Healthy Living
Bed Rest - More Harm Than Good?
By David Perlmutter, MD, FACN
Bed rest has long been advocated as an important adjunct in the treatment of a variety of illnesses. Indeed Hippocrates stated "In every movement of the body, whenever one begins to endure pain, it will be relieved by rest". Bed rest is commonly recommended in the treatment of myocardial infarction, following various surgical procedures, for acute low back pain, to prevent early threatened abortion, and in the treatment of tuberculosis, rheumatoid arthritis, acute infectious hepatitis, and other illnesses.
But it should be remembered that bed rest is a form of medical treatment and therefore, should be scrutinized in terms of its effectiveness. Studies dating back to the 1940's have shown that bed rest offers virtually no advantage for post-operative patients following various types of surgeries and actually may increase the risk of various complications including osteoporosis, deep vein thrombosis, bed sores, and pneumonia.
In a report entitled, Bed Rest: a Potentially Harmful Treatment Needing More Careful Evaluation appearing in the October 9, 1999 issue of The Lancet, researchers evaluated the medical literature comparing bed rest to ambulation in a variety of common circumstances. Their results revealed that bed rest offered virtually no advantage over ambulation in a variety of common medical problems including acute low back pain, pulmonary tuberculosis, rheumatoid arthritis, as well as following surgical procedures such as liver biopsy, cardiac cathaterization, and lumbar puncture.
As the author stated "published results give little support for bed rest as a form of management in a wide range of settings, and suggest that it may actually delay recovery and even harm the patient. . . . Ideas about bed rest seem so entrenched that medical practice has been slow to change - even when faced with evidence of ineffectiveness. For example, a study of protocols used after spinal puncture in 1998 found that more than 80% of neurological units in the UK still insist on bed rest despite evidence from 17 years earlier that bed rest has no value. There are also reports that bed rest is still being over-prescribed after myocardial infarction and cardiac cathaterization, and for acute low back pain." Further, in specifically commenting on the use of bed rest following myocardial infarction, the author stated "the value of bed rest was questioned in 1938 because during the two months of forced bed rest more patients died of pulmonary infarction, uremia (kidney failure), and pneumonia, than of cardiac complications. Despite recommendations in 1944 for the period of bed rest to be cut to two weeks, six years later standard clinical practice still prescribed four weeks or more of bed rest. Since that time, large scale clinical trials have shown that bed rest is unnecessary, and one showed that there is significant danger associated with hospital bed rest after myocardial infarction. In current clinical practice only 12 hours of bed rest is prescribed, with ambulation in the ward by day 3." Finally, to quote from a report entitled "Abuse of rest as a therapeutic measure for patients with cardiovascular disease" appearing in the Journal of the American Medical Association, over 50 years ago, "the physician must always consider complete bed rest as a highly unphysiologic and definitely hazardous form of therapy, to be ordered only for specific indications and discontinued as early as possible."
When physicians make recommendations for a particular therapeutic intervention, it is hoped that this recommendation is made on the basis of reviewing the scientific literature supporting its effectiveness. For example, when a particular antibiotic is used in a specific infectious disease, it is generally assumed that there is scientific literature supporting the usefulness of that particular drug in treating the suspected infectious agent. Bed rest is no less a therapeutic intervention. Therefore, it to should be recommended only in the presence of a strong scientific support based on a retrospective analysis of outcome. In many instances, there is virtually no support for the recommendation of bed rest, and indeed its utilization may increase the risk of potentially dangerous complications.