Prospective studies that compared initial bed rest with ambulation, in addition to standard anticoagulation treatment, in patients with deep vein thrombosis and/or pulmonary embolism were eligible for inclusion in the review. Prospective registries were included where treatment groups and outcomes were clearly described. Anticoagulation regimens had to be similar across the treatment groups, and patients had to be adequately described. Studies had to include at least one of the following outcomes: occurrence of new pulmonary embolism; all-cause mortality; and new or progression of deep vein thrombosis.
Symptomatic and asymptomatic pulmonary embolism patients were included, and their mean age ranged from 52 to 66 years. The number of days patients were confined to bed ranged from three to nine. Some ambulated patients were allowed to move immediately, others up to two days following treatment. All the included studies used low molecular weight heparin (dalteparin or enoxaparin, where specified) as the anticoagulant treatment.
Two reviewers independently selected the studies, and disagreements were resolved by consensus.