varying between 2 hours and 6 hours. The results suggested that 2.5 hours rest is sufficient after catheterisation with 5F or 6F catheters, and 4 hours is sufficient after catheterisation with 7F catheters.

In fifteen trials investigating bed rest as a primary treatment, six outcomes were better with bed rest, but none significantly, whereas twenty-five outcomes were worse and nine significantly so. Three trials on the use of bed rest in obstetrics were included: one reported significantly worse outcomes with bed rest in the first stage of labour.

Authors' conclusions

The authors state that overall there was no evidence that bed rest has any significant beneficial effect when used as a treatment or when used after surgery. Indeed, in some disorders it seems to be harmful.

CRD commentary

The authors have stated their research question and some inclusion and exclusion criteria. The literature search appears to be thorough although it is not clear whether there were any language restrictions. It is possible that additional relevant studies may have been missed because the searches were limited to published data which may also have led to publication bias. The authors do not report whom, or how many of the authors, performed the selection of studies or who performed the data extraction. There is no validity assessment of the included studies.

The review was a narrative presentation of individual odds ratios (ORs) and 95% confidence intervals (CIs) with a narrative summary of the results. The authors stated that pooling was not possible because there was much variation in the application of the strictness and duration of bed rest, even within disease groups.

The authors' conclusions appear to follow from the results but these should be viewed with caution because of the methodological limitations in the process of the review.

Implications of the review for practice and research

Practice: The authors state that the findings support modern recommendations that bed rest should no longer be offered for acute low back pain, myocardial infarction, pulmonary tuberculosis, or acute infectious hepatitis. Bed rest should be considered a highly unphysiologic and definitely hazardous form of therapy, to be ordered only for specific indications and discontinued as soon as possible. The indications for which bed rest should be prescribed, and for how long, are yet to be defined.

Research: The authors state that further studies need to be done to establish evidence for the benefit or harm of bed rest as a treatment.

Bibliographic details

Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999; 354: 1229-1233. [PubMed: 10520630]

Other publications of related interest

These additional published commentaries may also be of interest. Reis S. Review: early mobilsation may be better than bed rest for medical conditions and after surgery 2000;5(3):76. Burson T. Review: early mobilisation is better than bed rest for medical conditions and after healthcare procedures. Evid Based Nurs 2000;3:52.

Indexing Status

Subject indexing assigned by NLM

MeSH

Bed Rest /adverse effects; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome

AccessionNumber

11999009726

Database entry date

31/12/2000

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.