Electrical stimulation vs. standard care for chronic ulcer healing: a systematic review and meta- analysis of randomised controlled trials

BackgroundWe conducted a systematic review to investigate the effect of electrical stimulation on ulcer healing compared to usual treatment and/or sham stimulation. This systematic review also aimed to investigate the effect of different types of electrical stimulation on ulcer size reduction. Materials and MethodsMEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to October 2013 on randomised controlled trials (RCTs), in English and on human subjects, which assessed the effect of electrical stimulation on ulcer size as compared to standard care and/or sham stimulation. Data from included RCTs were pooled with use of fixed and random effects meta-analysis of the weighted mean change differences between the comparator groups. Heterogeneity across studies was assessed with the I-2 statistic. ResultsTwenty-one studies were eligible for inclusion in the meta-analysis. In six trials (n=210), electrical stimulation improved mean percentage change in ulcer size over total studies periods by 2462%, 95% confidence interval (CI) 1998-2927, P<000001 with no heterogeneity. In three trials (n=176), electrical stimulation insignificantly improved mean weekly change in ulcer size by 164%, 95% (CI) -381 to 709, P=056 with significant heterogeneity (I-2=96%, P<000001). In six trials (n=266), electrical stimulation decreased ulcer size by 242cm(2), 95% (CI) 166-317, P<000001, with significant heterogeneity. In one trial (n=16), electrical stimulation also insignificantly improved the mean daily percentage change in ulcer size by 063%, 95% (CI) -012 to 137, P=010, with significant heterogeneity. ConclusionsElectrical stimulation appears to increase the rate of ulcer healing and may be superior to standard care for ulcer treatment.