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Changing Perspectives: Putting bedrest to rest

Putting bedrest to rest

In the previous century, bedrest was often used as a therapy by itself.1 The ancient Greeks prescribed it, as did clinicians in the late 19th century until the Second World War. Back then, a myocardial infarction required patients to lie down for four weeks.

The logistic challenges of the Second World War changed the paradigm. Hospitals full of wounded soldiers had to make room for the most wounded, thus mobilising patients earlier than usual. Clinicians noted that this improved outcomes. Additionally, studies carried out in preparation for space missions demonstrated muscle loss and functional decline in immobile subjects. Since then, detrimental health effects of immobilisation have been reported for almost any organ in the human body.2-4 Myocardial damage, postural hypotension, atelectasis, higher rate of pulmonary and urinary tract infections, thrombosis, sarcopenia, reflux disease, constipation, diverticulitis and numerous other effects are associated with prolonged bedrest.

This insight has shaped current practice: the use of physiotherapists and enhanced ambulatory care are examples of measures implemented throughout modern medicine. However, while the importance of mobilisation is undeniable, health institutions are still designed primarily around the bed. Further measures, for example altered ward designs, may be introduced to promote patient mobility and further reduce adverse health effects in an increasingly sedentary, obese and aging society.

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Changing Perspectives: Bed rest

Bed rest

The lumbosacral radicular syndrome is associated with radiating pain in one or more lumbar or sacral dermatomes. Patients are treated mostly with conservative treatment first and for decades the mainstay of this conservative treatment was strict bed rest for 14 days. Clinical trials back in the 90’s already showed that bed rest in patients with a lumbosacral radicular syndrome is not more effective than ‘watchful waiting’ and ‘watchful exercise’.

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