Bed rest

Bed rest
Bed rest
	The Invalid (c. 1870), painting by Louis Lang in the Brooklyn Museum
Other names	cessation, expiration, halt, shutdown, stoppage surcease, and termination
	[edit on Wikidata]

Bed rest, also referred to as the rest-cure, is a medical treatment in which a person lies in bed for most of the time to try to cure an illness.^[1] Bed rest refers to voluntarily lying in bed as a treatment and not being confined to bed because of a health impairment which physically prevents leaving bed. The practice is still used although a 1999 systematic review found no benefits for any of the 17 conditions studied and no proven benefit for any conditions at all, beyond that imposed by symptoms.^[2]

In the United States, nearly 20% of pregnant women have some degree of restricted activity prescribed^[3] despite the growing data showing it to be dangerous, causing some experts to call its use "unethical".^[2]^[4]^[5]

Medical uses

Extended bed rest has been proven to be a potentially harmful treatment needing more careful evaluation.^[2]

Pregnancy

Women who are pregnant and are experiencing early labor, vaginal bleeding, and cervix complications have been prescribed bed rest. This practice in 2013 was strongly discouraged due to no evidence of benefit and evidence of potential harm.^[6]

Evidence is unclear if it affects the risk of preterm birth and due to potential side effects the practice is not routinely recommended.^[7] It is also not recommended for routine use in pregnant women with high blood pressure^[8] or to prevent miscarriage.^[9]

Women pregnant with twins or higher-order multiples are at higher risk for pregnancy complications. Routine bed rest in twin pregnancies (bed rest in the absence of complications) does not improve outcomes.^[10] Bed rest is therefore not recommended routinely in those with a multiple pregnancy.^[10]

Use in combination with assisted reproductive technology such as embryo transfer is also not recommended.^[11]

Back pain

For people with back pain bed rest has previously been recommended.^[12] Bed rest, however, is less beneficial than staying active.^[13] As a treatment for low back pain, bed rest should not be used for more than 48 hours.^[14]

Other

As of 2016 it is unclear if bed rest is useful for people in wheelchairs who have pressure ulcers.^[15]
Bed rest may be sufficient treatment for mild cases of Sydenham chorea.^[16]
In those with deep vein thrombosis early movement rather than bed rest appears helpful.^[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 hypertension, potentially inducing a vasovagal response.

Additionally, prolonged bed rest can lead to the formation of skin pressure ulcers.^[19] Even physical exercise in bed fails to address certain adverse effects.^[20]

Phlebothrombosis is marked by the formation of a clot in a vein without prior inflammation of the wall of the vein. It is associated with prolonged bed rest, surgery, pregnancy, and other conditions in which blood flow becomes sluggish or the blood coagulates more readily than normal. The affected area, usually the leg, may become swollen and tender. The danger is that the clot may become dislodged and travel to the lungs (a pulmonary embolism).^[21]

Technique

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 was a culturally accepted response to some of the adversities of life.^{[citation needed]} Melville Arnott noted the increased use of bed rest in late-19th and early-20th century medical practice:

It has, of course always been recognised that rest is essential for the acutely ill person [...]. But there is little mention of bed rest in the 18th and early 19th century by such authors as Withering, Heberden, and Stokes. [...] The mid-19th century saw the impact of Hilton's Rest and Pain^[24] [...]. In one case after another Hilton scored success, after all sorts of fantastic treatments had failed, because he recognised the value of rest in inflammation - particularly in osteomylitis and bone and joint tuberculosis which was then so prevalent. As so often happens, opinion swung to the opposite extreme, and rest came to be regarded as the universal healer. [...] Another reason for undue emphasis on bed rest may be the tendency, since the 19th century, to treat illness in hospital, rather than at home. In most hospitals, even today, the patient is expected to be in bed: the whole organisation is geared to such a state, and there is little provision for the up patient. [...] Furthermore, the routine of the bed bath and the bedpan is firmly established in nursing care. Indeed, many of our older hospitals - especially those for the chronic sick, with large inadequately heated wards and too few nurses - enforce bed rest as the only modus operandi.^[25]

In addition to bed rest, patients were secluded from all family contact to reduce dependence on others. The only person whom bed-rest patients were allowed to see was the nurse who massaged, bathed, and clothed them. Not only were patients isolated in bed for an extended time, they were advised to avoid other activities that might mentally exhaust them - such as writing or drawing.^[26]

In some extreme cases electrotherapy was prescribed. The food the patient was served usually consisted of fatty dairy products to revitalize the body. This "rest cure" as well as its name were created by Doctor Silas Weir Mitchell (1829-1914),^[27]^[28] 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, suffer complications of prostration, or die.

Before the advent of effective antihypertension medications, bed rest was 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, feminist writer Charlotte Perkins Gilman published "The Yellow Wallpaper", a horror short-story based on her experience when placed under the rest cure by Dr. Silas W. Mitchell himself. She wasn't allowed to write in a journal, paint a picture, or release her imagination in any way, though she was artistically inclined. If she ever felt ill, she was simply told to return to bed. Her specific instructions from Dr. 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."^[29] Gilman abided by Mitchell's instructions for several months before practically losing control of her sanity.

Eventually, Gilman divorced her husband and pursued a life as a writer and women's rights activist. She later explained in her 1935 autobiography The Living of Charlotte Perkins Gilman that she could not be restrained to the domestic lifestyle without losing her sanity, and that "it was not a choice between going and staying, but between going, sane, and staying, insane."^[30]

The narrator in "The Yellow Wallpaper" reflected her own authentic account. The narrator was advised by her husband to perform the rest cure and avoid creative activities while struggling with fits of depression. After becoming obsessed with the yellow wallpaper in her room, the narrator suffers a mental breakdown and frees a "woman behind the wall", metaphorically resembling Gilman's own mental break and release from female expectations. Gilman sent her short story to Dr. Mitchell, hoping that he might change his treatment of women with mental health and help save people from her own experience.^[31] The story became a symbol of feminism in the 1970s at the time of its rediscovery.^[32]

The author Virginia Woolf was prescribed the rest cure, which she parodied in her novel Mrs Dalloway (1925) with the description "you invoke proportion; order rest in bed; rest in solitude; silence and rest; rest without friends, without books, without messages; six months rest; until a man who went in weighing seven stone six comes out weighing twelve".^[33]

Some negative effects of bed rest were historically attributed to drugs taken in bed rest.^[34]

References

^ Collin (2008). Dictionary of Medical Terms. A&C Black – via Credo Reference.
^ ^a ^b ^c Allen, C; Glasziou, P; Del Mar, C (9 October 1999). "Bed rest: a potentially harmful treatment needing more careful evaluation". Lancet. 354 (9186): 1229–33. doi:10.1016/s0140-6736(98)10063-6. PMID 10520630. S2CID 12196831.
^ Bed Rest During Pregnancy
^ "Archived copy". Archived from the original on 2013-10-04. Retrieved 2013-06-23.{{cite web}}: CS1 maint: archived copy as title (link)
^ McCall, Christina A.; Grimes, David A.; Lyerly, Anne Drapkin (June 2013). ""Therapeutic" bed rest in pregnancy: unethical and unsupported by data". Obstetrics and Gynecology. 121 (6): 1305–1308. doi:10.1097/AOG.0b013e318293f12f. ISSN 1873-233X. PMID 23812466.
^ McCall, CA; Grimes, DA; Lyerly, AD (June 2013). ""Therapeutic" bed rest in pregnancy: unethical and unsupported by data". Obstetrics and Gynecology. 121 (6): 1305–8. doi:10.1097/aog.0b013e318293f12f. PMID 23812466.
^ Sosa, CG; Althabe, F; Belizán, JM; Bergel, E (30 March 2015). "Bed rest in singleton pregnancies for preventing preterm birth". The Cochrane Database of Systematic Reviews. 2015 (3): CD003581. doi:10.1002/14651858.CD003581.pub3. hdl:11336/51713. PMC 7144825. PMID 25821121.
^ Meher, Shireen; Abalos, Edgardo; Carroli, Guillermo; Meher, Shireen (2005). "Bed rest with or without hospitalisation for hypertension during pregnancy". Cochrane Database of Systematic Reviews. 2010 (4): CD003514. doi:10.1002/14651858.CD003514.pub2. PMC 8715743. PMID 16235323.
^ Aleman, Alicia; Althabe, Fernando; Belizán, José M; Bergel, Eduardo; Althabe, Fernando (2005). "Bed rest during pregnancy for preventing miscarriage". Cochrane Database of Systematic Reviews. 2010 (2): CD003576. doi:10.1002/14651858.CD003576.pub2. PMC 8721648. PMID 15846669.
^ ^a ^b Crowther, Caroline A; Han, Shanshan; Crowther, Caroline A (2010). "Hospitalisation and bed rest for multiple pregnancy". Cochrane Database of Systematic Reviews. 2010 (7): CD000110. doi:10.1002/14651858.CD000110.pub2. PMC 7051031. PMID 20614420.
^ Küçük, M (April 2013). "Bed rest after embryo transfer: Is it harmful?". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 167 (2): 123–6. doi:10.1016/j.ejogrb.2012.11.017. PMID 23274041.
^ Weiner, Richard (2002). Pain management: a practical guide for clinicians. Boca Raton: CRC Press. p. 741. ISBN 978-0-8493-0926-7.
^ Hagen, KB; Jamtvedt, G; Hilde, G; Winnem, MF (1 March 2005). "The updated cochrane review of bed rest for low back pain and sciatica". Spine. 30 (5): 542–6. doi:10.1097/01.brs.0000154625.02586.95. PMID 15738787. S2CID 33969187.
^ North American Spine Society (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, North American Spine Society, retrieved 25 March 2013
^ Moore, ZE; van Etten, MT; Dumville, JC (17 October 2016). "Bed rest for pressure ulcer healing in wheelchair users". The Cochrane Database of Systematic Reviews. 2016 (10): CD011999. doi:10.1002/14651858.CD011999.pub2. PMC 6457936. PMID 27748506.
^ "Sydenham Chorea Information Page | National Institute of Neurological Disorders and Stroke". ninds.nih.gov. Retrieved 30 January 2017.
^ Izcovich, A; Popoff, F; Rada, G (28 June 2016). "Early mobilization versus bed rest for deep vein thrombosis". Medwave. 16 (Suppl2): e6478. doi:10.5867/medwave.2016.6478. PMID 27391009.
^ Bleeker MW, De Groot PC, Rongen GA, et al. (October 2005). "Vascular adaptation to deconditioning and the effect of an exercise countermeasure: results of the Berlin Bed Rest study". Journal of Applied Physiology. 99 (4): 1293–300. doi:10.1152/japplphysiol.00118.2005. PMID 15932956.
^ "Ulcer." The Columbia Encyclopedia, Columbia University, and Paul Lagasse, Columbia University Press, 2016. Credo Reference.
^ Woods, Susan L. (2005). Cardiac nursing. Hagerstwon: Lippincott Williams & Wilkins. p. 921. ISBN 978-0-7817-4718-9.
^ Sell, Rebecca; Rothenberg, Mikel; Chapman, Charles F. (November 1, 2012). Dictionary of Medical Terms (6th ed.). New York: Barron's Educational Series. ISBN 978-0-7641-4758-6. Archived from the original on 10 May 2017. Retrieved 5 September 2016.
^ "Bed rest during pregnancy: Get the facts". Mayo Clinic. 2011. Retrieved 27 March 2014.
^
Atsunori Kamiya; Satoshi Iwase; Daisaku Michikami; Qi Fu; Tadaaki Mano (1 March 2000). "Head-down bed rest alters sympathetic and cardiovascular responses to mental stress". American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. 279 (2): R440 – R447. doi:10.1152/ajpregu.2000.279.2.R440. PMID 10938230. S2CID 26443012. To examine effects of microgravity on vasomotor sympathetic and peripheral vasodilator responses to mental stress, we performed 10 min of mental arithmetic (MA) before and after 14 days of 6° head-down bed rest (HDBR), a ground-based simulation of spaceflight.
- Millet, C.; Custaud, MA; Maillet, A; Allevard, AM; Duvareille, M; Gauquelin-Koch, G; Gharib, C; Fortrat, JO (March 2001). "Endocrine responses to 7 days of head-down bed rest and orthostatic tests in men and women". Clinical Physiology. 21 (2): 172–183. doi:10.1046/j.1365-2281.2001.00315.x. PMID 11318825.
- Edgell, Heather (December 2007). "WISE-2005: adrenergic responses of women following 56-days, 6° head-down bed rest with or without exercise countermeasures". Environmental, Exercise and Respiratory Physiology.
- Randa L. Shehab; Robert E. Schlegel (August–September 1998). "The NASA performance assessment workstation: Cognitive performance during head-down bed rest". Acta Astronautica. 43 (3–6): 223–233. Bibcode:1998AcAau..43..223S. doi:10.1016/s0094-5765(98)00156-8. PMID 11541926.
- Wilson, Thad (4 January 2003). "Effects of 14 days of head-down tilt bed rest on cutaneous vasoconstrictor responses in humans". Journal of Applied Physiology. 94 (6): 2113–2118. doi:10.1152/japplphysiol.00067.2002. PMID 12524372. S2CID 6965213.
- Meck, Janice V.; Dreyer, Sherlene A.; Warren, L. Elisabeth (May 2009). "Long-Duration Head-Down Bed Rest: Project Overview, Vital Signs, and Fluid Balance". Aviation, Space, and Environmental Medicine. 80 (Supplement 1): A1 – A8. doi:10.3357/asem.br01.2009. PMID 19476163.
- Shibasaki, Manabu (November 1, 2003). "Exercise throughout 6° head-down tilt bed rest preserves thermoregulatory responses". Journal of Applied Physiology. 95 (5): 1817–1823. doi:10.1152/japplphysiol.00188.2003. PMID 12882999.
^ Hilton, John (1879) [1863]. Jacobson, W. H. A. (ed.). On Rest and Pain: a Course of Lectures on the Influence of Mechanical and Physiological Rest in the Treatment of Accidents and Surgical Diseases, and the Diagnostic Value of Pain, delivered at the Royal College of Surgeons of England in the years 1860, 1861, and 1862 (2 ed.). New York: William Wood. Retrieved 7 July 2024.
^ Arnott, W. Melville (June 1954). "The Abuse of Rest". Original Articles. The Lancet. London: J. Onwhyn: 1252. Retrieved 7 July 2024.
^ Geller, Jeffery L. (1994). Women of the Asylum: Voices from Behind the Walls 1840-1945. New York: Anchor Books. pp. 161–168.
^ Cervetti, Nancy (2012). S. Weir Mitchell, 1829-1914: Philadelphia's Literary Physician. Penn State series in the history of the book. University Park, Pennsylvania: The Pennsylvania State University Press. p. 1. ISBN 9780271054032. Retrieved 7 July 2024. His creation of the rest cure to treat hysteria and neurasthenia originated in his treatment of Civil War soldiers who suffered from burning pain and phantom limbs, the latter a term he coined.
^ The Oxford English Dictionary quotes an example of the phrase "rest cure" in use as early as 1860 - "rest cure". Oxford English Dictionary (Online ed.). Oxford University Press. (Subscription or participating institution membership required.).
^ Gilman, Charlotte Perkins. "The Yellow Wallpaper". The Norton Anthology of English Literature. New York: Gale, 1996. 230-37. Print.
^ Geller, Jeffery L. (1994). Women of the Asylum: Voices from Behind the Walls 1840-1945. New York: Anchor Books. pp. 161–167.
^ Gilman, Charlotte. ""Why I Wrote "The Yellow Wallpaper"". Charlotte Perkins Gilman.
^ "Feminist Gothic in "The Yellow Wallpaper"".
^ Lee, Hermione (1996). Virginia Woolf (1. publ. in Great Britain ed.). London: Chatto & Windus. ISBN 978-0-7011-6507-9.
^ Dock, William (1944). "The evil sequelae of complete bed rest". Journal of the American Medical Association. 125 (16): 1083. doi:10.1001/jama.1944.02850340009004. ISSN 0002-9955.