Bed rest



Bed rest is a medical treatment involving a period of consistent (day and night) recumbence in bed. It is used as a treatment for an illness or medical condition, especially when prescribed or chosen rather than resulting from severe prostration or imminent death. 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. Some clinicians now regard bed rest as being at best neutral to outcome, and in some cases potentially harmful to patients.

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 human 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 was mainly prescribed by doctor Silas Weir Mitchell, and was almost always prescribed to women, many of whom were suffering from depression. It was not effective and caused many to go insane or die. In the middle of the twentieth century, bedrest 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.

Indications
Bed rest is commonly prescribed in the following 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.
 * 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.
 * 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 (bedrest in the absence of complications) does not improve outcomes; however, bed rest is almost always prescribed for women carrying triplets or more.
 * Heart diseases
 * Bed rest is an important measure in the cases of chorea. In the mild cases it may suffice for treatment.
 * Acute gout, as early ambulation may precipitate a recurrence.

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. 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. Even physical exercise in bed fails to address certain adverse effects.

It is also a major cause of thrombosis, mainly by reducing blood flow in the legs.