title: A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries.
abstract: BACKGROUND
  Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited.
  
  
  OBJECTIVE
  To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI.
  
  
  METHODS
  Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments.
  
  
  RESULTS
  Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant).
  
  
  CONCLUSIONS
  The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials.
authors: Liang Qin
authors: LQ
authors: Liu
authors: Julie
authors: J
authors: Moody
authors: Michael
authors: M
authors: Traynor
authors: Sue
authors: S
authors: Dyson
authors: Angela
authors: A
authors: Gall
mesh_terms: D015331:Cohort Studies; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D003668:Pressure Ulcer / Q000209:etiology* / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy*
keywords: Electrical stimulation; Pressure ulcer; Spinal cord injury; Systematic review