Significance: Delayed healing of skin wounds is a serious problem for the patients, clinicians, and society. The application of interventions with proven effectiveness to increase wound healing is relevant. Recent Advances: This article summarizes the results of effect studies with the application of electrostimulation (ES) as additional treatment to standard wound care (SWC). Therefore, five published narrative reviews are discussed. In addition, 15 studies with a clear randomized controlled trial design are analyzed systematically and the results are presented in four forest plots. The healing rate is expressed in the outcome measure percentage area reduction in 4 weeks of treatment (PAR4). This leads to a continuous measure with mean differences between the percentage healing in the experimental group (SWC plus ES) and in the control group (SWC alone or SWC plus placebo ES). Adding ES to SWC in all wound types increases PAR4 by an extra 26.7% (95% confidence interval [CI] 15.6, 37.8); adding unidirectional ES to SWC increases PAR4 by 30.8% (95% CI 20.9, 40.6) and adding unidirectional ES to the treatment of pressure ulcers increases PAR4 by 42.7% (95% CI 32.0, 53.3). Critical Issues: There is a discrepancy between the proven effectiveness of ES as additional treatment to SWC and the application of ES in real practice. Possible drawbacks are the lack of clinical expertise concerning the proper application of ES and the extra time effort and necessary equipment that are needed. Future Directions: Clinicians concerned about the optimal treatment of patients with delayed wound healing should improve their practical competency to be able to apply ES. SCOPE AND SIGNIFICANCEChronic wounds are a serious problem for patients, clinicians, and society. This review focuses on the clinical effectiveness and practicality of the application of electrostimulation (ES) as an additional treatment in wound care.Electrotherapy (ET) is sometimes defined in a broad way gathering all modalities developed with an electrical apparatus that is applied to a patient with therapeutic objectives (like ultrasound, laser, shortwave, or shockwave therapy); however, in this review, ET is defined in a smaller way meaning those therapies that apply an electrical stimulus to the patient. ET can be classified in three categories: low frequency ( < 1,000 Hz), medium frequency (1,000-300,000 Hz), and high frequency ( > 300,000 Hz). Stimulation of neuromuscular tissues is just possible with low-and mediumfrequency ET and that is why these forms are also indicated as ES. In this review, the effectiveness of lowfrequency ES on wound healing is evaluated. In low-frequency ES, at least two electrodes are attached to the body to realize an electric circuit leading to an internal electric field

To study the effects of infrared (IR) Sauna, a form of total-body hyperthermia in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients were treated for a 4-week period with a series of eight IR treatments. Seventeen RA patients and 17 AS patients were studied. IR was well tolerated, and no adverse effects were reported, no exacerbation of disease. Pain and stiffness decreased clinically, and improvements were statistically significant (p<0.05 and p<0.001 in RA and AS patients, respectively) during an IR session. Fatigue also decreased. Both RA and AS patients felt comfortable on average during and especially after treatment. In the RA and AS patients, pain, stiffness, and fatigue also showed clinical improvements during the 4-week treatment period, but these did not reach statistical significance. No relevant changes in disease activity scores were found, indicating no exacerbation of disease activity. In conclusion, infrared treatment has statistically significant short-term beneficial effects and clinically relevant period effects during treatment in RA and AS patients without enhancing disease activity. IR has good tolerability and no adverse effects.

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al 3 concluded that adding extra strengthening exercises (even described as ''a large dose'') to a standard exercise program does not result in a better outcome: so, just sexy. However, Powell and Lewis 12 regarded the statement ''You need to strengthen your shoulder'' as not sexy at all. So, is muscle strength relevant or not relevant for patients with shoulder pain (SP)?Most patients with SP can generate less power on the SP side as compared with the healthy side. 5,8 Is that clinical symptom caused by muscular insufficiency? Maybe, but more often the reduced tendon capability is the most relevant variable. Patients with subacromial pain syndrome (SAPS) are also described as having rotator cuff-related SP, where inflammation in the rotator cuff tendon is the source of nociception and pain awareness. 6 Furthermore, patients with SAPS are confronted with rather long episodes of pain; so, sensitization plays a role and mental dysfunctions can easily develop, such as decreased self-confidence (''I'm not capable to realize that performance'') and dysfunctional cognitions (''My shoulder is damaged''). Besides local somatic tendonrelated factors, mental, cognitive, and process factors are correlated to the amount of SP. 2,6,7,9 A physical therapist using a handheld dynamometer to examine the generation of muscle strength is aware that many variables influence the outcome in Newton-meters. In fact, strength is a multimodal outcome. Is an increased amount of strength correlated with a decreased amount of SP? In my opinion, in the normal rehabilitation of patients with SAPS, that correlation is correct: if SP decreases, most patients can generate more strength attributed to better muscle-tendon performance and a decrease of mental, cognitive, and process dysfunctions (eg, sensitization). 12 Recently we researched the literature to formulate recommendations for Dutch general practitioners to treat their patients with SAPS the best way. As with most other