Tuesday, December 22, 2009

Flat Bed Rest The truth is out there!

Someone else has done a search to compare bedrest publications and found the same damning evidence that I did all those years ago.

I suggest you download the pdf and read the whole paper and if you are still unconvinced about the validity of Inclined Therapy, I suggest you conduct your own search of the published papers.

Bed rest: a potentially harmful treatment needing more careful

Chris Allen, Paul Glasziou, Chris Del Mar

Ideas about bed rest seem so entrenched that medical
practice has been slow to change—even when faced with
evidence of ineffectiveness. For example, a study of
protocols used after spinal puncture in 1998 found that
more than 80% of neurological units in the UK still
insist on bed rest" despite evidence from 17 years earlier
that bed rest has no value." There are also reports that
bed rest is still being over-prescribed after myocardial
infarction and cardiac catheterisation, and for acute low
back pain."-"
Bed rest after myocardial infarction was prescribed on
the basis of theoretical evidence of the supposed
workload put on the heart, and circumstantial evidence
on the appearance of old and new infarcts."" The value
of bed rest was questioned in 1938 because during the
2 months of forced bed rest more patients died of
pulmonary infarction, uraemia, and pneumonia than of
cardiac complications." Despite recommendations in
1944 for the period of bed rest to be cut to 2 weeks,'"
6 years later standard clinical practice still prescribed
4 weeks or more of bed rest.'' Since that time; largescale
clinical trials have shown that bed rest is
unnecessary,'"''^'''' and one showed that there is
significant danger associated with hospital bed rest after
myocardial infarction.™ In current clinical practice" only
12 h of bed rest is prescibed, with ambuiation in the
ward by day 3.
Rest is often imposed by symptoms (mainly weakness)
rather than the physician, and in that case there is little
choice. We have to distinguish the use of bed rest in the
management of those symptoms (palliation) from its use
to speed recovery (prescribed treatment). Perhaps the
patient is the best judge of the amount of rest required.
Advice given in 1944 seems curiously apt today, "The
physician must always consider complete bed rest as a
highly unphysiologic and definitely hazardous form of
therapy, to be ordered only for specific indications and
discontinued as early as possible".* The indications for
which bed rest should be prescribed, and for how long,
are yet to be defined.
Chris Allen did the searches, assembled and analysed the tables, and
wrote the first draft. Paul Glasziou was responsible for the idea and
extracted and analysed the data for the tables. Chris Del Mar concieved
the idea and wrote subsequent drafts.

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