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

PainSci » bibliography » Hagen et al 2005
Tags: self-treatment, back pain, neurology, sciatica, leg, treatment, pain problems, spine, butt, hip, limbs

Three pages on PainSci cite Hagen 2005: 1. Mobilize!2. The Complete Guide to Low Back Pain3. The Art of Rest

PainSci notes on Hagen 2005:

From the abstract: “For people with acute low back pain, advice to rest in bed is less effective than advice to stay active.” There is even “high quality evidence” that bed rest leads to more pain.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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.

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