Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Jun 16;2010(6):CD007612.
doi: 10.1002/14651858.CD007612.pub2.

Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica

Kristin Thuve Dahm  1 , Kjetil G Brurberg, Gro Jamtvedt, Kåre Birger Hagen
Affiliations
Meta-Analysis

Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica

Kristin Thuve Dahm et al. Cochrane Database Syst Rev. .

Abstract

Background: Acute low-back pain (LBP) is a common reason to consult a general practitioner. Debate continues on the comparative effectiveness of advice on bed rest and staying active as part of the primary care management.

Objectives: To determine the effects of advice to rest in bed or stay active for patients with acute low-back pain or sciatica.

Search strategy: We searched the Cochrane Back Review Group Trials Register, CENTRAL, MEDLINE, EMBASE, Sport, and SCISEARCH to May 2009, reference lists of relevant articles, and contacted authors of relevant articles.

Selection criteria: Randomised trials of the effectiveness of advice to stay active or rest in bed for patients with acute LBP or sciatica. The main outcomes were pain, functional status, recovery and return to work.

Data collection and analysis: Two authors independently selected trials, assessed the risk of bias and extracted data. The trials were combined qualitatively or statistically, depending on data availability and presentation.

Main results: We included ten RCTs with varying risk of bias. For patients with acute LBP, results from two trials (N = 401) suggest small improvements in pain relief (SMD 0.22 (95% CI: 0.02 to 0.41) and functional status (SMD 0.29 (95% CI: 0.09 to 0.49) in favour of advice to stay active. For patients with sciatica, there is moderate quality evidence of little or no difference in pain relief (SMD -0.03 (95% CI: -0.24 to 0.18)) or functional status (SMD 0.19 (95% CI: -0.02 to 0.41)), between advice to rest in bed or stay active.Low quality evidence (3 RCTs, N = 931) suggests little or no difference between exercises, advice to rest in bed or stay active for patients with acute LBP. Low quality evidence (1 RCT, N = 250) suggests little or no difference between physiotherapy, advice to rest in bed or stay active for patients with sciatica. No trials that compared different ways of delivering advice.

Authors' conclusions: Moderate quality evidence shows that patients with acute LBP may experience small benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed; patients with sciatica experience little or no difference between the two approaches. Low quality evidence suggests little or no difference between those who received advice to stay active, exercises or physiotherapy. Further research is very likely to have an important impact on the estimate of effect and is likely to change our confidence in it.

PubMed Disclaimer

Conflict of interest statement

None

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Bed rest versus advice to stay active, Outcome 1 Pain Intensity, 3‐4 weeks.
1.2
1.2. Analysis
Comparison 1 Bed rest versus advice to stay active, Outcome 2 Pain Intensity, 12 weeks.
1.3
1.3. Analysis
Comparison 1 Bed rest versus advice to stay active, Outcome 3 Functional status, 3‐4 weeks.
1.4
1.4. Analysis
Comparison 1 Bed rest versus advice to stay active, Outcome 4 Functional status, 12 weeks.
1.5
1.5. Analysis
Comparison 1 Bed rest versus advice to stay active, Outcome 5 Length of sick leave, 3‐4 weeks.
1.6
1.6. Analysis
Comparison 1 Bed rest versus advice to stay active, Outcome 6 Length of sick leave, 12 weeks.
2.1
2.1. Analysis
Comparison 2 Bed rest versus other treatments, Outcome 1 Pain Intensity, 10 days ‐ 3 weeks.
2.2
2.2. Analysis
Comparison 2 Bed rest versus other treatments, Outcome 2 Pain Intensity, 12 weeks.
2.3
2.3. Analysis
Comparison 2 Bed rest versus other treatments, Outcome 3 Functional status, 3 weeks.
2.4
2.4. Analysis
Comparison 2 Bed rest versus other treatments, Outcome 4 Functional status, 12 weeks.
2.5
2.5. Analysis
Comparison 2 Bed rest versus other treatments, Outcome 5 Length of sick leave, 3 weeks.
2.6
2.6. Analysis
Comparison 2 Bed rest versus other treatments, Outcome 6 Length of sick leave, 12 weeks.
3.1
3.1. Analysis
Comparison 3 Short bed rest versus long bed rest, Outcome 1 Pain intensity.
3.2
3.2. Analysis
Comparison 3 Short bed rest versus long bed rest, Outcome 2 Proportion of patients recovered.
4.1
4.1. Analysis
Comparison 4 Advice to stay active versus other treatment, Outcome 1 Pain Intensity, 3‐4 weeks.
4.2
4.2. Analysis
Comparison 4 Advice to stay active versus other treatment, Outcome 2 Pain Intensity, 12 weeks.
4.3
4.3. Analysis
Comparison 4 Advice to stay active versus other treatment, Outcome 3 Functional status, 3‐4 weeks.
4.4
4.4. Analysis
Comparison 4 Advice to stay active versus other treatment, Outcome 4 Functional status, 12 weeks.
4.5
4.5. Analysis
Comparison 4 Advice to stay active versus other treatment, Outcome 5 Length of sick leave, 3‐4 weeks.
4.6
4.6. Analysis
Comparison 4 Advice to stay active versus other treatment, Outcome 6 Length of sick leave, 12 weeks.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Deyo 1986 {published data only}
    1. Deyo RA, Diehl AK, Rosenthal M. How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med 1986;315(17):1064‐70. - PubMed
Gilbert 1985 {published data only}
    1. Gilbert JR, Taylor DW, Hildebrand A, Evans C. Clinical trial of common treatments for low back pain in family practice. Br Med J Clin Res Ed 1985;291(6498):791‐4. - PMC - PubMed
Hofstee 2002 {published and unpublished data}
    1. Hofstee DJ, Gutenbeek JMM, Hoogland PH, Houwelingen HC, Kloet A, Lötters F, et al. Westeinde sciatica trial: randomized controlled study of bed rest and physiotherapy for acute sciatica. J Neurosurg 2002;96(1 Suppl):45‐9. - PubMed
Malmivaara 1995 {published and unpublished data}
    1. Malmivaara A, Hakkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, et al. The treatment of acute low back pain ‐ bed rest, exercises, or ordinary activity?. N Engl J Med 1995;332(6):351‐5. - PubMed
Postacchini 1988 {published data only}
    1. Postacchini F, Facchini M, Palieri P. Efficacy of various forms of conservative treatment in low back pain: a comparative study. Neuro‐orthopedics 1988;6(1):28‐35.
Rozenberg 2002 {published data only}
    1. Rozenberg S, Delval C, Rezvani Y, Olovieri‐Apicella N, Kuntz JL, Legrand E, et al. Bed rest or normal activity for patients with acute low back pain: a randomized controlled trial. Spine 2002;27(14):1487‐93. - PubMed
Szpalski 1992 {published data only}
    1. Szpalski M, Hayez JP. How many days of bed rest for acute low back pain? Objective assessment of trunk function. Eur Spine J 1992;1(1):29‐31. - PubMed
Vroomen 1999 {published data only}
    1. Vroomen PCAJ, Marc CTFM, Wilmink JT, Kester ADM, Knottnerus JA. Lack of effectiveness of bed rest for sciatica. N Engl J Med 1999;340(6):418‐23. - PubMed
Wiesel 1980 {published data only}
    1. Wiesel SW, Cuckler JM, Deluca F, Jones F, ZeideMS, Rothman RH. Acute low‐back pain ‐ An objective analysis of conservative therapy. Spine 1980;5(4):324‐30. - PubMed
Wilkinson 1995 {published data only}
    1. Wilkinson MJ. Does 48 hours’ bed rest influence the outcome of acute low back pain?. Br J Gen Pract 1995;45(398):481‐4. - PMC - PubMed

References to studies excluded from this review

Coomes 1961 {published data only}
    1. Coomes NE. A comparison between epidural anaesthesia and bedrest in sciatica. BMJ 1961;1(5218):20‐4. - PMC - PubMed
Godges 2008 {published data only}
    1. Joseph J Godges, Marie A Anger, Grenith Zimmerman, Anthony Delitto. Effects of Education on Return‐to‐Work Status for People With Fear‐Avoidance Beliefs and Acute LowBack Pain. Physical Therapy 2008;88(2):231‐239. - PubMed
Hancock 2007 {published data only}
    1. Mark J Hancock, Chris G Maher, Jane Latimer, Andrew J McLachlan, Chris W Cooper, Richard O Day, Megan F Spindler, James H McAuley. Assessment of diclofenac or spinal manipulative therapy, orboth, in addition to recommended fi rst‐line treatment foracute low back pain: a randomised controlled trial. Lancet 2007;370:1638‐43. - PubMed
Paatelma 2008 {published data only}
    1. Paatelma M, Kilpikoski S, Simonen R, Heinonen A, Alen M, Videman T. Orthopedic manual therapy, Mckenzie method or advice onely for low back pain in working adults: A randomizedcontrolled trial with one year follow‐up. J Rehabil Med 2008;40:858‐863. - PubMed
Pal 1986 {published data only}
    1. Pal B, Mangion P, Hossain MA, Diffey BL. A controlled trial of continuous lumbar traction in the treatment of back pain and sciatica. Br J Rheumatol 1986;25:1181‐3. - PubMed
Rupert 1988 {published data only}
    1. Rupert RL, Wagnon R, Thompson P, Ezzeldin MT. Chiropractic adjustments: results of a controlled trial in Egypt. Intl Rev Chiro 1985:58‐60.

Additional references

Allen 1999
    1. Allen C, Glasziou P, Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999;354(9):1229‐33. - PubMed
Bortz 1984
    1. Bortz WM. The disuse syndrome. West J Med Nov. 1984;141(5):691‐4. - PMC - PubMed
Cohen 1988
    1. Cohen J. Statistical power analysis for the behavioral sciences. 1st Edition. New York, San Francisco, London: Academic press, 1988.
Convertino 1997
    1. Convertino VA, Bloomfield SA, Greenleaf JE. An overview of the issues: physiological effects of bed rest and restricted activity. Med Sci Sports Exerc 1997;29:187‐90. - PubMed
Furlan 2009
    1. Furlan AD, Pennick V, Bombardier C, Tulder M, Editorial Board, Cochrane Back Review Group. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 2009;34(18):1929‐41. - PubMed
Hagen 2004
    1. Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for acute low‐back pain and sciatica. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD001254.pub2] - DOI - PubMed
Higgins 2009
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org.
Hilde 2002
    1. Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for low‐back and sciatica. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD003632.pub2] - DOI
Mayer 1988
    1. Mayer TG, Gatchel RJ. Functional restoration for spinal disorders. The sports medicine approach. Philadelphia: Lea & Febiger, 1988.
Nachemson 2000
    1. Nachemson A, Waddell G, Nordlund A. Prevalence of pain in the neck and lower back [Förekomst av smärta i nacken och ländryggen]. In: Nachemson A, Johnson E editor(s). Prevalence neck and low back pain. in Neck and Back Pain. Stockholm: The Swedish Council on Technology Assessment in Health Care, 2000.
Waddell 1987
    1. Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low‐back pain. Spine 1987;12:632‐44. - PubMed
Waddell 1997
    1. Waddell G, Feder G, Moshie L. Systematic reviews of bed rest and advice to stay active for acute low back pain. British Journal of General Practice 1997;47:647‐52. - PMC - PubMed
Wheeler 1995
    1. Wheeler AH, Hanley EN. Nonoperative treatment for low back pain. Rest to restoration. Spine 1995;20(3):375‐8. - PubMed