Electrical stimulation for pressure ulcer treatment in people with spinal cord injuries: a meta analysis and systematic review

Introduction: Pressure ulcer (PU) is one of the most common secondary complications following a spinal cord injury (SCI). Electrical stimulation (ES) can confer benefit to pressure ulcer treatment in SCI1,2. However, to date, the clinical guidelines regarding the use of ES for PU healing in SCI remain limited. This systematic review was therefore conducted to identify the updated evidence, and to critically appraise and meta-analyze the research evidence on ES for PU treatment in spinal cord injuries. Methods: Review was limited to peer-reviewed studies published in English from 1970 to 2014. A free-text and keyword/MESH terms search of five databases (Medline, CINAHL, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials), in addition to manual searches of other resources and retrieved articles, was undertaken on 3rd March 2014. Studies included randomized controlled trials (RCTs), and non-randomized prospective controlled trials. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring the effectiveness of PU treatment was included. Methodological quality was evaluated using established instruments by two independent reviewers. Results: Eleven studies applied ES for PU treatment in SCI were identified, one case series and two case reports were excluded, remaining eight controlled studies were included in this review. Within the eight studies, 5/8 studies were RCTs, 2/5 had Jadad score of 3 or greater that was considered as good quality; other three studies were prospective non-RCTs. ES was delivered through surface electrodes in all studies. Pooled analysis of prospective Non-RCT showed a significant higher healing rate (% healing per day) with ES in (mean difference 0.78, 95% CI 0.32-1.25), but not in pooled analysis of RCTs (mean difference -0.07, 95% CI -0.82-0.96). Discussion: The methodological quality of studies included in this review was poor. Although a significant effect of ES on enhancement of PU healing is shown in non-RCTs. There is no significant beneficial effect of ES on PU healing in pooled analysis of RCTs. Future research is suggested to improve study design, standardize ES parameters and conduct more rigorous large sample sized randomised controlled trials.