title: Westeinde sciatica trial: randomized controlled study of bed rest and physiotherapy for acute sciatica.
abstract: OBJECTIVE
  The authors conducted a study to compare the efficacies of three nonsurgical treatment strategies in patients with sciatica. Their hypothesis was that bed rest, physiotherapy, and continuation of activities of daily living (ADLs) (control treatment) are each of equivalent efficacy.
  
  
  METHODS
  This randomized controlled trial was designed for comparison of bed rest, physiotherapy, and continuation of ADLs. The setting was an outpatient clinic. General practitioners were asked to refer patients for treatment as soon as possible. The authors enrolled 250 patients (< 60 years of age) with sciatica of less than 1-month's duration and who had not yet been treated with bed rest or physiotherapy. Primary outcome measures were radicular pain (based on a visual analog pain scale [VAPS]) and hampered ADLs (Quebec Disability Scale [QDS]). Secondary outcome measures were the rates of treatment-related failure and surgical treatment. Measures were assessed at baseline and during follow up at 1, 2, and 6 months. Mean differences in VAPS and QDS scores between bed rest and control treatment were 2.5 (95% confidence interval [CI] -6.4 to 11.4) and -4.8 (95% CI -10.6 to 0.9) at 1 month and 0.9 (95% CI -8.7 to 10.4) and -2.7 (95% CI -9.9 to 4.4) at 2 months, respectively. The respective differences between physiotherapy and control treatment were 0.8 (95% CI -8.2 to 9.8) and -0.5 (95% CI -6.3 to 5.3) at 1 month and -0.3 (95% CI -9.4 to 10) and 0.0 (95% CI -7.2 to 7.3) at 2 months. The respective odds ratios for treatment failure and surgical treatment of bed rest compared with control treatment were 1.6 (95% CI 0.8-3.5) and 1.5 (95% CI 0.7-3.6) at 6 months. When physiotherapy was compared with control treatment, these ratios were 1.5 (95% CI 0.7-3.2) and 1.2 (95% CI 0.5-2.9) at 6 months, respectively.
  
  
  CONCLUSIONS
  Bed rest and physiotherapy are not more effective in acute sciatica than continuation of ADLs.
authors.affiliation: Department of Neurology, Medical Center Haaglanden, Westeinde, The Hague, The Netherlands. DJ.Hofstee@StJansdal.nl
authors.forename: Derk J
authors.initials: DJ
authors.lastname: Hofstee
authors.forename: Johanna M M
authors.initials: JM
authors.lastname: Gijtenbeek
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hoogland
authors.forename: Hans C
authors.initials: HC
authors.lastname: van Houwelingen
authors.forename: Alfred
authors.initials: A
authors.lastname: Kloet
authors.forename: Freek
authors.initials: F
authors.lastname: Lötters
authors.forename: Joseph Th J
authors.initials: JT
authors.lastname: Tans
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D001510:Bed Rest; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012585:Sciatica / Q000534:rehabilitation*; D016896:Treatment Outcome