Bed rest

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This article is about a medical treatment. For the type of pillow, see pillow.
The Invalid, painting by Louis Lang in the Brooklyn Museum

Bed rest is a medical treatment in which a person lies in bed for most of some period of time to gain health benefits. Bed rest refers to voluntarily lying in bed as a treatment, and not being confined to bed because of a health impairment which restricts a person from leaving the bed. Even though the practice is still commonly used for an array of conditions it is not shown to be an effective treatment for any illness.[1]

Bed rest is especially used when prescribed or chosen. Even though most patients in hospitals spend most of their time in the hospital beds, bed rest more often refers to an extended period of recumbence at home. It is commonly part of pregnancy in United States of America where it is prescribed to nearly 20% of pregnant women[2] despite the growing volume of data showing it to be dangerous, causing some experts to call its use "unethical".[3][4][5]

Indications[edit]

There are no known conditions where bed rest is shown to be an effective treatment.[1] However, bed rest is commonly prescribed in the following cases despite the known risks.

  • For sufferers of acute pain in the spine or joints; for example, in the case of backache the unloading of the corresponding spinal segment decreases the intradiscal pressure, and it would bring relief in cases such as compression of spinal nerve. The prescribed duration of bed rest vary and opinions differ.[6] As a treatment for low back pain, bed rest should not be used for more than 48 hours.[7]
  • Bed rest is prescribed for some maternal or fetal complications of pregnancy, such as preterm labor, high blood pressure, incompetent cervix, or fetal growth problems. In the past it was a general prescription during any kind of pregnancy, now deprecated.[8]
  • Women pregnant with twins or higher-order multiples are at higher risk for preterm labor, preeclampsia (toxemia), and other pregnancy complications, thus bed rest is common in these cases. About 50% of women pregnant with twins will be on some form of bed rest for at least part of their pregnancy. Recent studies have shown that routine bed rest in twin pregnancies (bed rest in the absence of complications) does not improve outcomes; however, bed rest is almost always prescribed for women carrying triplets or more.[9]
  • Heart diseases
  • Bed rest is an important measure in the cases of chorea. In the mild cases it may suffice for treatment.[10]
  • Acute gout, as early ambulation may precipitate a recurrence.[11]

Inclined bed rest is a common practice for people suffering from some forms of Gastroesophageal reflux disease[12][13] and heart disease [14] and for patients who are on a ventilator.[15] Despite its prevalence, several studies exploring the effects of tilting the head of a bed have found no support for beneficial health claims.[16][17]

Adverse effects[edit]

Prolonged bed rest has long been known to have deleterious physiological effects, such as muscle atrophy and other forms of deconditioning such as arterial constriction.[18] Besides lack of physical exercise it was shown that another important factor is that the hydrostatic pressure (caused by gravity) acts anomalously, resulting in altered distribution of body fluids. Even physical exercise in bed fails to address certain adverse effects.[19]

It is also a major cause of thrombosis,[20] mainly by reducing blood flow in the legs.[21]

Technique[edit]

This man in 1945 England has been prescribed complete bed rest, and accepts assistance so as not to sit up to drink

Complete bed rest refers to discouraging the person in treatment from sitting up for any reason, including daily activities like drinking water.[22]

Placing the head of a bed lower than the foot is sometimes used as a means of simulating the physiology of spaceflight.[23]

History[edit]

As a treatment, bed rest is mentioned in the earliest medical writings. The rest cure, or bed rest cure, was a 19th-century treatment for many mental disorders, particularly hysteria. "Taking to bed" and becoming an "invalid" for an indefinite period of time was a culturally accepted response to some of the adversities of life. In addition to bed rest, patients were secluded from all family contact in order to reduce dependence on others. The only person that bed rest patients were allowed to see was the nurse who massaged, bathed, and clothed them. Patients were also not allowed to use their hands at all. In some extreme cases electrotherapy was prescribed. The food the patient was served usually consisted of fatty dairy products in order to revitalize the body with new energy. This cure as well as its name were created by doctor Silas Weir Mitchell, and it was almost always prescribed to women, many of whom were suffering from depression; especially postpartum depression. It was not effective and caused many to go insane or die. In the middle of the 20th century, bed rest was still a standard treatment for markedly high blood pressure. It is still used in cases of carditis secondary to rheumatic fever. Its popularity and perceived efficacy have varied greatly over the centuries.

Some negative effects of bed rest were historically attributed to drugs taken in bed rest.[24]

References[edit]

  1. ^ a b Bed Rest Ineffective as Therapy : The Journal of Family Practice
  2. ^ Bed Rest During Pregnancy
  3. ^ Allen C, Glasziou P, Del Mar C (October 1999). "Bed rest: a potentially harmful treatment needing more careful evaluation". Lancet 354 (9186): 1229–33. doi:10.1016/S0140-6736(98)10063-6. PMID 10520630. Lay summaryUniversity of Queensland News Online (October 9, 1999). 
  4. ^ Is It ‘Unethical’ To Prescribe Bed Rest For Pregnant Women? | CommonHealth
  5. ^ http://arms.evidence.nhs.uk/resources/qipp/664578/attachment
  6. ^ Weiner, Richard (2002). Pain management: a practical guide for clinicians. Boca Raton: CRC Press. p. 741. ISBN 0-8493-0926-3. 
  7. ^ North American Spine Society (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (North American Spine Society), retrieved 25 March 2013 , which cites
  8. ^
    • Bowers, Nancy (2001). "Bed Rest". The multiple pregnancy sourcebook: pregnancy and the first days with twins, triplets, and more. Chicago: Contemporary Books. ISBN 0-7373-0306-9. [page needed]
    • Sosa, Claudio; Althabe, Fernando; Belizán, José M; Bergel, Eduardo; Sosa, Claudio (2004). Bed rest in singleton pregnancies for preventing preterm birth. doi:10.1002/14651858.CD003581.pub2. 
    • Meher, Shireen; Abalos, Edgardo; Carroli, Guillermo; Meher, Shireen (2005). Bed rest with or without hospitalisation for hypertension during pregnancy. doi:10.1002/14651858.CD003514.pub2. 
    • Aleman, Alicia; Althabe, Fernando; Belizán, José M; Bergel, Eduardo; Althabe, Fernando (2005). Bed rest during pregnancy for preventing miscarriage. doi:10.1002/14651858.CD003576.pub2. 
  9. ^ Crowther, Caroline A; Han, Shanshan; Crowther, Caroline A (2010). Hospitalisation and bed rest for multiple pregnancy. doi:10.1002/14651858.CD000110.pub2. 
  10. ^ NINDS Sydenham Chorea Information Page of the National Institute of Neurological Disorders and Stroke
  11. ^ Page 251 in: Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6. 
  12. ^ Richter, Joel E.; Donald O. Castell (April 1981). "Current Approaches in the Medical Treatment of Oesophageal Reflux". Drugs 21 (4). 
  13. ^ Hamilton, John W; Ronald J. Boisen MD; Dennis T. Yamamoto MD; Joanne L. Wagner; Mark Reichelderfer MD (May 1988). "Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid". Digestive Diseases and Sciences 33 (5): 518–522. doi:10.1007/BF01798350. PMID 3359906. 
  14. ^ Reynolds, Sharon RN, CS-ACNP, MSN; Waterhouse, Kathleen RN, CS-ACNP, MSN; Miller, Kathleen H. RN, CS-ACNP, EdD (2001). "Head of bed elevation, early walking, and patient comfort after percutaneous transluminal coronary angioplasty". Dimensions of Critical Care Nursing 20 (3): 44–51. doi:10.1097/00003465-200105000-00013. PMID 22076400. 
  15. ^
    • Niël-Weise, Barbara S. (2011). "An evidence-based recommendation on bed head elevation for mechanically ventilated patients". Petra Gastmeier, Axel Kola, Ralf P Vonberg, Jan C Wille, and Peterhans J van den Broek. Critical Care 15 (2): 1–9. doi:10.1186/cc10135. Retrieved 30 June 2013. 
    • Keeley, Libby (November–December 2007). "Reducing the risk of ventilator-acquired pneumonia through head of bed elevation". Nursing in Critical Care 12 (6): 287–294. doi:10.1111/j.1478-5153.2007.00247.x. PMID 17983363. 
    • Peterson, M ME; Schwab, W PhD; McCutcheon, K CCN; van Oostrom, J H. PhD; Gravenstein, N MD; Caruso, L MD (November 2008). "Effects of elevating the head of bed on interface pressure in volunteers". Critical Care Medicine 36 (11). 
    • Frank Lyerla, RN, PhD, Cynthia LeRouge, PhD, CPA, Dorothy A. Cooke, RN, PhD, Debra Turpin, RN, MSN, ONC and Lisa Wilson, RN, BSN (2010). "A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation". Am J Crit Care 19 (1): 39–47. doi:10.4037/ajcc2010836. PMID 20045847. 
  16. ^ Wojner, Anne W.; El-Mitwalli, Ashraf; Alexandrov, Andrei V. (February 2002). "Effect of Head Positioning on Intracranial Blood Flow Velocities in Acute Ischemic Stroke: A Pilot Study". Critical Care Nursing Quarterly 24 (4). "Current nursing practice for the care of patients with ischemic stroke advocates routine elevation of the head of the bed (HOB) to 30°. Evidence supporting this practice is lacking, and it may reflect inappropriate generalization of findings from studies conducted primarily on traumatic brain injury patients with associated increased intracranial pressure to the ischemic stroke population." 
  17. ^ Vincent J. Miele MD, Ali Sadrolhefazi MD, Julian E. Bailes MD (May 2005). "Influence of head position on the effectiveness of twist drill craniostomy for chronic subdural hematoma". Surgical Neurology 63 (5). 
  18. ^ Bleeker MW, De Groot PC, Rongen GA, et al. (October 2005). "Vascular adaptation to deconditioning and the effect of an exercise countermeasure: results of the Berlin Bed Rest study". Journal of Applied Physiology 99 (4): 1293–300. doi:10.1152/japplphysiol.00118.2005. PMID 15932956. 
  19. ^ Woods, Susan L. (2005). Cardiac nursing. Hagerstwon: Lippincott Williams & Wilkins. p. 921. ISBN 0-7817-4718-X. 
  20. ^ Mitchell, Richard Sheppard; Kumar, Vinay; Robbins, Stanley L.; Abbas, Abul K.; Fausto, Nelson (2007). "Chapter 4". Robbins basic pathology (8th ed.). Saunders/Elsevier. ISBN 1-4160-2973-7. [page needed]
  21. ^ Hypercoagulability during Pregnancy Lab Lines. A publication of the Department of Pathology and Laboratory Medicine at the University of Cincinnati. September/October 2002 Volume 8, Issue 5
  22. ^ Mayo Clinic Staff (2011). "Bed rest during pregnancy: Get the facts - Mayo Clinic". mayoclinic.org. Retrieved 27 March 2014. 
  23. ^
    • Atsunori Kamiya, Satoshi Iwase, Daisaku Michikami, Qi Fu, and Tadaaki Mano (1 March 2000). "Head-down bed rest alters sympathetic and cardiovascular responses to mental stress". AJP - Regu Physiol. "To examine effects of microgravity on vasomotor sympathetic and peripheral vasodilator responses to mental stress, we performed 10 min of mental arithmetic (MA) before and after 14 days of 6° head-down bed rest (HDBR), a ground-based simulation of spaceflight." 
    • Millet, C.; Custaud, MA; Maillet, A; Allevard, AM; Duvareille, M; Gauquelin-Koch, G; Gharib, C; Fortrat, JO (March 2001). "Endocrine responses to 7 days of head-down bed rest and orthostatic tests in men and women". Clinical Physiology 21 (2): 172–183. doi:10.1046/j.1365-2281.2001.00315.x. PMID 11318825. 
    • Edgell, Heather (December 2007). "WISE-2005: adrenergic responses of women following 56-days, 6° head-down bed rest with or without exercise countermeasures". Environmental, Exercise and Respiratory Physiology. 
    • Randa L. Shehab; Robert E. Schlegel (August–September 1998). "The NASA performance assessment workstation: Cognitive performance during head-down bed rest". Acta Astronautica: 223–233. 
    • Wilson, Thad (4 January 2003). "Effects of 14 days of head-down tilt bed rest on cutaneous vasoconstrictor responses in humans". Journal of Applied Physiology. 
    • Meck, Janice V.; Dreyer, Sherlene A.; Warren, L. Elisabeth (May 2009). "Long-Duration Head-Down Bed Rest: Project Overview, Vital Signs, and Fluid Balance". Aviation, Space, and Environmental Medicine 80 (Supplement 1): A1–A8. doi:10.3357/asem.br01.2009. 
    • Shibasaki, Manabu (November 1, 2003). "Exercise throughout 6° head-down tilt bed rest preserves thermoregulatory responses". Journal of Applied Physiology 95 (5). 
  24. ^ Dock, William (1944). "THE EVIL SEQUELAE OF COMPLETE BED REST". Journal of the American Medical Association 125 (16): 1083. doi:10.1001/jama.1944.02850340009004. ISSN 0002-9955.