Electrical stimulation therapy to promote healing of chronic wounds: a review of reviews

Purpose: The overall objective of this study is to identify and appraise all of the existing clinical research literature that has evaluated the effect of electrical stimulation therapy (EST) on wound healing outcomes in adults with various types of chronic wounds. Methods: A systematic and comprehensive search of four electronic databases and gray literature was carried out, and references included in related review articles were checked. Prospective and controlled clinical trials, systematic reviews (SRs), and meta-analyses that assessed the effects of EST on wound healing outcomes were described and appraised. A total PRISMA score was assigned for each included SR based on criteria included in the assessment of multiple systematic reviews (AMSTAR) measurement tool. The percentage of available research that was identified in the SR was also calculated. Results: Sixty-two clinical research studies involving 2082 patients with pressure ulcers, venous leg ulcers, diabetic foot wounds, and arterial/ischemic wounds, and ulcers of mixed etiology were located. Thirty-three of the studies with 1370 patients compared wound size reduction after EST to a control group. Eighteen reviews that used a systematic approach to identify, select, and evaluate published studies on this topic have yielded conflicting results. Poorer quality SRs with a low total PRISMA score were more likely to yield negative or inconclusive findings. Most of these low-quality SRs had very vague research questions and included less than 50% of the available literature that was known to exist. Results from 22 well-designed randomized clinical trials and 10 high-quality SRs consistently support that EST can stimulate faster wound size reduction and/or produce a greater number of closed wounds compared to a group of similar patients receiving either standard wound care or sham EST. Conclusion: Pooled results from well-conducted SRs provide strong support for the use of EST on various types of chronic wounds and pressure ulcers in particular.