Applying electric and electromagnetic energy as adjuvant treatment for pressure ulcers: a critical review.

Chronic pressure ulcers are a significant health problem especially in the aging population. National estimated annual treatment costs are in the billions of dollars. Only two treatment-related recommendations receive high ratings for reported experimental evidence of validity: Use of moist wound dressings and adjunctive electrotherapy for unresponsive Stage III and IV and recalcitrant Stage II ulcers. A critical literature review pertaining to electrotherapy reveals a myriad of electrical treatment modalities varying greatly in electric current type, strength, direction, frequency, waveform, and underlying voltage. However, few clinical trials pertaining to electrotherapy exist with almost all of them characterized by a small sample size leading to a biased group assignment with no possibility for stratification by ulcer stage, site, and other important factors. Power analysis shows that a sample size of at least 164 subjects is needed to permit cost-effectiveness evaluation with attention to critical variables. "Time to healing" is recommended as the treatment outcome measure to permit proper efficiency comparisons between the various treatment modalities and controls. These comparisons are crucial in a cost-conscious environment.