Skip to main content

Electrical Stimulation Therapy for Pressure Ulcers: Does it Work?

Mr J is a 67 year-old man with a history of multiple sclerosis complicated by paraplegia, bilateral upper and lower extremity contractures, and multiple pressure ulcers.  He had required multiple hospitalizations for his wounds, and I met him after an extended hospitalization necessitating debridement when he was transferred to a skilled nursing facility for ongoing wound care.  Given the extent of his wounds, he was started on electrical stimulation therapy.  I had never heard of this type of treatment, so I wondered, in patients with pressure ulcers, is electrical stimulation therapy more effective than standard wound care?


Electrical stimulation therapy is the application of a current across a wound.  The theoretical mechanism of this therapy is to replicate the “current of injury” that occurs normally when there is a break in the skin.  This current of injury has been shown in various models to promote angiogenesis, fibroblast migration promoting granulation, and keratinocyte migration promoting epithelialization.

I searched the terms “electrical stimulation treatment pressure ulcers” on PubMed Clinical Queries looking for a meta-analysis.  I found an article that pooled data from 15 different studies, including both randomized control trials and observational studies, for a sample of 909 electrical stimulation patients and 371 controls.  The main outcome was mean percent wound healing, which was coded or calculated independently by 2 authors. 

The results showed that patients who received electrical stimulation to their pressure ulcers had a mean percent wound healing of 13.5 more than the controls, which translates to 144% increase in wound healing.  This effect was the same when analyzing just the randomized control trials, suggesting that the effect is not driven by a placebo effect.

In summary, it seems that electrical stimulation can improve wound healing compared to standard wound care.  Although statistically significant, it is hard to know if this outcome is clinically significant, as the potentially more important outcome is complete closure of the wound.  Further, the analysis included studies that employed different electrical stimulation modalities, which raises the question about what is the best way to deliver electrical stimulation therapy.  For example, what is the optimal positioning of the electrodes relative to the wound?  What is the optimal current (direct or alternating) setting?  How long should the electrical current be applied and at what frequency?

Back to the Patient: Mr J received several treatments with electrical stimulation with some improvement in his wounds.  However, one wound did not heal and was found to be infected necessitating further surgical debridement so he was readmitted to the hospital. 

Take Home Points:
Electrical stimulation can improve wound healing for patients with pressure ulcers.
There are still more questions to be answered about the best way to deliver electrical stimulation therapy to be most effective.

 Reference: Gardner, S. E., Frantz, R. A., & Schmidt, F. L. Effect of electrical stimulation on chronic wound healing: A meta-analysis. Wound Repair Regen. 1999 Nov-Dec;7(6):495-503.
Picture Courtersy: las - initially

by: Natalie Young, MD, MS, Geriatrics and Palliative Medicine fellow at Icahn School of Medicine at Mount Sinai, New York.


This post is part of the #GeriCases series, in which we discuss a clinical case in geriatrics and palliative medicine and the attempt to provide patient-centered care with the use of best available evidence. 
Ravishankar Ramaswamy, MD
@RavRamaswamy
Section Editor, #GeriCases

Comments

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…

Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block

Nursing homes are a tough place to do palliative care.  There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice.  So what can we do to improve the palliative care outlook in nursing homes?

On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week.  Lieve led a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries.  Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes.  I struggle with just trying to improve palliative care in one site!

We discuss with Lieve the results of the study, her take on why they got…