Electrical Stimulation in the Treatment of Pressure Injuries: A Systematic Review of Clinical Trials

Abstract

ABSTRACT GENERAL PURPOSE To provide information on evidence-based practice regarding the use of electrical stimulation for pressure injury management. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Apply clinical practice recommendations related to the use of electrical stimulation in the treatment of pressure injuries. 2. Identify issues related to the use of electrical stimulation to treat pressure injuries. OBJECTIVE To summarize evidence regarding the use of electrical stimulation for pressure injury (PI) management with a systematic review of randomized clinical trials. DATA SOURCES The authors searched scientific databases (PubMed, EBSCO, Medline, and Elsevier) and the online resources of gray publications for studies published between January 1, 1980, and June 20, 2021, using the keywords “electrostimulation,” “electrical stimulation,” “pressure ulcer,” “pressure injury,” “bedsore,” and “decubitus ulcer.” STUDY SELECTION The search procedure generated 342 articles. Of these, 241 were disqualified after title screening, 52 after abstract screening, and 33 after full-text review; 16 articles were included in the review. Included articles were full-text reports of randomized clinical trials involving patients with PIs that had at least two patient groups, detailed how wounds healed, and were written in English. DATA EXTRACTION The authors extracted information about the purpose and design of each trial, patient inclusion and exclusion criteria, research methods, statistical analysis, findings, and conclusions. DATA SYNTHESIS Researchers applied high-voltage monophasic pulsed current (HVMPC) in 10 trials, two trials used low-voltage monophasic pulsed current, three trials tested a low-voltage biphasic pulsed current, and one trial used low-intensity direct current. CONCLUSIONS The effect of HVMPC in the treatment of PIs has been most thoroughly investigated in clinical trials. The results are consistent and indicate that HVMPC (twin-peak impulse, 50–154 μs, 100 pps, 45–60 min/d) is effective in PI treatment.