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The Updated Cochrane Review of Bed Rest for Low Back Pain and Sciatica

Hagen, Kåre B., PhD*; Jamtvedt, Gro, MPH; Hilde, Gunvor, MSc; Winnem, Michael F., MD§

doi: 10.1097/01.brs.0000154625.02586.95
Cochrane Collaboration Review

Study Design. A systematic review within the Cochrane Collaboration Back Review Group.

Objectives. To report the main results from the updated version of the Cochrane Review on bed rest for low back pain.

Summary of Background Data. There has been a growing amount of evidence showing that bed rest is not beneficial for people with low back pain. However, existing systematic reviews are unclear regarding the effects of bed rest for different types of low back pain.

Methods. All randomized studies available in systematic searches up to March 2003 were included. Two reviewers independently selected trials for inclusion assessed the validity of included trials and extracted data. Investigators were contacted to obtain missing information.

Results. Two new trials comparing advice to rest in bed with advice to stay active were included. There is high quality evidence that people with acute low back pain who are advised to rest in bed have a little more pain (standardized mean difference 0.22, 95% confidence interval: 0.02–0.41) and a little less functional recovery (standardized mean difference 0.29, 95% confidence interval: 0.05–0.45) than those advised to stay active. For patients with sciatica, there is moderate quality evidence of little or no difference in pain (standardized mean difference −0.03, 95% confidence interval: −0.24–0.18) or functional status (standardized mean difference 0.19, 95% confidence interval: −0.02–0.41) between bed rest and staying active.

Conclusion. For people with acute low back pain, 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.

Existing systematic reviews are unclear regarding the effects of bed rest for different types of low back pain. By including 2 new trials, analyzing acute low back pain and sciatica separately and assessing the quality of evidence with a systematic and explicit method, this updated review revealed a somewhat different effect of bed rest for acute low back pain and sciatica.

From the *National Resource Centre for Rehabilitation in Rheumatology, Oslo, Norway, †Norwegian Health Services Research Centre, Oslo, Norway, ‡38 Patterson Close SW, Calgary, Canada, and §GlaxoSmithKlein, Oslo, Norway.

Supported by the Directorate for Health and Social Affairs in Norway, where 3 of the authors (K.B.H., G.J., G.H.) previously have been employed.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Kåre B. Hagen, PhD, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, Oslo 0319, Norway; E-mail: kare.birger.hagen@nrrk.no

© 2005 Lippincott Williams & Wilkins, Inc.