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What is the evidence for using bed rest as part of hospital treatment of severe anorexia nervosa?
  1. Ali Ibrahim1,
  2. Darren Cutinha1,
  3. Agnes Ayton2
  1. 1 Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, London, UK
  2. 2 Cotswold House, Oxford Health NHS Foundation Trust Adult Mental Health Services, Oxford, Oxfordshire, UK
  1. Correspondence to Dr Agnes Ayton; agnes.ayton{at}oxfordhealth.nhs.uk

Abstract

Bed rest is commonly used on medical and paediatric wards as part of nursing management of the physically compromised patient with severe anorexia nervosa. The aim of this study was to review the evidence base of bed rest as an intervention in the management of severe anorexia nervosa. We searched MEDLINE, PubMed, Embase, PsychInfo, CINAHL, HMIC, AMED, HBE, BNI and guidelines written in English until April 2018 using the following terms: bed rest and anorexia nervosa. After exclusion of duplicates, three guidelines and eight articles were included. The papers were methodologically heterogeneous, and therefore, quantitative summary was not possible. There have been no randomised controlled trials to compare the benefits and harms of bed rest as the focus of intervention in the treatment of anorexia nervosa. Several papers showed that patients have a strong preference for less restrictive approaches. These are also less intensive in nursing time. Negative physical consequences were described in a number of studies: these included lower heart rate, impaired bone turn over and increased risk of infection. We found no evidence to support bed rest in hospital treatment of anorexia nervosa. The risks associated with bed rest are significant and include both physical and psychological harm, and these can be avoided by early mobilisation. Given the established complications of bed rest in other critically ill patient populations, it is difficult to recommend the enforcement of bed rest for patients with anorexia nervosa. Future research should focus on safe early mobilisation, which would reduce complications and improve patient satisfaction.

  • eating disorders
  • adult psychiatry

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Footnotes

  • AI and AA contributed equally.

  • Contributors AI and AA developed the research question and carried out the literature review. AI ad AA drafted the paper. DC helped revising the paper. All authors have agreed to the final version before submission.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at This work was presented as a poster at the 2nd Congress on Evidence Based Mental Health: from research to clinical practice Kavala, Greece, 28 June–1 July 2018.

  • Patient consent for publication Not required.

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