A Cochrane review included 10 studies.
For patients with acute LBP, results from two trials (N = 401) suggest small improvements in pain relief (SMD 0.22 (95% CI 0.02 to 0.41) and functional status (SMD 0.29 (95% CI 0.09 to 0.49) in favour of advice to stay active. For patients with sciatica, there is moderate quality evidence of little or no difference in pain relief (SMD -0.03 (95% CI -0.24 to 0.18)) or functional status (SMD 0.19 (95% CI -0.02 to 0.41)), between advice to rest in bed or stay active. Low quality evidence (3 RCTs, N = 931) suggests little or no difference between exercises, advice to rest in bed or stay active for patients with acute LBP. Low quality evidence (1 RCT, N = 250) suggests little or no difference between physiotherapy, advice to rest in bed or stay active for patients with sciatica.
There is high quality evidence that people with acute low-back pain (LBP) who are advised to rest in bed have a little more pain [Standardised Mean Difference (SMD) 0.22 (95% Confidence Interval (CI): 0.02, 0.41)] and a little less functional recovery [SMD 0.29 (95% CI: 0.05, 0.45)] than those advised to stay active. For patients with sciatica, there is high quality evidence of little or no difference in pain [SMD -0.03 (95% CI: -0.24, 0.18)] or functional status [SMD 0.19 (95% CI: -0.02, 0.41)], between bed rest and staying active. For patients with acute LBP, there is moderate quality evidence of little or no difference in pain intensity or functional status between bed rest and exercises. For patients with sciatica, there is moderate quality evidence of little or no difference in pain intensity between bed rest and physiotherapy, but small improvements in functional status [Weighted Mean Difference 6.9 (on a 0-100 scale) (95% CI: 1.09, 12.74)] with physiotherapy. There is moderate quality evidence of little or no difference in pain intensity or functional status between two to three days and seven days of bed rest. A systematic review including 10 RCTs of bed rest (n=1 438) and 8 RCTs (n=1 784) of advice to stay active was abstracted in DARE. 8 trials on bed rest showed that bed rest was not effective. All eight trials on advice to stay active showed consistently positive results. There was no difference in pain or initial recovery, but there was a greater patient satisfaction. Three trials showed that advice to stay active led to a faster return to work, one showed no significant difference. Chronic disability (3 trials) and health care use for back pain in the next year (1 trial) were reduced. In a randomized, controlled study 186 patients were divided into 3 groups. The patients in group 1 were recommended 2 days of bed rest, the patients in group 2 were recommended bending exercises of the back several times a day, and patients in group 3 were recommended to perform ordinary daily activities in the limits of pain. In a follow-up of 3 weeks, the patients in group 2 had recovered more slowly according to several outcome measures, but also the patients in the bed rest group had recovered more slowly than the patients in group 3. At 12 weeks, both groups 1 and 2 had recovered more slowly than group 3. The differences were particularly marked in the length of sick leaves: in group 3 the length of the sick leave was on average 4.5 days, in the exercise group 7.5 days, and in the bed rest group 9 days.