Electrical stimulation therapy for the treatment of pressure ulcers in individuals with spinal cord injury: a systematic review and meta-analysis

To conduct a systematic review and meta-analysis on the effects of electrical stimulation therapy (EST) on healing pressure ulcers in individuals with spinal cord injury (SCI). CINAHL, The Cochrane Library, PubMed, SCOPUS, EMBASE, Nursing & Allied Health and Dissertation & Theses databases were searched for relevant English language articles from the date of inception to 31 January 2014. Separate searches were conducted in Google Scholar and academic journals specialised in wound care. Two reviewers independently assessed study eligibility. Studies were included if EST was used to treat pressure ulcers in individuals with SCI. A total of 599 articles were screened, and 15 studies met the inclusion criteria. A meta-analysis with five studies demonstrated that EST significantly decreased the ulcer size by 132%/day [95% confidence interval (CI): 058-205, P < 0001] compared to standard wound care (SWC) or sham EST. Another meta-analysis conducted with four studies showed that EST increased the risk of wound healing by 155 times compared with standard wound care or sham EST (95% CI: 112 to 215, P < 00001). Because of the wide array of outcome measures across studies, a single meta-analysis could not be conducted. EST appears to be an effective adjunctive therapy to accelerate and increase pressure ulcer closure in individuals with SCI.