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Arora M1,2, Harvey L1,2, Glinsky J1,2, Nier L3, Lavrencic L3, Kifley A1,2, Cameron I1,2
1The University of Sydney, John Walsh Centre for Rehabilitation Research, St Leonards, Australia, 2Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia, 3Royal North Shore Hospital, Spinal Unit, St Leonards, Australia
Background: Pressure ulcers (PU) are a disabling consequence of immobility. There is an initial evidence to suggest that electrical stimulation (ES) is therapeutic. This is based on a small number of non-Cochrane reviews and clinical guidelines; however, it is not clear whether these recommendations are justified because the reviews and studies that they are based upon have methodological limitations.
Purpose: We undertook this systematic review to establish whether ES is effective, whether the potential for therapeutic effect outweighs any potential for harm, and whether the associated cost, time and inconvenience of administering ES is justified. Most importantly, we undertook this systematic review to know the quality of the evidence that underpins any recommendation for ES.
Methods: Randomised controlled trials were included with no restrictions with respect to language, date of publication or study setting. In May 2017, a thorough search was conducted as per the Cochrane standards. Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias. There were 5 primary and 4 secondary outcomes of interest (e.g. proportion of PU healed, time to complete healing of PU and adverse events). Meta-analyses were conducted and the quality of the evidence for the main outcomes were assessed using GRADE.
Results: We identified 166 records from the electronic searches. Of these, 17 studies with 932 PU (772 participants) met the inclusion criteria. Half the studies were at risk of performance and detection bias, and 26% were at risk of attrition and selective reporting bias. ES may slightly increase the proportion of PU healed when compared to control (RR 1.84, 95% CI 1.26 to 2.68). The evidence was low quality. It is uncertain whether ES decreases the time to complete healing of PU when compared to control (HR 1.06, 95% CI 0.47 to 2.41). The evidence was very low quality. It is uncertain whether ES has associated adverse events when compared to control.
Conclusion(s): ES may slightly increase the proportion of PU healed but its effect on time to complete healing is uncertain, compared to no ES.
Implications: The evidence to date is insufficient to support the widespread use of ES for PU. Future research needs to be focussed on large-scale trials which included a cost-effective analysis with careful reporting of adverse events.
Keywords: Pressure injuries, electrical stimulation, systematic review
Funding acknowledgements: No funding
Purpose: We undertook this systematic review to establish whether ES is effective, whether the potential for therapeutic effect outweighs any potential for harm, and whether the associated cost, time and inconvenience of administering ES is justified. Most importantly, we undertook this systematic review to know the quality of the evidence that underpins any recommendation for ES.
Methods: Randomised controlled trials were included with no restrictions with respect to language, date of publication or study setting. In May 2017, a thorough search was conducted as per the Cochrane standards. Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias. There were 5 primary and 4 secondary outcomes of interest (e.g. proportion of PU healed, time to complete healing of PU and adverse events). Meta-analyses were conducted and the quality of the evidence for the main outcomes were assessed using GRADE.
Results: We identified 166 records from the electronic searches. Of these, 17 studies with 932 PU (772 participants) met the inclusion criteria. Half the studies were at risk of performance and detection bias, and 26% were at risk of attrition and selective reporting bias. ES may slightly increase the proportion of PU healed when compared to control (RR 1.84, 95% CI 1.26 to 2.68). The evidence was low quality. It is uncertain whether ES decreases the time to complete healing of PU when compared to control (HR 1.06, 95% CI 0.47 to 2.41). The evidence was very low quality. It is uncertain whether ES has associated adverse events when compared to control.
Conclusion(s): ES may slightly increase the proportion of PU healed but its effect on time to complete healing is uncertain, compared to no ES.
Implications: The evidence to date is insufficient to support the widespread use of ES for PU. Future research needs to be focussed on large-scale trials which included a cost-effective analysis with careful reporting of adverse events.
Keywords: Pressure injuries, electrical stimulation, systematic review
Funding acknowledgements: No funding
Topic: Neurology; Disability & rehabilitation
Ethics approval required: No
Institution: Northern Sydney Local Health District
Ethics committee: Human Research Ethics Committee
Reason not required: Systematic Review
All authors, affiliations and abstracts have been published as submitted.
