STUDY DESIGN: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effects of advice to rest in bed for patients with acute low back pain (LBP) or sciatica. SUMMARY OF BACKGROUND DATA: Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain. METHODS: All randomized studies available in systematic searches (electronic databases, contact with authors, and reference lists) 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: Nine trials with a total of 1435 patients were included. Four trials compared bed rest with advice to stay active, and the overall results were heterogeneous. Overall, results from two high-quality studies indicate no difference in pain intensity at the 3-week follow-up (standardized mean difference 0.0; 95% confidence interval (CI) -0.3 to 0.2), and a small difference in functional status in favor of staying active (weighted mean difference 3.2 (on a 0 to 100 scale); 95% CI 0.6 to 5.8). In two high-quality trials no differences were reported in pain intensity between 2 to 3 days of bed rest and 7 days of bed rest. In another two high-quality trials, no differences were found between bed rest and exercises in pain intensity of functional status. CONCLUSION: Bed rest compared with advice to stay active at best has no effect, and at worst may have slightly harmful effects on LBP. There is not an important difference in the effects of bed rest compared with exercised in the treatment of acute low back pain, or 7 days compared with 2 to 3 days of bed rest in patients with low back pain of different durations with and without radiating pain.
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