Bed rest

The Invalid, painting by Louis Lang in the Brooklyn Museum

Bed rest is a medical treatment in which a person lies in bed for most of some period of time to gain health benefits. Bed rest refers to voluntarily lying in bed as a treatment, and not being confined to bed because of a health impairment which restricts a person from leaving the bed. The practice is still commonly used for an array of conditions although a 1999 systematic review found no benefits in any of the 17 conditions for which it had been prescribed.^[1]

Bed rest is especially used when prescribed or chosen. Even though most patients in hospitals spend most of their time in the hospital beds, bed rest more often refers to an extended period of recumbence at home. In the United States of America, nearly 20% of pregnant women have some degree of restricted activity prescribed at some point during pregnancy^[2] despite the growing volume of data showing it to be dangerous, causing some experts to call its use "unethical".^[3][4][5]

Indications

While bed rest has not been proven to have beneficial effects for any condition,^[1] it continues to be commonly prescribed in certain cases:

• For sufferers of acute pain in the spine or joints; for example, in the case of backache the unloading of the corresponding spinal segment decreases the intradiscal pressure, and it would bring relief in cases such as compression of spinal nerve. The prescribed duration of bed rest vary and opinions differ.^[6] As a treatment for low back pain, bed rest should not be used for more than 48 hours.^[7]
• Bed rest is prescribed for some maternal or fetal complications of pregnancy, such as preterm labor, high blood pressure, incompetent cervix, or fetal growth problems. In the past it was a general prescription during any kind of pregnancy, now deprecated.^[8]
• Women pregnant with twins or higher-order multiples are at higher risk for preterm labor, preeclampsia (toxemia), and other pregnancy complications, thus bed rest is common in these cases. About 50% of women pregnant with twins will be on some form of bed rest for at least part of their pregnancy. Recent studies have shown that routine bed rest in twin pregnancies (bed rest in the absence of complications) does not improve outcomes; however, bed rest is almost always prescribed for women carrying triplets or more.^[9]
• Heart diseases
• Bed rest is an important measure in the cases of chorea. In the mild cases it may suffice for treatment.^[10]
• Acute gout, as early ambulation may precipitate a recurrence.^[11]

Inclined bed rest is a common practice for people suffering from some forms of Gastroesophageal reflux disease^[12][13] and heart disease ^[14] and for patients who are on a ventilator.^[15] Despite its prevalence, several studies exploring the effects of tilting the head of a bed have found no support for beneficial health claims.^[16][17]

Adverse effects

Prolonged bed rest has long been known to have deleterious physiological effects, such as muscle atrophy and other forms of deconditioning such as arterial constriction.^[18] Besides lack of physical exercise it was shown that another important factor is that the hydrostatic pressure (caused by gravity) acts anomalously, resulting in altered distribution of body fluids. In other words, when getting up, this can cause an orthostatic hypertensive, potentially inducing a Vasovagal response. Even physical exercise in bed fails to address certain adverse effects.^[19]

It is also a major cause of thrombosis,^[20] mainly by reducing blood flow in the legs.^[21]

Technique

This man in 1945 England has been prescribed complete bed rest, and accepts assistance so as not to sit up to drink

Complete bed rest refers to discouraging the person in treatment from sitting up for any reason, including daily activities like drinking water.^[22]

Placing the head of a bed lower than the foot is sometimes used as a means of simulating the physiology of spaceflight.^[23]

History

As a treatment, bed rest is mentioned in the earliest medical writings. The rest cure, or bed rest cure, was a 19th-century treatment for many mental disorders, particularly hysteria. "Taking to bed" and becoming an "invalid" for an indefinite period of time was a culturally accepted response to some of the adversities of life. In addition to bed rest, patients were secluded from all family contact in order to reduce dependence on others. The only person that bed rest patients were allowed to see was the nurse who massaged, bathed, and clothed them. Patients were also not allowed to use their hands at all. In some extreme cases electrotherapy was prescribed. The food the patient was served usually consisted of fatty dairy products in order to revitalize the body with new energy. This cure as well as its name were created by doctor Silas Weir Mitchell, and it was almost always prescribed to women, many of whom were suffering from depression; especially postpartum depression. It was not effective and caused many to go insane or die. In the middle of the 20th century, bed rest was still a standard treatment for markedly high blood pressure. It is still used in cases of carditis secondary to rheumatic fever. Its popularity and perceived efficacy have varied greatly over the centuries.

In 1892, an author by the name of Charlotte Perkins Gilman released "The Yellow Wallpaper", a horror story based on her personal experience when placed under the rest cure. She wasn't allowed to write in a journal, paint a picture, or release her imagination in any way whatsoever. If she ever felt ill, she was simply told to return to bed. Her specific instructions from Dr. Weir Mitchell were to "Live as domestic a life as possible. Have your child with you all the time... Lie down an hour after each meal. Have but two hours' intellectual life a day. And never touch pen, brush or pencil as long as you live."^[24]The short story became a symbol of feminism in the 1970s at the time of its rediscovery.^[25]

Some negative effects of bed rest were historically attributed to drugs taken in bed rest.^[26]

Further reading

• "The Yellow Wallpaper" by Charlotte Perkins Gilman

References