Electrical stimulation improves outcomes, reduces costs of pressure ulcers
MedWire News: Adding electrical stimulation to standard care improves the healing of wounds associated with pressure ulcers and reduces costs associated with their management, scientists say.
Pressure ulcers affect up to 33% of patients with spinal cord injuries and are typically treated with standard wound-care procedures such as debridement and physical therapy, explain Nicole Mittmann (Sunnybrook Health Sciences Center, Toronto, Canada) and fellow researchers in the Archives of Physical Medicine and Rehabilitation.
Given that pressure ulcers are associated with several serious complications and are increasing in incidence, there is much interest in novel treatments such as electrical stimulation.
Electrical stimulation involves the application of low-level electrical current via electrodes directly to the wound and is thought to alter protein synthesis, cell migration, tissue oxygenation, and angiogenesis within the wound.
Several previous studies have suggested that electrical stimulation is a beneficial adjunct to standard wound-care; however, the cost implications of adding such treatments are unclear.
Noting this, Mittmann and team constructed a model that allowed estimation of the incremental cost-effectiveness of electrical stimulation plus standard wound-care compared with standard wound-care alone. The model included data on clinical outcomes from published studies in patients with pressure ulcers, and data on costs to health systems and medical resource use from a randomized trial of electrical stimulation plus standard care versus electrical stimulation alone.
The model showed that adding electrical stimulation to standard care was associated with a 16.4% increase in the number of pressure ulcers healed and a reduction in average overall costs of approximately US$ 230 (€ 159) per year.
"Using this decision analytic framework, the addition of electrical stimulation to standard wound care for the treatment of pressure ulcers in individuals with spinal cord injuries resulted in better outcomes and lower costs translating into a dominant economic scenario," summarize the investigators.
Discussing the clinical implication of their work, the authors note that electrical stimulation is not routinely used, despite the fact that the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel recommends consideration of electrical stimulation in stage II wounds that are not responding to treatment and in all stage III/IV wounds. This is perhaps due to older electrical stimulation machines that were not portable and a lack of awareness of newer, more-portable machines. There is also a perception of increased costs, the authors write, a misconception which the current study should correct, they conclude.
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By Philip Ford