Polak A, Kucio C, Kloth LC, Paczula M, Hordynska E, Ickowicz T, Blaszczak E, Kucio E, Oleszczyk K, Ficek K, Franek A, et al.
Ostomy/wound management. Date of publication 2018 Feb 1;volume 64(2):10-29.
1. Ostomy Wound Manage. 2018 Feb;64(2):10-29.
A Randomized, Controlled Clinical Study to Assess the Effect of Anodal and
Cathodal Electrical Stimulation on Periwound Skin Blood Flow and Pressure Ulcer
Size Reduction in Persons with Neurological Injuries.
Polak A(1), Kucio C(2), Kloth LC(3), Paczula M(4), Hordynska E(5), Ickowicz T(6),
Blaszczak E(7), Kucio E(8), Oleszczyk K(9), Ficek K(10), Franek A(7).
Author information:
(1)Department of Physical Therapy, Academy of Physical Education, Katowice,
Poland; Medical and Rehabilitation Center "Medi-Spatz," Gliwice, Poland.
(2)Department of Physical Therapy, Academy of Physical Education, Katowice;
Department of Internal Medicine, Multi-specialized Hospital, Jaworzno, Poland.
(3)Department of Physical Therapy, Marquette University, Milwaukee, WI.
(4)Department of Physical Therapy, Academy of Physical Education, Katowice; and
Rehabilitation Center "Repty," Tarnowskie Gory, Poland.
(5)Department of Neurological Rehabilitation, Rehabilitation Center "Repty,"
Tarnowskie Gory.
(6)Department of Physical Therapy, Academy of Physical Education, Katowice; and
Rehabilitation Center "Repty," Tarnowskie Gory.
(7)Department of Medical Biophysics, Medical University of Silesia, Katowice.
(8)Department of Physical Therapy, Academy of Physical Education, Katowice.
(9)Rehabilitation Center "Repty," Tarnowskie Gory.
(10)Department of Physical Therapy, Academy of Physical Education, Katowice;
Medical and Rehabilitation Center "Galen-Ortopedia," Bierun, Poland.
The use of electrical stimulation (ES) should be considered for treating
nonhealing pressure ulcers (PUs), but optimal ES wound treatment protocols have
yet to be established. A randomized, controlled, double-blind clinical study was
conducted to evaluate the effects of cathodal and anodal high-voltage monophasic
pulsed current (HVMPC) on periwound skin blood flow (PSBF) and size reduction of
Stage 2 to Stage 4 PUs of at least 4 weeks' duration. Persons >18 years of age,
hospitalized with neurological injuries, at high risk for PU development (Norton
scale <14 points; Waterlow scale >15 points), and with at least 1 Stage 2 to
Stage 4 PU were eligible to participate in the study. Persons with necrotic
wounds, osteomyelitis, electronic or metal implants in the PU area, PUs in need
of surgical intervention, acute wound inflammation, diabetes (HBA1c >7%),
diabetic neuropathy, cancer, and/or allergies to standard wound treatments were
excluded. Patients were randomly assigned to 1 of 3 groups: anodal (AG), cathodal
(CG), or placebo (PG) ES. All groups received individualized PU prevention and
standard wound care. In the PG, sham ES was applied; the AG and CG were treated
with anodal and cathodal HVMPC, respectively (154 μs 100 Hz; 360 µC/second; 1.08
C/day), 50 minutes per day, 5 days per week, for a maximum of 8 weeks. PSBF was
measured using laser Doppler flowmetry at baseline, week 2, and week 4, and wound
surface area measurements were obtained and analyzed using a digitizer connected
to a personal computer. Data analysis utilized the maximum-likelihood chi-squared
test, the analysis of variance Kruskal-Wallis test, the Kruskal-Wallis post-hoc
test, and Spearman's rank order correlation. Nonlinear approximation based on
exponential function was used to calculate treatment time needed to reduce the
wound area by 50%. In all tests, the level of significance was set at P ≤.05. Of
the 61 participating patients, 20 were in the AG (mean age 53.2 ± 13.82 years),
21 in the CG (mean age 55.67 ± 17.83 years), and 20 in the PG (mean age 52.5 ±
13.18 years). PUs (baseline size range 1.01 cm2 to 59.57 cm2; duration 4 to 48
weeks) were most frequently located in the sacral region (73.77%) and classified
as Stage 3 (62.29%). PSBF at week 2 was significantly higher in the AG and CG
than in the PG (P <.05). Week 4 differences were not statistically significant.
Wound percentage area reduction calculated at week 8 for the AG (64.10% ± 29.22%)
and CG (74.06% ± 23.23%) were significantly different from PG ulcers (41.42% ±
27.88%; P = .0391 and P = .0024, respectively). In both ES groups, PSBF at week 4
and percent wound surface area reductions between weeks 4 and 8 were positively
correlated, but only the AG correlation was statistically significant (P = .049).
In this study, both ES modalities improved blood flow and wound area reduction
rate. Studies examining optimal ES treatment times for healing to occur, the
effect of comorbidities and baseline wound variables on ES outcomes, and the
nature of the relationship between blood flow and healing are necessary.
PMID: 29481324 [Indexed for MEDLINE]
