Effectiveness of bed rest after mild traumatic brain injury: a randomised trial of no versus six days of bed rest

Abstract

Background: Outcome after mild traumatic brain injury (MTBI) is determined largely by the appearance of post-traumatic complaints (PTC). The prevalence of PTC after six months is estimated to be between 20 and 80%. Bed rest has been advocated to prevent PTC but its effectiveness has never been established. Objective: To evaluate the effect of bed rest on the severity of PTC after MTBI. Methods: Patients presenting with MTBI to the emergency room were randomly assigned to two intervention strategies. One group was advised not to take bed rest (NO) and the other to take full bed rest (FULL) for six days after the trauma. The primary outcome measures were severity of PTC on a visual analogue scale and physical and mental health on the medical outcomes study 36 item short form health survey (SF-36) at two weeks and three and six months after the trauma. Results: Between October 1996 and July 1999, 107 (54 NO, 53 FULL) patients were enrolled. Outcome variables in both groups clearly improved between two weeks and six months. After adjustment for differences in baseline variables, most PTC tended to be somewhat more severe in the FULL group six months after the trauma, but no significant differences were found. Neither were there any significant differences in the outcome parameters between the two groups after three months. Two weeks after the trauma, most PTC in the FULL group were slightly less severe than those in the NO group, and physical subscores of the SF-36 in the FULL group were slightly better. These differences were not significant. Patients in the FULL group reported significantly less dizziness during the intervention period. Conclusions: As a means of speeding up recovery of patients with PTC after MTBI, bed rest is no more effective than no bed rest at all. Bed rest probably has some palliative effect within the first two weeks after the trauma.

Concussion: Improving Nurses' Knowledge in the Emergency Department

“…This reinforces that extended bedrest after MTBI does not result in better recovery than return to usual activities (de Kruijk et al, 2002). …”

“…The second study was a Dutch study (de Kruijk et al, 2002), comparing the effectiveness of extended bedrest to promote a return to activities. The intervention group were assigned to 6 days of full bedrest and told to return to full activity between 7 and 11 days; the control group was encouraged to remain on bed rest for no more than 4 hours during the first day then told to return to full activity within 4-days post injury.…”

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

“…37 de Kruijk et al (2002) randomized adults discharged with acute mTBI to usual care or strict bedrest and found that both treatments resulted in no significant differences in actual amounts of outpatient bedrest and no differences in outcomes at 2 weeks, 3 months, and 6 months. 38 Given that these previous studies of more stringent rest in concussed adults similarly failed to demonstrate…”

Hypopituitarism in childhood and adolescence following traumatic brain injury: the case for prospective endocrine investigation

“…Mild (or 'minor') head injury should have a GCS score of R13. Such an injury will have been caused by a blunt blow to the head in which post-traumatic amnesia lasts for !1 h. If there was an initial loss of consciousness at the time of injury, then it would have been !15 min duration and there is an absence of focal neurological signs (15). Children with a GCS %8 have severe head injury.…”