Bed rest or normal activity for patients with acute low back pain: a randomized controlled trial.
BACKGROUND
The management of common low back pain has two principal objectives: to relieve acute pain and to attempt prevention of transition to chronicity. Several studies have shown the ineffectiveness of prolonged periods of bed rest.


OBJECTIVE
To compare 4 days of bed rest with continued normal daily activity in acute low back pain, taking into account the type of work (physical or sedentary labor).


METHODS
This open, comparative multicenter study enrolled 281 ambulatory patients, ages 18 to 65 years, with low back pain (onset < 72 hours). The subjects did not have pain radiating below the buttocks and did not have work-related injuries. They were randomized into two treatment groups: one instructed to continue normal activity (insofar as the pain allowed), and the other prescribed 4 days of bed rest. After inclusion, patients were seen at three visits: on day 6 or 7, after 1 month, and after 3 months.


RESULTS
On day 6 or 7, pain intensity was similar for both groups, as was the overall judgment of the treatment by patients and physicians. At 1 and 3 months, the groups again had equivalent intensity of back pain, functional disability, and vertebral stiffness. A higher proportion of patients in the bed rest group than in the normal activity group had an initial sick leave (86% vs 52%; P < 0.0001). This difference was greater for the patients whose work was sedentary.


CONCLUSIONS
For patients with acute low back pain, normal activity is at least equivalent to bed rest. The findings of this study indicate that prescriptions for bed rest, and thus for sick leaves, should be limited when the physical demands of the job are similar to those for daily life activities.
Department of Rheumatology, Pitié-Salpêtrière Hospital, Paris, France. sylvie.rozenberg@psl.ap-hop-paris.fr
Sylvie
S
Rozenberg
Cécile
C
Delval
Yvonne
Y
Rezvani
Nicole
N
Olivieri-Apicella
Jean-Louis
JL
Kuntz
Eric
E
Legrand
Jean-Pierre
JP
Valat
Francis
F
Blotman
Jean
J
Meadeb
Denis
D
Rolland
Stéphane
S
Hary
Bernard
B
Duplan
Jean-Louis
JL
Feldmann
Pierre
P
Bourgeois
D000203:Activities of Daily Living; D000328:Adult; D001510:Bed Rest; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome