Therapeutic ultrasound for pressure ulcers.
BACKGROUND
Pressure ulcers have been recorded as occurring in 5 to 32% of patients admitted to a UK District General Hospital (the precise rate depends on case-mix) and 4 to 7% in the community. They represent a major burden of sickness and reduced quality of life for patients and their carers, and are costly to health service providers. Pressure ulcers are treated by using wound dressings, relieving pressure on the wound, by treating concurrent conditions which may delay healing, and by the use of physical therapies such as electrical stimulation, laser therapy and ultrasound.


OBJECTIVE
To assess the effect of therapeutic ultrasound on the healing of pressure ulcers.


METHODS
We searched the Cochrane Wounds Group Specialised Register and the Cochrane Central Register of Controlled Trials in May 2006. In addition we hand searched journals, conference proceedings, bibliographies and reference lists of articles.


METHODS
Randomised controlled trials (RCTs) comparing therapeutic ultrasound with sham ultrasound or standard treatment.


METHODS
Two authors independently checked the result of the search to identify relevant RCTs. Details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing information by contacting authors. Data extraction was checked by a second author. Meta-analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar.


RESULTS
Three trials involving 146 people were included. Two RCTs compared ultrasound therapy with sham ultrasound and the third compared a combination of ultrasound and ultraviolet light with laser and with standard treatment. Neither of the two RCTs comparing ultrasound with sham found a significant difference in healing rates. The trials were pooled, in the absence of significant heterogeneity. There was no evidence of benefit associated with the use of ultrasound in the treatment of pressure ulcers. In the three-arm comparison there was no statistically significant difference in ulcers healed.


CONCLUSIONS
There is no evidence of benefit of ultrasound therapy in the treatment of pressure ulcers. However, the possibility of beneficial or harmful effect cannot be ruled out due to the small number of trials, some with methodological limitations and small numbers of participants. Further research is needed.
Baba-Akbari Sari
A
A
University of York, Department of Health Sciences, Area 2, Seebohm Rowntree Building, Heslington, York, UK YO10 5DD. aba102@york.ac.uk
Flemming
K
K
Cullum
N A
NA
Wollina
U
U
D006801:Humans; D003668:Pressure Ulcer / Q000532:radiotherapy / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D014464:Ultrasonic Therapy; D014467:Ultraviolet Therapy