Electrical stimulation for treating pressure ulcers

Cochrane Database of Systematic Reviews, 2020 · DOI: 10.1002/14651858.CD012196.pub2 · Published: January 1, 2020

Simple Explanation

This review looked at whether electrical stimulation (ES) can help heal pressure ulcers. Pressure ulcers are injuries to the skin and/or underlying tissue caused by sustained pressure. ES is provided by an electrical current applied to the skin, requiring at least two electrodes connected to a battery-powered device. The review analyzed 20 randomized controlled trials comparing ES (plus standard care) with sham/no ES (plus standard care). The review found that ES probably increases the proportion of pressure ulcers healed and the rate of pressure ulcer healing, but its effect on time to complete healing and the surface area of pressure ulcers is uncertain.

Study Duration

Not specified

Participants

913 participants

Evidence Level

Systematic Review of RCTs

Key Findings

1
ES probably increases the proportion of pressure ulcers healed compared with no ES (risk ratio (RR) 1.99, 95% confidence interval (CI) 1.39 to 2.85; I2 = 0%; 11 studies, 501 participants (512 pressure ulcers)).
2
It is uncertain whether ES decreases pressure ulcer severity on a composite measure compared with no ES (mean diﬀerence (MD) -2.43, 95% CI -6.14 to 1.28; 1 study, 15 participants (15 pressure ulcers)).
3
ES probably increases the rate of pressure ulcer healing compared with no ES (MD 4.59% per week, 95% CI 3.49 to 5.69; I2 = 25%; 12 studies, 561 participants (613 pressure ulcers)).

Research Summary

We identified 20 eligible studies. There is moderate certainty evidence that electrical stimulation (ES) probably increases the proportion of pressure ulcers healed compared with no ES. There is uncertainty as to whether ES reduces the surface area of pressure ulcers. We could not pool the data for this outcome because there was considerable statistical heterogeneity between studies (I2 = 96%), and the certainty of the evidence for this outcome is very low. Adverse events were poorly reported and included redness of the skin, itchy skin, dizziness and delusions, deterioration of the pressure ulcer, limb amputation, and occasionally death; the certainty of evidence for this outcome is low and it is diﬀicult to attribute adverse events to interventions.

Practical Implications

Clinical Practice

ES probably increases the proportion of pressure ulcers healed, but its eﬀect on time to complete healing is uncertain, and the certainty of evidence for all outcomes is moderate, low or very low. The evidence to date is insuﬀicient to support the widespread use of ES for pressure ulcers other than for research purposes.

Research Design and Reporting

Future studies must focus on minimising bias. Importantly, they need to randomly allocate participants to groups, use concealed allocation and blind assessors. Adequate follow-up of participants will also help minimise bias. Importantly, studies need to register their protocols and adhere to preplanned statistical analyses.

Areas of Future Research

Studies need to determine the eﬀect of ES on all key outcomes. There is a pressing need to include outcome measures that are important to patients. This needs to include time to complete healing, quality of life, depression and consumers' perceptions of treatments.

Study Limitations

1
Poor reporting and the lack of consistency between authors in the way outcome data were expressed
2
Failure to blind therapists (60% of studies), incomplete outcome data (30% of studies) and failure to blind assessors to outcomes (10% of studies).
3
Six studies did not account for non-independence of data, resulting in unit of analyses issues

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