The Devil In Your Bed

Bed rest is not always the right 

postscript to illness, writes Biplab Das 

The saddest part of any illness are the days of recovery. Lying on one's bed and missing all the daily activities can be quite a nightmare. But who can deny the doctor's advice? Since time unknown bed rest has been a pivotal mode of convalescence. However, findings of a new research are all set to break the myth. 

In a recent issue of Lancet, Paul Glaszion of the University of Queensland, Australia has published a study, which reveals the detrimental effects of bed rest. Developing on the ideas of co-researcher Chris Del Mar, Glaszion amassed evidence from various journals and reports to arrive at his conclusion. 

A research was done in the 1940's, which showed that bed rest had very few advantages. The effects were far reaching and could manifest in the form of deep-vein thrombosis, bed sores, weakened bone mass and pneumonia. The study induced doctors to reduce the period of rest from weeks to days. 

Taking the cue from this earlier research, Glaszion's team started working on 15 disorders. Of the 5,777 patients studied, the team found significant differences between the mobilised patients and those undergoing bed rests as a prophylactic (tending to ward off disease) treatment after medication and primary treatment. The team avoided the statistical procedure of pooled analysis to avert any error in their assessment. 

Out of 24 trials of bed rest, seven patients showed positive results. Other 26 trials registered poor performance. In cases of cardiac catheterisation, ambulation was introduced and thus increased the length of bed rest. 

Other trials elucidated that recommendations of bed rest in cases of acute low back pain, pulmonary tuberculosis, and infectious hepatitis were harmful. It also showed hazardous outcomes in the early stage of pregnancy. Moreover, the research team could not garner any evidence to show the positive effects of bed rest after surgery. 

Analysing the results, Glaszion's team suggested that bed rest may not only slow down the process of recovery, but can also jeopardise the patient. 

Although the team is confident of its findings, they think that the study is not conclusive, as they had to reject some interesting cases because of the inability to make controlled studies. For example, the benefits of bed rest after intra-articular steroid injection in the treatment of knee-joint inflammation were excluded because the environment could not be manipulated. 

Despite the outcome of the research, bed rest still continues to enjoy a monopoly with most physicians. In 1998, a report published in the British Medical Journal stated that more than 80 per cent of neurological units in the UK still have faith in bed rest. 

Another study published in the American Journal of Critical Care reveals that physicians are still obsessed with the idea of bed rest leading to an overdose of it especially after cardiac diseases and acute low back pain. In 1938, circumstantial evidence in a certain case had pointed to the fact that the patient's death was caused by bed rest. 

"The physicians must always consider complete bed rest as a highly unphysiological and hazardous form of therapy, to be ordered only for specific indications and discontinued as early as possible." This piece of advice given by W. Dock 50 years ago seems pertinent even today. 

But bed rest should not be confused with the rest that a physically weak person needs. It should also be noted that bed rest is a mode of treatment and cannot be prescribed arbitrarily. 

Glaszion's study has revealed that it is a sort of a drug, which should be administered according to its need. Currently, the Australian team is trying to focus on cases where bed rest might play the role of a remedy.