Is Bed Rest Helpful as an Intervention in the Management of Severe Anorexia Nervosa in Hospitals?

Abstract

Background: Bed rest has been part of treatment of severe anorexia nervosa in hospitals both in the UK and internationally. It is commonly used on medical and paediatric wards and both the adult and Junior MARSIPAN [1] guidelines recommend bed rest as part of nursing management of the physically compromised patient. However, recently there has been increasing awareness of the negative effect of bed rest in other patient populations.

The aim of this study was to review the evidence base of using bed rest as an intervention in the management of severe anorexia nervosa.

Methods: We searched on HDAS NICE website the following data bases: Medline, Pubmed, Embase, PsychInfo, Cinahl, Hmic, Amed, HBE, BNI including title and abstract for the following search terms: bed rest, anorexia nervosa, randomized controlled trial.

Results: 21,591 papers included the search term ‘bed rest’ and 56,131 ‘anorexia nervosa’. After exclusion of duplicates, only 17 papers included both topics. There were no randomised controlled trials. Negative physical consequences were described in a number of studies, and included lower heart rate, venous thrombosis, impaired bone turn over and increased risk of infection. Several papers showed that patients have a strong preference for less restrictive approaches. These are also less intensive in nursing time.

Conclusions: The evidence to support the use of bed rest in the management of hospitalised patients with severe anorexia nervosa is extremely limited. The risks associated with bed rest are significant, and include both physical and psychological harm. Given the clear risk of harm, it is difficult to recommend a randomised controlled trial on the subject, and the practice is best avoided altogether. Risks associated with initial refeeding can be managed in less restrictive manner.

Reference 1.

Royal College of Psychiatrists MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa CR189. 2014.