A discussion of the virtues or otherwise of bed rest in the management of medical disorders, by doctors at the University of Queensland, is published in the Lancet for October 9. It is agreed that sleep is a daily requirement for normal function, and that anyone feeling very weak from illness can do little else than go to bed promptly. The assumption that bed benefits most illnesses has been little challenged, and goes back to Hippocrates. The advice to rest in bed specifically for myocardial infarction, psychiatric diseases, and after orthopaedic surgery has long been accepted, rather uncritically.
The association between beds and patients is a product of the hospital culture, and it has been almost forgotten that bed rest is a treatment in its own right, in hospital or otherwise. Like any other treatment, its value should be critically assessed. It has been recognised that confinement to bed may increase the hazards of deep-vein thrombosis, bedsores, osteoporosis and pneumonia.
The doctors from Queensland university examined records relating to a total of 5,777 patients. The patients had been prescribed bed rest for 15 different conditions. The two major indications were prophylaxis after a medical procedure and primary treatment for acute low back pain, spontaneous labour, hypertension of pregnancy, early threatened abortion, uncomplicated myocardial infarction, pulmonary tuberculosis, acute infectious hepatitis and rheumatoid arthritis.
No evidence was found that bed rest benefited patients after surgery, and in some conditions it was harmful. Forcing a patient beyond his or her capacity for exercise may certainly be counterproductive.
In general, ideas regarding the virtues of bed rest as such seem to be so entrenched that any doubts have been slow in establishing themselves. It seems likely that bed rest is overprescribed after myocardial infarction and cardiac catheterisation, and for acute low back pain. When a degree of rest is imposed by the patient's symptoms, particularly weakness, there is little choice but to prescribe bed rest. However, it should be understood that this constitutes palliation rather than a measure to speed recovery.
Essentially, complete bed rest, as opposed to bed for achieving sleep, is unphysiological, and the possible hazards it presents dictate that it be prescribed with discrimination, and discontinued as soon as possible.