Non-Thermal Pulsed Electromagnetic Energy
Keast et al. (2006), in updating best practices recommendations for the prevention and treatment of pressure injuries, recommends considering electromagnetic fields as one adjunctive modality for stimulating closure of chronic non-healing pressure injuries even though results from more than one RCT are not consistent. Electromagnetic energy is believed to act at the proliferative stage of wound healing to promote production of granulation tissue formation (Houghton & Campbell 2007).
Discussion
An RCT studying the effects of electromagnetic energy on pressure injury healing in patients with SCI (Salzberg et al. 1995) evaluated the effects of non-thermal pulsed electromagnetic energy for healing of stage II and III ulcers in patients with SCI. In the stage II ulcer group (n=10), a greater proportion of ulcers healed (84%) after one week of treatment compared to the control group (40%; p=0.01). For complete healing, the treatment group healed in a median 13 days versus 31.5 days for controls (p<0.001). In the stage III ulcer group, healing was also associated with non-thermal pulsed electromagnetic energy treatment where three of five ulcers healed, on average, within 43 days. In the control group, none of the ulcers healed. Ulcer area decreased 70.6% in the treatment group versus 20.7% in the control group.
In a Cochrane systematic review, Ravaghi et al. (2006) examined two articles and found no statistically significant difference in the healing rates of people treated with electromagnetic therapy compared to controls. More research is needed to further our understanding of the mechanism of action of non-thermal pulsed electromagnetic energy and its role in pressure injury healing in individuals post-SCI.
Conclusion
There is level 1b evidence (from one randomized controlled trial: Salzberg et al. 1995) that pulsed electromagnetic energy accelerates healing of stage II and III pressure injuries post-SCI.
