Efficacy of Bimodal High-Voltage Monopulsed Current in the Treatment of Pressure Ulcer: A Systematic Review
Background: We aimed to systematically evaluate the efficacy of high-voltage pulsed current (HVPC) in the treatment of pressure ulcer.
Methods: We searched the databases of PubMed, Cochrane Library, Elsevier and EMBASE to identify randomized controlled studies on the application of HVPC in pressure ulcer treatment, up to January 2019. Two authors independently screened the literature according to the inclusion and exclusion criteria, extracted the data and evaluated the quality. RevMan 5.3 software was used for statistical analysis. Four randomized controlled trials involving a total of 176 patients were included in the study.
Results: Meta-analysis showed that the percentage of wound area reduction in the HVPC treatment group was higher than that in the control group (95%CI 24.59, 47.76, P<0.001). Descriptive analysis showed that there was no significant difference in wound healing between the HVPC treatment group and the control group. One study reported that there was contact dermatitis, and the rest of the studies reported no adverse events.
Conclusion: Compared with the conventional therapy, the combination with HVPC therapy can reduce the area of pressure ulcers more effectively. However, due to the small number of the studies included in this evaluation, the conclusions need to be verified by more high-quality studies.
2. Lala D, Dumont FS, Leblond J, Houghton PE, Noreau L (2014). Impact of pressure ulcers on individuals living with a spinal cord injury. Arch Phys Med Rehabil, 95: 2312-2319.
3. Watson T (2000). The role of electrotherapy in contemporary physiotherapy practice. Man Ther, 5: 132-141.
4. Kloth LC (2005). Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments, and clinical trials. Int J Low Extrem Wounds, 4: 23-44.
5. Houghton PE (2014). Clinical trials involving biphasic pulsed current, microcurrent, and/or low-intensity direct current. Adv Wound Care (New Rochelle), 3: 166-183.
6. Polak A, Franek A, Taradaj J (2014). High-voltage pulsed current electrical stimula-tion in wound treatment. Adv Wound Care (New Rochelle), 3: 104-117.
7. Polak A, Kucio C, Kloth LC (2018). A Ran-domized, Controlled Clinical Study to Assess the Effect of Anodal and Ca-thodal Electrical Stimulation on Peri-wound Skin Blood Flow and Pressure Ulcer Size Reduction in Persons with Neurological Injuries. Ostomy Wound Man-age, 64: 10-29.
8. Houghton PE, Kincaid CB, Lovell M et al (2003). Effect of electrical stimulation on chronic leg ulcer size and appearance. Phys Ther, 83: 17-28.
9. Gilcreast DM, Stotts NA, Froelicher ES (1998). Effect of electrical stimulation on foot skin perfusion in persons with or at risk for diabetic foot ulcers. Wound Rep Reg, 6: 434-441.
10. Bora Karsli P, Gurcay E, Karaahmet OZ (2017). High-Voltage Electrical Stimula-tion versus Ultrasound in the Treatment of Pressure Ulcers. Adv Skin Wound Care, 30: 565-570.
11. Schmuckler J (2008). Acoustic pressure wound therapy to facilitate granulation tissue in sacral pressure ulcers in patients with compromised mobility: a case series. Ostomy Wound Manage, 54: 50-53.
12. Silva E D F H D, Martins C C, Guirro E C D O, et al (2010). High voltage electrical stimulation as an alternative treatment for chronic ulcers of the lower limbs. An Bras Dermatol, 85 (4): 567-569.
13. Kane A, Warwaruk-Rogers R, Ho C et al (2017). A Feasibility Study of Intermittent Electrical Stimulation to Prevent Deep Tissue Injury in the Intensive Care Unit.Adv Wound Care (New Rochelle), 6:115-124.
14. Lala D, Houghton PE, Kras-Dupuis A (2016). Developing a Model of Care for Healing Pressure Ulcers with Electrical Stimulation Therapy for Persons with Spinal Cord Injury. Top Spinal Cord InjRe-habil, 22:277-287.
15. Liu L, Moody J, Gall A (2016). A Quantita-tive, Pooled Analysis and Systematic Re-view of Controlled Trials on the Impact of Electrical Stimulation Settings and Placement on Pressure Ulcer Healing Rates in Persons With Spinal Cord Inju-ries. Ostomy Wound Manage, 62:16-34.
16. Smit, Christof A J, Groot D (2016). Effects of Electrical Stimulation on Risk Factors for Developing Pressure Ulcers in People with a Spinal Cord Injury: A Focused Re-view of Literature. Am J Phys Med Re-habil,95(7):535-52.
17. Yu K, Yoon Y S, Jeon J (2014). Poster 356 The Effect of Electrical Stimulation Combined with Foam Dressing on Ulcer Healing in Rats with Spinal Cord Injury. Adv Skin Wound Care, 6:S309-S310.
18. Functional Electrical Stimulation and Spinal Cord Injury. Physical Medicine and Rehabilita-tion Clinics of North America, 25:631-654.
19. Kawasaki L, Mushahwar VK, Ho C (2014). The mechanisms and evidence of efficacy of electrical stimulation for healing of pressure ulcer: A systematic review. Wound Repair Regen,22:161-173.
20. Dolbow DR, GorgeyA S, Dolbow J D (2013). Seat Pressure Changes after Eight Weeks of Functional Electrical Stimula-tion Cycling: A Pilot Study. Top Spinal Cord Inj Rehabil, 19:222-228.
21. Houghton PE, Campbell KE, Fraser CH (2010). Electrical Stimulation Therapy In-creases Rate of Healing of Pressure Ul-cers in Community-Dwelling People With Spinal Cord Injury.Arch Phys Med Re-habil,91:669-678.
22. Polak A, Kloth LC, Blaszczak E (2016). Evaluation of the Healing Progress of Pressure Ulcers Treated with Cathodal High-Voltage Monophasic Pulsed Cur-rent: Results of a Prospective, Double-blind, Randomized Clinical Trial. Adv Skin Wound Care,29:447-59.
23. PolakA, Kloth LC, Blaszczak E (2017). The Efficacy of Pressure Ulcer Treatment WithCathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Cur-rent: A Prospective, Randomized, Con-trolled Clinical Trial. PhysTher,97:777-789.
24. Franek A, Kostur R, Polak A et al (2012). Using high-voltage electrical stimulation in the treatment of recalcitrant pressure ulcers: results of a randomized, controlled clinical study. Ostomy Wound Manage, 58:30-44.
25. Recio AC, Felter CE, Schneider AC (2012). High-voltage electrical stimulation for the management of Stage III and IV pressure ulcers among adults with spinal cord inju-ry: Demonstration of its utility for recalci-trant wounds below the level of injury. J Spinal Cord Med,35:58-63.
26. Ahmad ET (2008). High-Voltage Pulsed Galvanic Stimulation: Effect of Treatment Duration on Healing of Chronic Pressure Ulcers. Ann Burns Fire Disasters, 21:124-128.
27. Polak A, Taradaj J, Nawrat-Szoltysik A (2016). Reduction of pressure ulcer size with high-voltage pulsed current and high-frequency ultrasound: a randomised trial.J Wound Care,25:742-754.
28. Griffin JW,Tooms RE, Mendius RA (1991). Efficacy of High Voltage Pulsed Current for Healing of Pressure Ulcers in Patients with Spinal Cord Injury. PhysTher,71:433-442.
29. Kloth LC, Feedar JA (1988). Acceleration of wound healing with high voltage, mo-nophasic, pulsed current. PhysTher,68:503-508.
30. Ourania C, Aekaterini D, Theodoros A, et al (2013). Wireless electrical stimulation: an innovative powerful tool for the treat-ment of a complicated chronic ulcer. Int J Low Extrem Wounds, 2013, 12 (1): 18-21.
31. Gardner SE, Frantz RA, Schmidt FL (1999). Effect of electrical stimulation on chronic wound healing: a meta-analysis. Wound Repair Regen,7:495-503.
32. Lala D, Spaulding SJ, Burke SM, Houghton PE (2016). Electrical stimulation therapy for the treatment of pressure ulcers in in-dividuals with spinal cord injury: a systemat-ic review and meta-analysis. Int Wound J,13:1214-1226.