Question: In patients with acute low-back pain
or sciatica, does bed rest reduce pain and improve function?
Data sources: Studies were identified by searching
databases, including the Cochrane Controlled Trials Register, Medline
(to 1998), Embase/Excerpta Medica (to 1998), Sport (to
1998), and Scisearch (to 1998); by scanning reference lists of articles;
and by contacting authors.
Study selection: 2 reviewers independently selected
studies that were randomized or quasi-randomized trials of bed rest
for persons between 16 and 80 years of age who had acute low-back
pain with radiation of pain below the knee (sciatica) or no radiation
of pain. Exclusion criteria were inflammatory joint disease, infection,
neoplasm, metastasis, osteoporosis, and fracture.
Data extraction: 2 reviewers independently assessed
the quality of the study methods. A third reviewer resolved any
disagreement. Data on participant characteristics, interventions,
and outcomes were extracted. Authors were contacted for any missing
data.
Results: 9 studies (3 in North America and 6 in
Europe) involving a total of 1435 patients met the selection criteria.
2 of 3 heterogeneous studies comparing the effects of bed rest with
those of maintaining activity had high-quality methods, and the
pooled results showed no difference in pain intensity
in the short term (£3 weeks) or the intermediate term
(3 to 12 weeks) (table). The pooled results of 3 studies showed
a slight decrease in functional status (Oswestry Low Back Pain Disability
Questionnaire) for the bed-rest group in the short term (P < 0.01);
the difference was not statistically significant in the intermediate
term (table). In 2 studies comparing shorter periods (2 to 4 days)
with longer periods (>4 days) of bed rest, no differences
existed between groups for pain intensity, functional status, or
time to recovery in the short or intermediate term. Of 4 studies
that examined other treatments, 2 compared bed rest with exercise and
found no differences for pain or restriction of activities of daily
living in the short, intermediate, or long (1-year) term. Bed rest
did not reduce pain or disability when compared with a combination
of bed rest, exercise, and education (1 study) or with manipulation,
drug therapy, physiotherapy, back school, or placebo (1 study).
Another study, with lower-quality methods, compared bed rest with
epidural anesthesia and showed that the mean time to recovery was longer
in the bed-rest group than in the epidural group (31 vs. 11 days,
P < 0.001). (table)
Conclusion: In patients with low-back pain or sciatica,
bed rest does not relieve pain better than advice to maintain activity,
and it leads to a decrease in function.