Effectiveness of bed rest after mild traumatic brain injury: a randomised trial of no versus six days of bed rest.
BACKGROUND
Outcome after mild traumatic brain injury (MTBI) is determined largely by the appearance of post-traumatic complaints (PTC). The prevalence of PTC after six months is estimated to be between 20 and 80%. Bed rest has been advocated to prevent PTC but its effectiveness has never been established.


OBJECTIVE
To evaluate the effect of bed rest on the severity of PTC after MTBI.


METHODS
Patients presenting with MTBI to the emergency room were randomly assigned to two intervention strategies. One group was advised not to take bed rest (NO) and the other to take full bed rest (FULL) for six days after the trauma. The primary outcome measures were severity of PTC on a visual analogue scale and physical and mental health on the medical outcomes study 36 item short form health survey (SF-36) at two weeks and three and six months after the trauma.


RESULTS
Between October 1996 and July 1999, 107 (54 NO, 53 FULL) patients were enrolled. Outcome variables in both groups clearly improved between two weeks and six months. After adjustment for differences in baseline variables, most PTC tended to be somewhat more severe in the FULL group six months after the trauma, but no significant differences were found. Neither were there any significant differences in the outcome parameters between the two groups after three months. Two weeks after the trauma, most PTC in the FULL group were slightly less severe than those in the NO group, and physical subscores of the SF-36 in the FULL group were slightly better. These differences were not significant. Patients in the FULL group reported significantly less dizziness during the intervention period.


CONCLUSIONS
As a means of speeding up recovery of patients with PTC after MTBI, bed rest is no more effective than no bed rest at all. Bed rest probably has some palliative effect within the first two weeks after the trauma.
Department of Neurology, University Hospital Maastricht, The Netherlands. jdk@sneu.azm.nl
J R
JR
de Kruijk
P
P
Leffers
S
S
Meerhoff
J
J
Rutten
A
A
Twijnstra
D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D000328:Adult; D000368:Aged; D001510:Bed Rest; D020208:Brain Injury, Chronic / Q000175:diagnosis / Q000534:rehabilitation; D004434:Early Ambulation; D005260:Female; D005500:Follow-Up Studies; D016489:Head Injuries, Closed / Q000175:diagnosis / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010043:Outcome and Process Assessment, Health Care