Westeinde Sciatica Trial: randomized controlled study of bed rest and physiotherapy for acute sciatica

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors conducted a study to compare the efficacies of three nonsurgical treatment strategies in patients with sciatica. Their hypothesis was that bed rest, physiotherapy, and continuation of activities of daily living (ADLs) (control treatment) are each of equivalent efficacy.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> This randomized controlled trial was designed for comparison of bed rest, physiotherapy, and continuation of ADLs. The setting was an outpatient clinic. General practitioners were asked to refer patients for treatment as soon as possible. The authors enrolled 250 patients (&lt; 60 years of age) with sciatica of less than 1-month's duration and who had not yet been treated with bed rest or physiotherapy. Primary outcome measures were radicular pain (based on a visual analog pain scale [VAPS]) and hampered ADLs (Quebec Disability Scale [QDS]). Secondary outcome measures were the rates of treatment-related failure and surgical treatment. Measures were assessed at baseline and during follow up at 1, 2, and 6 months.</jats:p> <jats:p content-type="fine-print">Mean differences in VAPS and QDS scores between bed rest and control treatment were 2.5 (95% confidence interval [CI] −6.4 to 11.4) and −4.8 (95% CI −10.6 to 0.9) at 1 month and 0.9 (95% CI −8.7 to 10.4) and −2.7 (95% CI −9.9 to 4.4) at 2 months, respectively. The respective differences between physiotherapy and control treatment were 0.8 (95% CI −8.2 to 9.8) and −0.5 (95% CI −6.3 to 5.3) at 1 month and −0.3 (95% CI −9.4 to 10) and 0.0 (95% CI −7.2 to 7.3) at 2 months. The respective odds ratios for treatment failure and surgical treatment of bed rest compared with control treatment were 1.6 (95% CI 0.8–3.5) and 1.5 (95% CI 0.7–3.6) at 6 months. When physiotherapy was compared with control treatment, these ratios were 1.5 (95% CI 0.7–3.2) and 1.2 (95% CI 0.5–2.9) at 6 months, respectively.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Bed rest and physiotherapy are not more effective in acute sciatica than continuation of ADLs.</jats:p>

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

“…There was no significant difference between bed rest and advice to keep active in two RCTs. 14,267 There was no significant difference between bed rest and mobilisation with exercises carried out in a hospital physiotherapy department, 267 between rest and spinal manipulation with exercises, pelvic traction and exercises, 137 or between bed rest and bed rest with vertical traction. 243 Pain intensity at short-term follow-up The results for pain intensity at short-term follow-up are presented in Table 129 and the accompanying forest plot (Figure 86).…”

“…14,145,243,256,267 Summary data of the interventions used are presented in Table 125. Two RCTs compared bed rest for 1 or 2 weeks with advice to keep active, 14 or continue activities of daily living.…”

“…Two RCTs compared bed rest for 1 or 2 weeks with advice to keep active, 14 or continue activities of daily living. 267 This last RCT 267 was a three-arm study which also compared bed rest with twice weekly hospital physiotherapy for at least 4 weeks, consisting of segmental mobilisation, exercises and hydrotherapy. Another three-arm RCT 256 compared rest and hot packs with hot packs, massage, mobilising and isotonic strengthening exercise, and also with intermittent pelvic traction and isometric strengthening exercises.…”

“…Sciatica was confirmed by imaging in one RCT. 267 There were no patients with spinal stenosis or sequestered discs, and previous back surgery was excluded in one RCT. 14 …”

“…Most studies were RCTs (4/5, 80%); however, the proportion that were of good quality was low (1/5, 20%). Only three had an adequate method of random number generation 14,243,267 and none documented a secure method of allocation concealment. Two studies had good external validity.…”