The updated cochrane review of bed rest for low back pain and sciatica.

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.