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.

Gerard Koel, PT, MSc

Figure 1.

Forest plot with the results of all 15 studies (left column) on all wound types comparing the mean differences between the experimental group (SWC plus ES) and the control group (SWC alone or SWC plus placebo ES). ES, electrostimulation; SWC, standard wound care; CI, confidence interval.

Figure 2.

Forest plot with the results of the 11 studies (left column)^,,,, that applied unidirectional ES on all wound types comparing the mean differences between the experimental group (SWC plus ES) and the control group (SWC alone or SWC plus placebo ES).

Figure 3.

Forest plot with the results of the four studies (left column)^,,, that applied bidirectional ES on all wound types comparing the mean differences between the experimental group (SWC plus ES) and the control group (SWC alone or SWC plus placebo ES).

Figure 4.

Forest plot with the results of the five studies (left column)^,,,, that applied unidirectional ES on pressure ulcers comparing the mean differences between the experimental group (SWC plus ES) and the control group (SWC alone or SWC plus placebo ES).