The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page


Table 2

Table 2 Evidence table of randomised controlled trials of bed rest





Treatment (t)

Controls (c)



Lindequist et al 1984


acute LBP +/- referred leg pain

family practice

Back school, physio training program, encourage phys activity despite LBP

analgesics PRN advice not to strain back

initial pain recovery
1 year sick leave
pt satisfaction with treatment

NS dif initial pain recovery or time off work
further 1 yr work loss: t 16% av 44 days, c 31% av 42 days NS
t more satisfied p < .05

Fordyce et al 1986


acute LBP
(1-10 days)

family practice, emergency room, ortho OP

time-contingent analgesics and programmed restoration of activity

traditional analgesics as required, ‘let pain be your guide’

1 yr claimed impairment (CI), activity level, ‘sickness’ & health care use (HCU)

NS difs at 6/52
1 yr CI t return to normal, c increased
p < .05
NS dif activity levels
c more ‘sick’ at 9-12 months p < .05
1 yr HCU: t fell c increased p < .01

Philips et al 1991


acute LBP
first episode
< 15 days

family practice or emergency room

Graded reactivation
+/- behavioural counselling

‘let pain guide’ return to normal
(factorial design)

pain at 6/12
(no rating of severity or disability)
exercise level

NS dif pain at 6/12
begin exer by 3 days: t 86% c 55%
p < .01

Lindstrom et al 1992a & b


sub-acute LBP

industrial blue collar workers

graded activity prog,
behav principles

tradit med care by own physician

pain, disab, mobility, strength, fitness, work loss

NS dif pain, 1 yr disab p< .01
t better 1 yr mobility & fitness but NS
RTW t 10 weeks c 15.1 weeks p .01
work loss in second FU year-
t 12.1 weeks c 19.6 weeks p .05

Linton et al 1993


acute back & neck pain
a) PH back pain
b) first attack

primary care & occup health

‘early activation’
reinforce healthy behav, maintain daily activities, training

‘treatment as usual’
analgesics, rest & sick leave

pain disability, satisfaction,
1 year sick leave

a) NS difs
b) NS difs pain or disab
t more satisfied p < .05
t signif less sick-listing

t 8 X less likely to devel chronic sick leave (> 200 days)

Malmivaara et al 1995


acute LBP
(av 5 days)

occupational health clinics

‘Ordinary activity’
avoid bed rest
continue routine activ as normally as pos

c1 back mobilising exer

c2 2 days bed rest

3 & 12/52
pain, disability lumbar flexion and days off work

t significantly fewer days and less severe pain, less disability, fewer days off work, lowest costs.

Wilkinson 1995


acute LBP
(< 7 days)

family practice

Stay mobile and no daytime rest

48 hours strict bed rest

7 & 28 days pain, disability, lumbar flexion & SLR

t tended to earlier recovery but no significant differences

Indahl et al 1995


LBP off work
8 weeks

population based (Nat insur claims)

intense personal advice, reduce fear, activity, normal walking, reduce sick behav, set goals
no spec work advice

‘conventional’ medical system'

return to work

still on sick leave at 200 days:

t 30% c 60% p < .001

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