The Effects of Electrical Stimulation on Chronic Wound Healing: A Systematic Review
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- electrical stimulation; wound healing; systematic review
BACKGROUND AND PURPOSE Electrical stimulation (ES) is an adjunct modality used to facilitate healing of chronic wounds. Current literature suggests electrical stimulation has some net benefit, although best-practice protocols have yet to be substantiated. The purpose of this systematic review is to analyze the existing literature about the use of ES to facilitate the treatment of chronic wounds. Key questions include : 1) What is the effect of ES on healing rates of chronic wounds when compared with standard care, 2) What parameters of ES are most beneficial, 3) Is the response toES wound-etiology specific, and 4) Do the benefits of ES continue to outweigh the harms? METHODS Cochrane, Cinahl and Medline were electronically searched using keywords “electrical stimulation” and/or “wound healing” from 1973 through 2014 resulting in a total of 1858 hits. Through title and abstraction review by multiple researchers, 1796 articles were eliminated with 62 remaining articles found appropriate for review. Of these, 34 were accessible for this study (11 randomized controlled trials, 5 clinical trials, 5 systematic reviews, 4 literature reviews, and 9 case reports). Statistical analysis was conducted using Review Manager software for the 11 RCTs. RESULTS Of the 11 RCT evaluated, 5 comparisons examined the relative strength of treatment effect based on wound type, ES protocol, and outcome measures. Although the results are mixed, studies examining the use of biphasic ES’s effect on healing rate and those examining the use of high voltage pulsed current’s (HVPC) effect on total surface area change showed results in favor of the experimental groups. Comparisons for ES on pressure ulcers showed favor for experimental groups in regards to closure rate outcome measures, and comparisons regarding diabetic ulcer healing rate with electrical stimulation treatment favored the experiment group. CONCLUSIONS Given the variability in wound type, ES parameters, and outcomes evaluated, few comparisons could be analyzed. Based on the available evidence, ES has a modest positive effect on healing rates when compared with standard care alone. Biphasic ES was most commonly studied for use in treatment of diabetic ulcers (4/4 studies), whereas pressure ulcers were managed with both biphasic (2/5 studies) and HVPC (3/5 studies) ES. More consistent outcome reporting is required to make direct comparisons. Finally, ES appears to be a safe adjunctive treatment with no adverse events reported in the studies analyzed.