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People with acute low-back pain who are advised to rest in bed have more pain and are less able to perform every day activities, on average, than those who are advised to stay active.

As many people get some relief from low back pain and sciatica (pain down the back and leg) by lying down, bed rest is often recommended. However, this review found that, for people with acute low-back pain, advice to rest in bed is less effective in reducing pain and improving an individual's ability to perform every day activities than advice to stay active. For people with sciatica, there were no important differences in the effects of advice to stay in bed compared with advice to stay active.

Abstract

Background

Low-back pain (LBP) is a common reason for consulting a general practitioner, and advice on daily activities is an important part of the primary care management of low-back pain.

Objectives

To assess the effects of advice to rest in bed for patients with acute LBP or sciatica.

Search strategy

We searched the Cochrane Back Group Specialized Registry, CENTRAL, MEDLINE, EMBASE, Sport, and SCISEARCH to March 2003, reference lists of relevant articles, and contacted authors of relevant articles.

Selection criteria

Randomised or controlled clinical trials with quasi-randomisation (alternate allocation, case record numbers, dates of birth, etc.), in any language, where the effectiveness of advice to rest in bed was evaluated. The main outcomes of interest were pain, functional status, recovery and return to work.

Data collection and analysis

Two authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Investigators were contacted to obtain missing information.

Main results

Eleven trials (1963 patients) were included in this updated version. There is high quality evidence that people with acute LBP who are advised to rest in bed have a little more pain [Standardised Mean Difference (SMD) 0.22 (95% Confidence Interval (CI): 0.02, 0.41)] and a little less functional recovery [SMD 0.29 (95% CI: 0.05, 0.45)] than those advised to stay active. For patients with sciatica, there is high quality evidence of little or no difference in pain [SMD -0.03 (95% CI: -0.24, 0.18)] or functional status [SMD 0.19 (95% CI: -0.02, 0.41)], between bed rest and staying active.

For patients with acute LBP, there is moderate quality evidence of little or no difference in pain intensity or functional status between bed rest and exercises. For patients with sciatica, there is moderate quality evidence of little or no difference in pain intensity between bed rest and physiotherapy, but small improvements in functional status [Weighted Mean Difference 6.9 (on a 0-100 scale) (95% CI: 1.09, 12.74)] with physiotherapy. There is moderate quality evidence of little or no difference in pain intensity or functional status between two to three days and seven days of bed rest.

Authors' conclusions

For people with acute LBP, advice to rest in bed is less effective than advice to stay active. For patients with sciatica, there is little or no difference between advice to rest in bed and advice to stay active. There is little or no difference in the effect of bed rest compared to exercises or physiotherapy, or seven days of bed rest compared with two to three.

Keith Physical Therapy "There are two ways of spreading light; to be the candle, or the mirror that reflects it." - Edith Wharton
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Our Mission Statement We are committed to one on one patient centered care with a hands on, holistic and thorough approach to therapy. What we offer We specialize in orthopedic management of spine and limb dysfunction with niches in temporomandibular joint disorders, foot orthotic fabrication, prosthetic rehabilitation, and chronic disease. Our population ranges from teenage athletes to the retiree. -The Red barn, Arcadia OK	Bed rest for acute low-back pain and sciatica People with acute low-back pain who are advised to rest in bed have more pain and are less able to perform every day activities, on average, than those who are advised to stay active. As many people get some relief from low back pain and sciatica (pain down the back and leg) by lying down, bed rest is often recommended. However, this review found that, for people with acute low-back pain, advice to rest in bed is less effective in reducing pain and improving an individual's ability to perform every day activities than advice to stay active. For people with sciatica, there were no important differences in the effects of advice to stay in bed compared with advice to stay active. Abstract Background Low-back pain (LBP) is a common reason for consulting a general practitioner, and advice on daily activities is an important part of the primary care management of low-back pain. Objectives To assess the effects of advice to rest in bed for patients with acute LBP or sciatica. Search strategy We searched the Cochrane Back Group Specialized Registry, CENTRAL, MEDLINE, EMBASE, Sport, and SCISEARCH to March 2003, reference lists of relevant articles, and contacted authors of relevant articles. Selection criteria Randomised or controlled clinical trials with quasi-randomisation (alternate allocation, case record numbers, dates of birth, etc.), in any language, where the effectiveness of advice to rest in bed was evaluated. The main outcomes of interest were pain, functional status, recovery and return to work. Data collection and analysis Two authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Investigators were contacted to obtain missing information. Main results Eleven trials (1963 patients) were included in this updated version. There is high quality evidence that people with acute LBP who are advised to rest in bed have a little more pain [Standardised Mean Difference (SMD) 0.22 (95% Confidence Interval (CI): 0.02, 0.41)] and a little less functional recovery [SMD 0.29 (95% CI: 0.05, 0.45)] than those advised to stay active. For patients with sciatica, there is high quality evidence of little or no difference in pain [SMD -0.03 (95% CI: -0.24, 0.18)] or functional status [SMD 0.19 (95% CI: -0.02, 0.41)], between bed rest and staying active. For patients with acute LBP, there is moderate quality evidence of little or no difference in pain intensity or functional status between bed rest and exercises. For patients with sciatica, there is moderate quality evidence of little or no difference in pain intensity between bed rest and physiotherapy, but small improvements in functional status [Weighted Mean Difference 6.9 (on a 0-100 scale) (95% CI: 1.09, 12.74)] with physiotherapy. There is moderate quality evidence of little or no difference in pain intensity or functional status between two to three days and seven days of bed rest. Authors' conclusions For people with acute LBP, advice to rest in bed is less effective than advice to stay active. For patients with sciatica, there is little or no difference between advice to rest in bed and advice to stay active. There is little or no difference in the effect of bed rest compared to exercises or physiotherapy, or seven days of bed rest compared with two to three. The Cochrane Database of Systematic Reviews 2007 Issue 1 Copyright © 2007 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd. Date of last Subtantial Update: July 31. 2004
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