Health Quality Ontario .
Ontario health technology assessment series. Date of publication 2017 Nov 8;volume 17(14):1-106.
1. Ont Health Technol Assess Ser. 2017 Nov 8;17(14):1-106. eCollection 2017.
Electrical Stimulation for Pressure Injuries: A Health Technology Assessment.
Health Quality Ontario.
Collaborators: Lambrinos A, Falk L, Ali A, Holubowich C, Walter M.
Background: Pressure injuries (bedsores) are common and reduce quality of life.
They are also costly and difficult to treat. This health technology assessment
evaluates the effectiveness, cost-effectiveness, budget impact, and lived
experience of adding electrical stimulation to standard wound care for pressure
injuries.
Methods: We conducted a systematic search for studies published to December 7,
2016, limited to randomized and non-randomized controlled trials examining the
effectiveness of electrical stimulation plus standard wound care versus standard
wound care alone for patients with pressure injuries. We assessed the quality of
evidence through Grading of Recommendations Assessment, Development, and
Evaluation (GRADE). In addition, we conducted an economic literature review and a
budget impact analysis to assess the cost-effectiveness and affordability of
electrical stimulation for treatment of pressure ulcers in Ontario. Given
uncertainties in clinical evidence and resource use, we did not conduct a primary
economic evaluation. Finally, we conducted qualitative interviews with patients
and caregivers about their experiences with pressure injuries, currently
available treatments, and (if applicable) electrical stimulation.
Results: Nine randomized controlled trials and two non-randomized controlled
trials were found from the systematic search. There was no significant difference
in complete pressure injury healing between adjunct electrical stimulation and
standard wound care. There was a significant difference in wound surface area
reduction favouring electrical stimulation compared with standard wound care.The
only study on cost-effectiveness of electrical stimulation was partially
applicable to the patient population of interest. Therefore, the
cost-effectiveness of electrical stimulation cannot be determined. We estimate
that the cost of publicly funding electrical stimulation for pressure injuries
would be $0.77 to $3.85 million yearly for the next 5 years.Patients and
caregivers reported that pressure injuries were burdensome and reduced their
quality of life. Patients and caregivers also noted that electrical stimulation
seemed to reduce the time it took the wounds to heal.
Conclusions: While electrical stimulation is safe to use (GRADE quality of
evidence: high) there is uncertainty about whether it improves wound healing
(GRADE quality of evidence: low). In Ontario, publicly funding electrical
stimulation for pressure injuries could result in extra costs of $0.77 to $3.85
million yearly for the next 5 years.
PMCID: PMC5700239
PMID: 29201261 [Indexed for MEDLINE]
