Electrostimulation: Current Status, Strength of Evidence Guidelines, and Meta-Analysis

Abstract

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

A Comparative Study of the Effects of Vibration and Electrical Stimulation Therapies on the Acceleration of Wound Healing in Diabetic Ulcers

“…A previous in vitro study revealed that ES could also reduce inflammation (Cho et al, 2000). In results similar to the effect of vibration, previous studies have also shown that ES accelerates wound healing in pressure, ischemic and diabetic ulcers (Eriksson et al, 1981;Goldman et al, 2003;Koel and Houghton, 2014).…”

Electrical stimulation therapy to promote healing of chronic wounds: a review of reviews

“…115 SRs that evaluated the effect of EST on all types of chronic wounds were generally well done and included the majority of available research that had been published at the time of the review. 102,[104][105][106]109 Only one of the eight SRs that focused specifically on the effects of EST or other physical modalities, did not support the use of EST for wound healing. 114 In the Cochrane review published in 2001, because of different outcomes measured at several time points, the meta-analysis evaluating the pooled effect of EST included only one RCT.…”

“…94,[97][98][99][101][102][103] Critical appraisal of SRs and meta-analyses Table 4 outlines the details of 18 reviews that have been published in the literature on the effect of EST on wound healing. 5,10,14,15,[104][105][106][107][108][109][110][111][112][113][114][115][116] Eight of the reviews completed at least some form of meta-analysis. 10,15,[104][105][106][107][108][109] Three other reports stated that although a meta-analysis was planned, none was done because of heterogeneity of included studies.…”

“…5,10,14,15,[104][105][106][107][108][109][110][111][112][113][114][115][116] Eight of the reviews completed at least some form of meta-analysis. 10,15,[104][105][106][107][108][109] Three other reports stated that although a meta-analysis was planned, none was done because of heterogeneity of included studies. 14,112,113 The first SR published on this topic was produced by Gardner et al in 1999, and impressively, it also included a meta-analysis.…”

“…109 The results of eleven of the 18 included SRs favored the use of EST in the treatment of various types of chronic wou nds. 5,10,102,104,105,[107][108][109][110][111]116 The authors' concluding statements regarding EST use in wound treatments obtained from each review are presented in Table 4. In four reviews, the authors' recommendations suggested that there was no evidence to support routine clinical use of EST for wound therapy.…”