Australasian Faculty of Rehabilitation Medicine
Recommendations from the Australasian Faculty of Rehabilitation Medicine. The Australasian Faculty of Rehabilitation Medicine (AFRM) is a Faculty of the Royal Australasian College of Physicians (RACP). AFRM provides training and continuing education for Rehabilitation Medicine Fellows and trainees throughout all stages of their career. AFRM trainees and Fellows are committed to providing high quality rehabilitation care to individuals and communities in Australia and New Zealand.
Do not prescribe spinal orthotics or bed rest for patients with non-specific low back pain.
There is insufficient and conflicting evidence on the effectiveness of spinal orthotics and other forms of lumbar support for treating or preventing low back pain, either as an intervention in its own right or as a supplement to other interventions.
While there is no evidence that short term bed rest is harmful, long periods of bed rest can lead to complications such as muscular atrophy. The only randomised control trial to assess optimal periods of bed rest suggests two days is as effective as any longer period but the evidence is of low quality. There is evidence to support other approaches, such as advice to stay active and exercise which help with pain relief and improved function.
- Belavy DL, Armbrecht G, Richardson CA, et al. Muscle atrophy and changes in spinal morphology: is the lumbar spine vulnerable after prolonged bed-rest? Spine 2011; 36(2):137-45.
- Dahm KT, Jamtvedt G, Hagen KB, et al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev 2009; (1):CD007612.
- Deyo RA, Diehl AK, Rosenthal M. How many days of bed rest for acute low back pain? A randomized clinical trial. N Engl J Med 1986; 23;315(17):1064-70.
- NICE. Low back pain and sciatica in over 16s: assessment and management. NICE Guideline NG59 2016.
- Oleske DM, Lavender SA, Andersson GBJ, et al. Are back supports plus education more effective than education alone in promoting recovery from low back pain? Results from a randomized clinical trial. Spine 2007; 32(19):2050-7.
- van Duijvenbode I, Jellema P, van Poppel M, et al. Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev 2008; (2):CD001823
A working group within AFRM initially identified 10 recommendations on low value practices in the field of rehabilitation medicine that may be widespread in Australia and New Zealand. Following a review of the evidence these were reduced to seven. An online survey based on these seven recommendations was distributed to all AFRM members asking them to rate these recommendations based on whether they thought they were evidence based, whether the low-value practices targeted were still being undertaken in significant numbers, and whether the recommendation was important in terms of reducing harm and unnecessary costs to patients. The working group reviewed the feedback and finalised the ‘top 5’ recommendations which were approved by AFRM Executive in mid-2017.
- 1 Do not discharge patients with osteoporotic fractures without an assessment and/or treatment for osteoporosis.
- 2 Do not prescribe spinal orthotics or bed rest for patients with non-specific low back pain.
- 3 Do not use Mini Mental State Examination as the only tool to assess cognitive deficit in acquired brain injury.
- 4 Do not routinely use splinting for prevention and/or management of contractures after stroke.
- 5 Do not use imaging for diagnosing non-specific acute low back pain in the absence of red flags.