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Skin Integrity and Pressure Injuries

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).

Author Year
Country
PEDro Score
Research Design
Sample Size

Methods

Outcome

Salzberg et al. 1995
USA
RCT
PEDro=8
N=30
Population: Stage II group: Age=24-69 yr. No data for Stage III group.
Intervention: A non-thermal pulsed high frequency, high peak power, electromagnetic energy (PEE), was delivered through a treatment head placed in light contact with the wound site and tuned to resonance in the area of the wound. Treatment was non-invasive and delivered through wound dressings for 30 minutes, twice daily for 12 wk or until healed. The control group received 12 wk of sham treatment.
Outcome Measures: Pressure injury Status.
1. Stage II group: Treatment (n=10), control (n=10). After 1 wk, the treatment group had a greater percentage of ulcers healed (84%) compared to the control group (40%), p=0.01 and the median size of ulcer was also smaller at one wk (2.7 versus 16.5 cm2, p=0.015).
2. For complete healing, the treatment group healed in a median of 13 days versus 31.5 days for the controls (p<0.001). 3. Given that there were more large ulcers (>60 cm2) in the sham group, data was reanalyzed for 15 subjects with ulcers <60 cm2 with similar results as found initially.
4. Stage III group: Treatment n=5, control n=5. 3/5 healed with an average of 43 days of treatment. 0/5 healed in control group. Ulcer area decreased by average 70.6% versus 20.7% in control group.

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.

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