Tags

Type your tag names separated by a space and hit enter

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

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.

Authors+Show Affiliations

Norwegian Knowledge Centre for the Health Services, PO Box 7004, St. Olavs Plass, Oslo, Norway, N-0130.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

20556780

Citation

Dahm, Kristin Thuve, et al. "Advice to Rest in Bed Versus Advice to Stay Active for Acute Low-back Pain and Sciatica." The Cochrane Database of Systematic Reviews, 2010, p. CD007612.
Dahm KT, Brurberg KG, Jamtvedt G, et al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010.
Dahm, K. T., Brurberg, K. G., Jamtvedt, G., & Hagen, K. B. (2010). Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. The Cochrane Database of Systematic Reviews, (6), CD007612. https://doi.org/10.1002/14651858.CD007612.pub2
Dahm KT, et al. Advice to Rest in Bed Versus Advice to Stay Active for Acute Low-back Pain and Sciatica. Cochrane Database Syst Rev. 2010 Jun 16;(6)CD007612. PubMed PMID: 20556780.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. AU - Dahm,Kristin Thuve, AU - Brurberg,Kjetil G, AU - Jamtvedt,Gro, AU - Hagen,Kåre Birger, Y1 - 2010/06/16/ PY - 2010/6/18/entrez PY - 2010/6/18/pubmed PY - 2010/7/28/medline SP - CD007612 EP - CD007612 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 6 N2 - 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. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/20556780/Advice_to_rest_in_bed_versus_advice_to_stay_active_for_acute_low_back_pain_and_sciatica_ L2 - https://doi.org/10.1002/14651858.CD007612.pub2 DB - PRIME DP - Unbound Medicine ER -