Bed rest: a potentially harmful treatment needing more careful evaluation

Background Bed rest is not only used in the management of patients who are not able to mobilise, but is also prescribed as a treatment for a large num ber of medical conditions, a procedure that has been challenged. We searche d the literature for evidence of benefit or harm of bed rest for any condit ion. Methods We systematically searched MEDLINE and the Cochrane library, and re trieved reports on randomised controlled trials of bed rest versus early mo bilisation for any medical condition, including medical procedures. Findings 39 trials of bed rest for 15 different conditions (total patients 5777) were found. In 24 trials investigating bed rest following a medical p rocedure, no outcomes improved significantly and eight worsened significant ly in some procedures (lumbar puncture, spinal anaesthesia, radiculography, and cardiac catheterisation). In 15 trials investigating bed rest as a pri mary treatment, no outcomes improved significantly and nine worsened signif icantly for some conditions (acute low back pain, labour, proteinuric hyper tension during pregnancy, myocardial infarction, and acute infectious hepat itis). Interpretation We should not assume any efficacy for bed rest. Further stud ies need to be done to establish evidence for the benefit or harm of bed re st as a treatment.