|
Year |
2002 |
|---|---|
|
Question Number |
274 |
|
Category |
Spine |
Question
To optimized recovery, mgt of acute back pain should consist of bed rest for what period of time ?
1) no more than 3 days followed by a return to normal activities ASAP
2) 2 -7 days followed by restricted activity for 2-3 weeks
3) at least 7 days with no additional restrictions
4) 2 wks followed by gradual return to normal activities
5) none under any circumstance
Figures
Answer (click for answer)
The correct answer is 1.
A study from the New England Journal of Medicine evaluated 203 pts with the dx of mechanical lower back pain. Pts were excluded if they had a major neurological deficit. Seventy -eight percent of the pts had acute pain (less than 30 days). Pt were excluded if they had fever, cancer, on anticoagulants, prior surgery , on steroids or if their pain was above T12. The study was stratified according to the number of episodes and the pts employment status at time of presentation. Pt were evaluated and filled out a questionnaire and were assigned to either 2 or 7 days of bed rest to be completed at the pts house under their discretion. On follow up pts were asked how long they actually spent in bed. Outcome assessment was grouped in 4 categories 1)functional status, 2) pt subjective assessment of pain, 3) objective signs/symptoms, 4) use of other service for LBP including admission to the hospital. Pts assigned to 2 days of bed rest missed 45% fewer days than those assigned to 7 days. No difference was found in any of the other outcomes.
Reference: Deyo RA, Diehl AK, Rosenthal M: How many days of bed rest for acute low back pain? A randomized clinical trial. N England J Med 1986;315:1064-70