Skip to main content

Some NLM-NCBI services and products are experiencing heavy traffic, which may affect performance and availability. We apologize for the inconvenience and appreciate your patience. For assistance, please contact our Help Desk at info@ncbi.nlm.nih.gov.

Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2002 Aug;73(2):167–172. doi: 10.1136/jnnp.73.2.167

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

J R de Kruijk 1, P Leffers 1, S Meerhoff 1, J Rutten 1, A Twijnstra 1
PMCID: PMC1737969  PMID: 12122176

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.

Full Text

The Full Text of this article is available as a PDF (285.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aaronson N. K., Muller M., Cohen P. D., Essink-Bot M. L., Fekkes M., Sanderman R., Sprangers M. A., te Velde A., Verrips E. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998 Nov;51(11):1055–1068. doi: 10.1016/s0895-4356(98)00097-3. [DOI] [PubMed] [Google Scholar]
  2. Alexander M. P. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. 1995 Jul;45(7):1253–1260. doi: 10.1212/wnl.45.7.1253. [DOI] [PubMed] [Google Scholar]
  3. Allen C., Glasziou P., Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet. 1999 Oct 9;354(9186):1229–1233. doi: 10.1016/s0140-6736(98)10063-6. [DOI] [PubMed] [Google Scholar]
  4. Bohnen N. I., Jolles J., Twijnstra A., Mellink R., Wijnen G. Late neurobehavioural symptoms after mild head injury. Brain Inj. 1995 Jan;9(1):27–33. doi: 10.3109/02699059509004568. [DOI] [PubMed] [Google Scholar]
  5. Bohnen N. I., Twijnstra A., Jolles J. A controlled trial with vasopressin analogue (DGAVP) on cognitive recovery immediately after head trauma. Neurology. 1993 Jan;43(1):103–106. doi: 10.1212/wnl.43.1_part_1.103. [DOI] [PubMed] [Google Scholar]
  6. Chapman E. H., Weintraub R. J., Milburn M. A., Pirozzi T. O., Woo E. Homeopathic treatment of mild traumatic brain injury: A randomized, double-blind, placebo-controlled clinical trial. J Head Trauma Rehabil. 1999 Dec;14(6):521–542. doi: 10.1097/00001199-199912000-00002. [DOI] [PubMed] [Google Scholar]
  7. Consensus conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury. JAMA. 1999 Sep 8;282(10):974–983. [PubMed] [Google Scholar]
  8. De Kruijk J. R., Twijnstra A., Meerhoff S., Leffers P. Management of mild traumatic brain injury: lack of consensus in Europe. Brain Inj. 2001 Feb;15(2):117–123. doi: 10.1080/026990501458353. [DOI] [PubMed] [Google Scholar]
  9. Haase J. Social-economic impact of head injury. Acta Neurochir Suppl (Wien) 1992;55:75–79. doi: 10.1007/978-3-7091-9233-7_20. [DOI] [PubMed] [Google Scholar]
  10. King N. S., Crawford S., Wenden F. J., Moss N. E., Wade D. T. Interventions and service need following mild and moderate head injury: the Oxford Head Injury Service. Clin Rehabil. 1997 Feb;11(1):13–27. doi: 10.1177/026921559701100104. [DOI] [PubMed] [Google Scholar]
  11. King N. S. Emotional, neuropsychological, and organic factors: their use in the prediction of persisting postconcussion symptoms after moderate and mild head injuries. J Neurol Neurosurg Psychiatry. 1996 Jul;61(1):75–81. doi: 10.1136/jnnp.61.1.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Levin H. S., Mattis S., Ruff R. M., Eisenberg H. M., Marshall L. F., Tabaddor K., High W. M., Jr, Frankowski R. F. Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg. 1987 Feb;66(2):234–243. doi: 10.3171/jns.1987.66.2.0234. [DOI] [PubMed] [Google Scholar]
  13. Levin H. S. Treatment of postconcussional symptoms with CDP-choline. J Neurol Sci. 1991 Jul;103 (Suppl):S39–S42. doi: 10.1016/0022-510x(91)90007-t. [DOI] [PubMed] [Google Scholar]
  14. McHorney C. A., Ware J. E., Jr, Raczek A. E. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993 Mar;31(3):247–263. doi: 10.1097/00005650-199303000-00006. [DOI] [PubMed] [Google Scholar]
  15. Merchant R. E., Bullock M. R., Carmack C. A., Shah A. K., Wilner K. D., Ko G., Williams S. A. A double-blind, placebo-controlled study of the safety, tolerability and pharmacokinetics of CP-101,606 in patients with a mild or moderate traumatic brain injury. Ann N Y Acad Sci. 1999;890:42–50. doi: 10.1111/j.1749-6632.1999.tb07979.x. [DOI] [PubMed] [Google Scholar]
  16. Minderhoud J. M., Boelens M. E., Huizenga J., Saan R. J. Treatment of minor head injuries. Clin Neurol Neurosurg. 1980;82(2):127–140. doi: 10.1016/0303-8467(80)90007-4. [DOI] [PubMed] [Google Scholar]
  17. Nell V., Yates D. W., Kruger J. An extended Glasgow Coma Scale (GCS-E) with enhanced sensitivity to mild brain injury. Arch Phys Med Rehabil. 2000 May;81(5):614–617. doi: 10.1016/s0003-9993(00)90044-3. [DOI] [PubMed] [Google Scholar]
  18. Paniak C., Phillips K., Toller-Lobe G., Durand A., Nagy J. Sensitivity of three recent questionnaires to mild traumatic brain injury-related effects. J Head Trauma Rehabil. 1999 Jun;14(3):211–219. doi: 10.1097/00001199-199906000-00002. [DOI] [PubMed] [Google Scholar]
  19. Paniak C., Toller-Lobe G., Durand A., Nagy J. A randomized trial of two treatments for mild traumatic brain injury. Brain Inj. 1998 Dec;12(12):1011–1023. doi: 10.1080/026990598121927. [DOI] [PubMed] [Google Scholar]
  20. Paniak C., Toller-Lobe G., Reynolds S., Melnyk A., Nagy J. A randomized trial of two treatments for mild traumatic brain injury: 1 year follow-up. Brain Inj. 2000 Mar;14(3):219–226. doi: 10.1080/026990500120691. [DOI] [PubMed] [Google Scholar]
  21. Ruff R. M., Jurica P. In search of a unified definition for mild traumatic brain injury. Brain Inj. 1999 Dec;13(12):943–952. doi: 10.1080/026990599120963. [DOI] [PubMed] [Google Scholar]
  22. Thornhill S., Teasdale G. M., Murray G. D., McEwen J., Roy C. W., Penny K. I. Disability in young people and adults one year after head injury: prospective cohort study. BMJ. 2000 Jun 17;320(7250):1631–1635. doi: 10.1136/bmj.320.7250.1631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Wade D. T., King N. S., Wenden F. J., Crawford S., Caldwell F. E. Routine follow up after head injury: a second randomised controlled trial. J Neurol Neurosurg Psychiatry. 1998 Aug;65(2):177–183. doi: 10.1136/jnnp.65.2.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. van der Naalt J., van Zomeren A. H., Sluiter W. J., Minderhoud J. M. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry. 1999 Feb;66(2):207–213. doi: 10.1136/jnnp.66.2.207. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES