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. Bed rest is especially used when prescribed or chosen. Bed rest is not especially used for 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. Even though the practice is still commonly used for an array of conditions it is not shown to be an effective treatment for any illness. It is commonly part of pregnancy in United States of America where it is prescribed to nearly 20% of pregnant women despite the growing volume of data showing it to be dangerous, causing some experts to call its use "unethical".

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 person 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 as well as its name were created by doctor Silas Weir Mitchell, 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 or die. In the middle of the 20th century, bed rest 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
There are no known conditions where bed rest is shown to be an effective treatment. However, bed rest is commonly prescribed in the following cases despite the known risks.


 * 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 (bed rest 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.

Inclined bed rest
Inclined bed rest is a common practice for people suffering from some forms of Gastroesophageal reflux disease and heart disease and for patients who are on a ventilator. Despite its prevalence, several studies exploring the effects of tilting the head of a bed have found no support for beneficial health claims. Placing the head of a bed lower than the foot is sometimes used as a means of simulating the physiology of spaceflight.

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.