Electrical stimulation therapy increases rate of healing of pressure ulcers in community-dwelling people with spinal cord injury.

OBJECTIVE To investigate whether electric stimulation therapy (EST) administered as part of a community-based, interdisciplinary wound care program accelerates healing of pressure ulcers in people with spinal cord injury (SCI). DESIGN Single-blind, parallel-group, randomized, controlled, clinical trial. SETTING Community-based home care setting, Ontario, Canada. PARTICIPANTS Adults (N=34; mean age +/- SD, 51+/-14y) with SCI and stage II to IV pressure ulcers. INTERVENTIONS Subjects were stratified based on wound severity and duration and randomly assigned to receive either a customized, community-based standard wound care (SWC) program that included pressure management or the wound care program plus high-voltage pulsed current applied to the wound bed (EST+SWC). MAIN OUTCOME MEASURES Wound healing measured by reduction in wound size and improvement in wound appearance at 3 months of treatment with EST+SWC or SWC. RESULTS The percentage decrease in wound surface area (WSA) at the end of the intervention period was significantly greater in the EST+SWC group (mean +/- SD, 70+/-25%) than in the SWC group (36+/-61%; P=.048). The proportion of stage III, IV, or X pressure ulcers improving by at least 50% WSA was significantly greater in the EST+SWC group than in the SWC group (P=.02). Wound appearance assessed using the photographic wound assessment tool was improved in wounds treated with EST+SWC but not SWC alone. CONCLUSIONS These results demonstrate that EST can stimulate healing of pressure ulcers of people with SCI. EST can be incorporated successfully into an interdisciplinary wound care program in the community.

[1]  Andrew A. Marino,et al.  Electric Silver Antisepsis , 1985, IEEE Transactions on Biomedical Engineering.

[2]  C. Mcintosh,et al.  Lower extremity wounds : a problem-based learning approach , 2008 .

[3]  L. Vogel,et al.  Adults With Pediatric-Onset Spinal Cord Injury: Part 1: Prevalence Of Medical Complications , 2002, The journal of spinal cord medicine.

[4]  A. Taly,et al.  Efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with disorders of the spinal cord: A randomized double-blind controlled trial. , 2004, Archives of physical medicine and rehabilitation.

[5]  M. Jünger,et al.  Behandlung von venösen Ulzera mit niederfrequentem gepulstem Strom (Dermapulse): Effekte auf die kutane Mikrozirkulation , 1997, Der Hautarzt.

[6]  Andrew A. Marino,et al.  Silver-nylon: a new antimicrobial agent , 1983, Antimicrobial Agents and Chemotherapy.

[7]  L. Kloth,et al.  Electrical Stimulation for Wound Healing: A Review of Evidence From In Vitro Studies, Animal Experiments, and Clinical Trials , 2005, The international journal of lower extremity wounds.

[8]  J. Kantor,et al.  Efficacy and prognostic value of simple wound measurements. , 1998, Archives of dermatology.

[9]  Kath Bogie,et al.  Reliability of electronic versus manual wound measurement techniques. , 2006, Archives of physical medicine and rehabilitation.

[10]  B. Stromberg.  Effects of Electrical Currents on Wound Contraction , 1988, Annals of plastic surgery.

[11]  A. Adunsky,et al.  Decubitus direct current treatment (DDCT) of pressure ulcers: results of a randomized double-blinded placebo controlled study. , 2005, Archives of gerontology and geriatrics.

[12]  A. Jackson,et al.  Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects. , 2005, Archives of physical medicine and rehabilitation.

[13]  Bates-Jensen Bm,et al.  Validity and reliability of the Pressure Sore Status Tool. , 1992 .

[14]  R. Frantz,et al.  A prospective study of the pressure ulcer scale for healing (PUSH). , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[15]  W. Jy,et al.  Electric stimulation of human fibroblasts causes an increase in Ca2+ influx and the exposure of additional insulin receptors , 1989, Journal of cellular physiology.

[16]  C. Fraser,et al.  Best Practice Recommendations for the Prevention and Treatment of Pressure Ulcers: Update 2006 , 2007, Advances in skin & wound care.

[17]  R. Sufit,et al.  A multicenter study on the use of pulsed low-intensity direct current for healing chronic stage II and stage III decubitus ulcers. , 1993, Archives of dermatology.

[18]  C. Majeske,et al.  Reliability of wound surface area measurements. , 1992, Physical therapy.

[19]  C. B. Kincaid,et al.  Effect of electrical stimulation on chronic leg ulcer size and appearance. , 2003, Physical therapy.

[20]  D. Armstrong,et al.  The benefit of electrical stimulation to enhance perfusion in persons with diabetes mellitus. , 1998, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[21]  M. Jünger,et al.  [Treatment of venous ulcers with low frequency pulsed current (Dermapulse): effects on cutaneous microcirculation]. , 1997, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.

[22]  C. B. Kincaid,et al.  Photographic assessment of the appearance of chronic pressure and leg ulcers. , 2000, Ostomy/wound management.

[23]  P. New,et al.  Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact. , 2004, Archives of physical medicine and rehabilitation.

[24]  L. Baker,et al.  Effect of electrical stimulation waveform on healing of ulcers in human beings with spinal cord injury , 1996, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[25]  K. Woo,et al.  Bacteriology, Inflammation, and Healing: A Study of Nanocrystalline Silver Dressings in Chronic Venous Leg Ulcers , 2007, Advances in skin & wound care.

[26]  R. Becker,et al.  In vitro effect of weak direct current on Staphylococcus aureus. , 1974, Clinical orthopaedics and related research.

[27]  L. Bourguignon,et al.  Electric stimulation of protein and DNA synthesis in human fibroblasts , 1987, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[28]  B. Adegoke,et al.  Acceleration of pressure ulcer healing in spinal cord injured patients using interrupted direct current. , 2001, African journal of medicine and medical sciences.

[29]  F. H. Siddiqui,et al.  Effect of high voltage pulsed galvanic stimulation on sacral transcutaneous oxygen tension levels in the spinal cord injured , 1993, Paraplegia.

[30]  S. Handelman,et al.  Inhibition and Killing of Oral Bacteria by Silver Ions Generated with Low Intensity Direct Current , 1978, Journal of dental research.

[31]  R. Mendius,et al.  Efficacy of high voltage pulsed current for healing of pressure ulcers in patients with spinal cord injury. , 1991, Physical therapy.

[32]  L. Wolcott,et al.  THE INFLUENCE OF ELECTRICAL CURRENT ON AN INFECTING MICROORGANISM IN WOUNDS * , 1974, Annals of the New York Academy of Sciences.

[33]  J. D. Feldman,et al.  Directional protrusive pseudopodial activity and motility in macrophages induced by extracellular electric fields. , 1982, Cell motility.

[34]  T. Phillips,et al.  Early healing rates and wound area measurements are reliable predictors of later complete wound closure , 2008, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[35]  R. Isseroff,et al.  Imposition of a physiologic DC electric field alters the migratory response of human keratinocytes on extracellular matrix molecules. , 1996, The Journal of investigative dermatology.

[36]  B. Kaada.  Promoted healing of chronic ulceration by transcutaneous nerve stimulation (TNS). , 1983, VASA. Zeitschrift fur Gefasskrankheiten.

[37]  R. Turk,et al.  Treatment of chronic wounds by means of electric and electromagnetic fields , 1993, Medical and Biological Engineering and Computing.

[38]  L. Vodovnik,et al.  Low frequency pulsed current and pressure ulcer healing , 1994 .

[39]  Susan L Garber,et al.  Pressure ulcers in veterans with spinal cord injury: a retrospective study. , 2003, Journal of rehabilitation research and development.

[40]  F. Mendel,et al.  Effect of a single 30-minute treatment of high voltage pulsed current on edema formation in frog hind limbs. , 1992, Physical therapy.

[41]  D. Keast,et al.  Preparing the wound bed--debridement, bacterial balance, and moisture balance. , 2000, Ostomy/wound management.

[42]  H. Thawer,et al.  EFFECTS OF ELECTRICAL STIMULATION ON THE HISTOLOGICAL PROPERTIES OF WOUNDS IN DIABETIC MICE , 2001, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[43]  L. Vodovnik,et al.  DC electrical stimulation for chronic wound healing enhancement Part 1. Clinical study and determination of electrical field distribution in the numerical wound model , 1997 .

[44]  R. H. Davis,et al.  The effect of electrical stimulation on wound healing in diabetic mice. , 1984, Journal of the American Podiatry Association.

[45]  M. Hayter,et al.  The effectiveness of silver-releasing dressings in the management of non-healing chronic wounds: a meta-analysis. , 2009, Journal of clinical nursing.

[46]  Lynne Broderick,et al.  Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset. , 2004, Archives of physical medicine and rehabilitation.