Is Bed Rest An Effective Treatment Modality for Pressure Ulcers?

    The body of evidence compiled against bed rest confirms what past and current "Users and Refusers" of this treatment modality have said for years: "It's impossible." "Don't make me do this." "Isn't there another way?"

    As I read the manuscript, I thought, "Yes, that's what I experienced. That's what I've heard others say. Now that someone else put it all in writing, perhaps clinicians will listen." My anecdotal evidence has never been enough to make clinicians change their methods. Anecdotal evidence seemingly is viewed as one person's story, not a common situation that needs to be addressed. Clinicians are taught to rely on scientific evidence — a larger picture of what is happening that carries more weight in terms of changing practice.

    With regard to bed rest, the desire for scientific evidence creates an intriguing dilemma. Anecdotally, the idea bed rest creates problems is supported by a body of evidence. Interestingly, the belief bed rest is effective is refuted by a body of evidence. The conclusion? Bed rest creates problems and is not effective. Perhaps now people will put the two findings together and re-think their enthusiasm for this treatment or at least be more open-minded to other pressure ulcer management methods that are less devastating.

    When my clinicians prescribed bed rest and I said I couldn't do it, I was told to buck up, toe the line, just do it, and any number of other phrases that either stated or implied that I was weak, headstrong, and in denial that this treatment was necessary. The only time bed rest has been tolerable for me is when the wound that sent me to bed made significant healing progress. Still, "Let's try this for a couple of weeks" is hard to accept because past experience indicates the distinct possibility that at the end of that period I'll see no improvement and I will have wasted 2 weeks of my life.

    Therein lies the main problem: depression. As noted in some studies in this article, depression comes not just from the "lack of kinesthetic and proprioceptive stimulation" but also from the lack of progress in the condition that confines the person to bed, as well as from an aggregate of physiological effects that together exacerbate that depression. Despite my knowing wound care is an inexact science and clinicians cannot be certain when or if something will help a given patient, for me bed rest for the duration of the "trial" makes the guesswork of wound care even more intolerable.

    It is somewhat chilling and unfulfilling to read clinical accounts of affective changes when my memory of experiences is so fresh. The term depression does not do justice to the blackness I have felt during weeks of bed rest. I try to hide it, to be thankful and happy and conversational with visitors and caregivers — to be the good patient and do what they tell me to do. But it's a minute-by-minute struggle through the black quicksand of depression. My caregivers and visitors don't know how to handle the depression because there's little they can do. Their awkward attempts at comfort are well intentioned, difficult for them to offer, and difficult for me to accept graciously.

    Compounding the depression is the fatigue and mental lethargy also noted in this article. My sleep patterns are thrown completely off, I nap at odd times all through the day, and can't sleep through a 7- to 8-hour night. I have trouble concentrating on a book or a sitcom or any TV program. I want used the time wisely to catch up on reading, move forward on research or projects, make phone calls to find better home insurance rates, learn about investing, and explore my other interests. But the motivation just isn't there and decreases daily, which leads to more depression as I realize that I'm wasting the time and there's nothing I can do about it.

    Surprisingly, one study found no benefits to any of the 15 health problems treated with bed rest, including pressure ulcers; intuitively, completely eliminating pressure should help ischial pressure ulcers. Eventually. Perhaps the slow progress made with these ulcers comes from the combination of physiological changes in the body and the detriments of bed rest.

    Because of their negative feelings toward bed rest, "Refusers" like me have been labeled noncompliant. I am grateful to the authors not only for not using that label in their article but also for validating my experience and emotions toward it. My experiences with and negativity toward bed rest are not uncommon and not due to flaws in my personality. My hope is that articles like this one will lead to positive changes in treatment for these devastating wounds.