Rethinking Bed Rest: A New Approach to Pressure Injury Management

The Hidden Costs of Immobility

Prolonged bed rest can lead to numerous complications affecting both cognitive and physical health. These adverse effects are well-documented in medical literature.

• Cognitive and psychosocial issues associated with extended immobilisation include depression, learned helplessness, perceptual changes, and fatigue³. These mental health impacts can significantly affect a patient's overall well-being and recovery.
• Physical complications of prolonged bed rest are equally concerning. Musculoskeletal issues such as muscle atrophy, contractures, and disuse osteoporosis can occur^4,5. The cardiovascular system is also affected, with patients experiencing increased heart rate, decreased cardiac reserve, and orthostatic hypotension. Additionally, the risk of infections, particularly urinary tract infections, increases with extended immobility⁵.
• Digestive problems are another common complication, though specific details were not provided in the search results. However, it's well-known that prolonged bed rest can lead to issues such as constipation and changes in appetite.
• Prolonged bed rest can significantly harm older adults in particular, by affecting multiple bodily systems, including cardiovascular, pulmonary, gastrointestinal, musculoskeletal, and urinary functions. This immobility can exacerbate existing health issues and lead to new medical conditions, compounding the problems that initially required bed rest⁶.

These complications underscore the importance of carefully managing bed rest periods and implementing strategies to mitigate these risks when prolonged immobilisation is necessary⁴.

Embracing Alternative Approaches: The Rise of Therapeutic Seating

Winkleman's research suggests that weight-bearing physical activity may actually promote healing of injured tissue, challenging the notion that complete immobility is necessary for wound repair⁴.

Considering the potential drawbacks associated with prolonged bed rest, healthcare professionals are increasingly turning to alternative strategies, such as therapeutic chairs, which allow patients to maintain an upright posture while effectively managing pressure points.

Advantages of Therapeutic Seating:

• Reduces time spent confined to bed
• Enables participation in occupational therapy / physiotherapy / therapies/ activities.
• Facilitates engagement in meaningful daily activities
• Enhances exposure to environmental stimuli
• Empowers patients to take an active role in their care

A Holistic Approach to Pressure Injury Care

To optimise healing while minimising the risks associated with extended bed rest, implementation of the following strategies could be considered;

1. Carefully limit periods of bed confinement
2. Incorporate regular therapy sessions
3. Utilise therapeutic seating options for out-of-bed time
4. Ensure optimal nutrition to support healing
5. Implement comprehensive pressure management throughout daily routines
6. Actively involve patients in care decisions and address their concerns

By adopting a more comprehensive approach to pressure ulcer management, we have the potential to improve outcomes for wheelchair users while enhancing their overall quality of life. As our understanding of wound healing continues to evolve, it's crucial for healthcare providers to remain adaptable and open to new evidence-based practices.

In conclusion, the traditional reliance on bed rest for pressure injury treatment is being challenged by emerging research. By embracing innovative approaches like therapeutic seating and encouraging controlled mobility, we can pave the way for more effective and patient-centred care strategies. As we move forward, continued research and open dialogue among healthcare professionals will be essential in refining our approach to pressure injury management.

References

1. Norton, L. and Sibbald, R.G. (2004) ‘Is bed rest an effective treatment modality for pressure ulcers?’, Ostomy Wound Manage, 50(10):40-2, 44-52; discussion 53. PMID: 15509881.
2. Moore, Z.E., Van Etten, M.T. and Dumville, J.C. (2016) ‘Bed rest for pressure ulcer healing in wheelchair users’, Cochrane Database Syst Rev, 10(10):CD011999. doi: 10.1002/14651858.CD011999.pub2. PMID: 27748506; PMCID: PMC6457936.
3. Liu, Q., Zhou, R., Chen, S. and Tan, C. (2012) ‘Effects of head-down bed rest on the executive functions and emotional response’, PLoS One, 7(12):e52160. doi: 10.1371/journal.pone.0052160. Epub 2012 Dec 17. PMID: 23284916; PMCID: PMC3524097.
4. Winkleman, C. (2008) ‘Bed rest in health and critical illness’, AACN Advanced Critical Care, 20(2): 254-66, DOI: 10.1097/NCI.0b013e3181ac838d.
5. Krasnoff, J. and Painter, P. (1999) ‘The physiological consequences of bed rest and inactivity’, Adv Ren Replace Ther, 6(2):124-32. doi: 10.1016/s1073-4449(99)70030-0. PMID: 10230879.
6. Guedes, L.P.C.M., Oliveira, M.L.C. and Carvalho, G.A. (2018) ‘Deleterious effects of prolonged bed rest on the body systems of the elderly - a review’, Revista Brasileira de Geriatria e Gerontologia, 21(4), pp.499-506.