Pressure Ulcers Table 11 Electrical Stimulation for Pressure Ulcer Healing Post SCI

Author Year
Country
Score
Research Design
Total Sample Size

Methods

Outcome

Houghton et al. 2010
Canada
PEDro=9
RCT
N=34

Population: Mean age=23-74 yr; Gender: male=20, female=14; Time since injury=1-51 yr; Severity of injury: complete and incomplete; Ulcer location: IT, sacrum, coccyx, hip, leg; Duration of ulcer=0.3-20 yr.
Intervention: Stimulation with monophasic high voltage pulsed current (HVPC) 19,200 min/day 7 days/wk with standard wound care (interdisciplinary team assessment) or standard wound care alone (SWC).
Outcome Measure: Percent decrease in wound surface area.
  1. Percent decrease in wound surface area was significantly greater (p=0.048) in those treated with HVPC+SWC (70 ± 25%); versus those with only SWC (36 ± 61%).
  2. Proportion of Stage III, IV, X pressure ulcers improving by at least 50% was significantly greater in the HVPC+SWC than in the SWC (p=0.20)

Cukjati et al. 2001
Slovenia
PEDro=5
RCT

N=217

Population: Mean age: 28-59 yr; Injury etiology: 71.7% SCI; Time since injury: 2-38 mo; Wound area >1cm2 and at least 4 wk duration; Ulcer location: trochanter, sacrum, gluteus, other; Ulcer duration: 3-18 wk.
Intervention: Biphasic-current stimulation (AC group) (N=136) received biphasic current by placing electrodes on intact skin across the wound. Direct-current stimulation (DC group) (N=35) received direct current (0.6mA) through positive electrode placed over wound and 4 negative electrodes placed on intact skin around the wound. Stimulation was applied 0.5hrs, 1hr, or 2 hours/day 7 days/wk. Comparisons were made to the Conservative treatment group (N=54) and sham group (N=23).
Outcome Measure: Wound healing rate.
  1. AC group healed significantly faster than the sham group (p=0.018) and at the same rate as the DC group (p=0.170) with the 2-hour wound treatment.
  2. AC group healed significantly faster than DC group with 1-hour treatment (p=0.001).
  3. Wound healing rate depend upon wound area, grade, shape, patient’s age, elapsed time from SCI to wound appearance, and elapsed time from wound appearance to beginning of treatment.

Adegoke & Badmos 2001
Nigeria
PEDro=6
RCT
N=7

Population: Mean age=21-60 yr; Mean ulcer surface area=15.8 mm; Ulcer location: greater trochanter and sacrum.
Intervention: Stimulation with interrupted direct current (IDC) and nursing care or placebo IDC and nursing care; 3-45 minute treatments 1x/wk for 4 wk.
Outcome Measures: Percent decrease in wound surface area.
  1. Surface area of pressure ulcers of IDC group decreased by 22.2% versus 2.6% in placebo IDC group.
  2. Most of the decrease in surface area occurred during the first two wk of the study (IDC group 15.4 to 13.3 mm2, % change 15.8%; placebo IDC group 15.4 to 15.1 mm2, % change 1.9%).

Karba et al. 1997
Slovenia
PEDro=6
RCT
N=50

Population: Pressure ulcer ≥ 500 mm2; Pressure ulcer stage: III or IV.
Intervention: DC+ group receiving positive stimulation electrode overlaid on ulcer; DC+/- group received the same stimulation but two electrodes were placed on healthy skin across the wound; SHAM group had electrodes placed on the wound but no current.
Outcome Measures: Relative rate of healing.
  1. The DC+ group reported significantly (p=0.028) greater relative healing rate (7.4%/day) compared to SHAM group (4.2%/day), while the DC+/- group (4.8%/day) had similar relative healing rates as the SHAM group .

Baker et al. 1996
USA
PEDro=4
RCT
N=80

PopulationMean age=17-76 yr; Gender: males=66, females=14; Time since injury: 1-420 mo; Severity of injury: complete and incomplete; Total number of wounds=192; Ulcer location: foot, thigh, ischial and sacral.
Intervention: Stimulation of A (asymmetric biphasic), vs. B (symmetric biphasic) vs. microcurrent (MC) group originally thought to incorporate stimulation below effective level became the 3rd treatment group when some early therapeutic effect was noted. All remained on their stimulation protocols until their ulcers healed, the MD intervened or subject withdrew from study. Control group received sham for 4 wk then were entered into either A or B groups. Electrical stimulation treatment for all subjects consisted of 1.5 hr of stimulation 5 days/wk.
Outcome Measures: Mean rate of healing.
  1. No statistical differences were noted between the initial or discharge ulcer areas or in the mean healing rates among the four treatment groups.
  2. Comparing the descriptive data by classifying them as good or poor healing responses failed to identify any statistically significant differences between the 2 groups.
  3. When looking at the good response group, the group A protocol was most effective as compared to the MC and C protocols (p<0.05). No significant differences were found between B protocol and other treatments.
  4. Those in the control group who had wounds healed by either protocol A or B showed that the healing rate was greater (43.3% Δ/wk) than it was during the control period (9.7% Δ/wk).

Jerčinović et al. 1994
Slovenia
PEDro=5
RCT
N=73

Population: Mean age: 18-68 yr; Severity of injury: >1 mo; Ulcer location: sacrum, legs, trochanter, gluteal, other.
Intervention: Stimulation with biphasic current (n=61) 2 hrs/day 5 days/wk for 4 wk in addition to conventional therapy was compared to the control group receiving conventional therapy alone (n=48).|
Outcome Measures: Mean rate of healing.
  1. The healing rate of the electrical stimulation group (5.7±7.1 %/day) was significantly higher (p=0.007) than the control group (2.7±3.6 %/day)
  2. There were 58 out of 81 pressure ulcers (61 electrical stimulation group and 20 cross-over group) which received electrical stimulation closed completely.

Griffin et al. 1991
USA
PEDro=7
RCT
N=17

PopulationMean age=10-74 yr; Gender: male=17; Time since injury=3-1820 wks; Severity of injury: complete and incomplete; Ulcer location: pelvic (sacral/coccygeal or gluteal/ischial) ulcers; Duration of ulcer=1-116 wk.
Intervention: Stimulation with high voltage pulsed current (HVPC) or placebo HVPC for one hour a day for 20 consecutive days. All patients received equivalent dressing changes. Wounds were mechanically debrided as necessary. “Efforts” were made to relieve pressure, but this was not described.
Outcome Measures: Percent decrease in wound surface area.
  1. Surface area of pressure ulcers of HVPC group decreased by 80% versus 52% in placebo HVPC group.
  2. Percentage of change decrease in the wound surface area (WSA) exhibited by the HVPC group was greater than placebo group at day 5 (p=0.03), day 15 (p=0.05) and day 20 (p=0.05).

Recio et al. 2012
USA
Case Series
N=3

Population: Adults with SCI and recalcitrant pressure ulcers; Ulcer location: heel, ischium, IT.
Intervention: High voltage electrical stimulation (HVES) was applied directly into the wound bed for 60 minutes 3-5 times/wk until completely healed.
Outcome Measures: Healing recalcitrant pressure ulcers.
  1. HVES enhanced healing of Stage III-IV pressure ulcers that were unresponsive to SWC.
  2. Long-standing (11-14 mo) pressure ulcers were completely healed after 7-22 wk of treatment with HVES.

Stefanovska et al. 1993
Slovenia
Prospective Controlled Trial
N=150

PopulationSCI with one or more pressure ulcers (otherwise, not specified).
Intervention: Currents were applied across the wounds by a pair of self-adhesive skin electrodes. DC group (n=18) treated with direct currents (600µA) for two hours daily. AC group (n=82) were treated with low frequency pulsed currents for two hours daily. CO group (n=50) received “conventional” treatment (not described) for the first mo.
Outcome Measures: Mean rate of healing.
  1. The healing rate for the AC group (n=42, 5.43%/day) was significantly better than the other two groups DC (n=12, 4.62%/day, p=0.03), CO (n=34, 2.87%/day, p=0.00), after excluding those with very deep, superficial or long-term wounds.
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