Skip to main content
SpringerLink
Log in

Effectiveness of electrophysical agents for treating pressure injuries: a systematic review

  • Review Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

Tissue injuries that affect the skin and/or adjacent tissues and are usually over a bony prominence are called pressure injuries. The prevalence of these dysfunctions remains high, and despite technological advances, there is no consensus on the most appropriate treatment. The objective of this review was to evaluate the efficacy of photobiomodulation (PBM), ultrasound, and high-frequency electrophysical agents in the healing of pressure injuries in adults and the elderly. The search was conducted in the PubMed, Embase, Cochrane Library, Web of Science, and PEDro databases; in clinical trial records, a list of references of the selected articles, as well as through manual search (Google), of the last 5 years in humans in English and Portuguese. Nine thousand and sixty-seven studies were identified, 13 pre-selected, and 6 were included in this systematic review. PBM showed similar efficacy to other technologies indicated in other studies in healing pressure injuries. PBM with red wavelength (660 nm) in stages 2 and 3 pressure injuries effectively promoted healing compared to standard care. It was observed that the use of PBM accelerates tissue repair in pressure injuries; therapeutic ultrasound showed similar efficacy to other electrophysical agents but was effective in reducing the area of pressure injuries when comparing pre- and post-intervention. No clinical studies using the high-frequency electrophysical agent have been described in the last 5 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M (2016) Revised National Pressure Ulcer Advisory Panel pressure injury staging system. J Wound Ostomy Continence Nurs 43(6):585–597. https://doi.org/10.1097/WON.0000000000000281

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kayser SA, Vangilder CA, Ayello EA, Lachenbruch C (2018) Prevalence and analysis of medical device-related pressure injuries: results from the International Pressure Ulcer Prevalence Survey. Adv Skin Wound Care 31(6):276–285. https://doi.org/10.1097/01.ASW.0000532475.11971.aa

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brito PA, Generoso SV, Correia MITD (2013) Prevalence of pressure ulcers in hospitals in Brazil and association with nutritional status-a multicenter, cross-sectional study. Nutrition 29(4):646–649. https://doi.org/10.1016/j.nut.2012.11.008

    Article  PubMed  Google Scholar 

  4. Pereira ÂL, Bachion MM (2005) Tratamento de feridas: análise da produção científica publicada na Revista Brasileira de Enfermagem de 1970–2003. Rev Bras Enferm 58(2):208–213. https://doi.org/10.1590/s0034-71672005000200016

    Article  PubMed  Google Scholar 

  5. Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD (2015) Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med 162(5):370–379. https://doi.org/10.7326/M14-1568

    Article  PubMed  Google Scholar 

  6. Oliveira A, Simões S, Ascenso A, Reis CP (2022) Therapeutic advances in wound healing. J Dermatol Treat 33(1):2–22. https://doi.org/10.1080/09546634.2020.1730296

    Article  CAS  Google Scholar 

  7. Ennis WJ, Lee C, Plummer M, Meneses P (2011) Current status of the use of modalities in wound care: electrical stimulation and ultrasound therapy. Plastic Reconstr Surg 127(SUPPL. 1 S):93–102. https://doi.org/10.1097/PRS.0b013e3181fbe2fd

    Article  CAS  Google Scholar 

  8. Machado RS, Viana S, Sbruzzi G (2017) Low-level laser therapy in the treatment of pressure ulcers: systematic review. Lasers Med Sci 32(4):937–944. https://doi.org/10.1007/s10103-017-2150-9

    Article  PubMed  Google Scholar 

  9. Petz FFC, Félix JVC, Roehrs H, Pott FS, Stocco JGD, Marcos RL, Meier MJ (2020) Effect of photobiomodulation on repairing pressure ulcers in adult and elderly patients: a systematic review. Photochem Photobiol 96(1):191–199. https://doi.org/10.1111/php.13162

    Article  CAS  PubMed  Google Scholar 

  10. Karsli PB, Gurcay E, Karaahmet OZ, Cakci A (2017) High-voltage electrical stimulation versus ultrasound in the treatment of pressure ulcers. Adv Skin Wound Care 30(12):565–570. https://doi.org/10.1097/01.ASW.0000526606.72489.99

    Article  Google Scholar 

  11. Fyfe MC, Bullock MI (1985) Therapeutic ultrasound: some historical background and development in knowledge of its effect on healing. Aust J Physiother 31(6):220–224

    Article  CAS  PubMed  Google Scholar 

  12. de Oliveira PD, Oliveira DAAP, Martinago CC, Frederico RCP, Soares CP, de Oliveira RF (2015) Effect of low-intensity pulsed ultrasound therapy on a fibroblasts cell culture. Fisioter Pesq 22(2):112–118. https://doi.org/10.0590/1809-2950/12860222022015

    Article  Google Scholar 

  13. Cullum N, Liu Z (2017) Therapeutic ultrasound for venous leg ulcers. Cochrane Database Syst Rev 5:CD001180. https://doi.org/10.1002/14651858.CD001180.pub4

    Article  PubMed  Google Scholar 

  14. Korelo RIG, Fernandes LC (2017) Ultrassom terapêutico para cicatrização de feridas: revisão sistemática. ConScientiae Saúde 15(3):518–529. https://doi.org/10.5585/conssaude.v15n3.6421

    Article  Google Scholar 

  15. Gupta A (2018) Augmenting wound healing with photobiomodulation therapy, Chap 10; 135–146. In Hamblin MR, Ferraresi C, Huang Y, de Freitas LF, Carroll JD. Low-Level Light Therapy: Photobiomodulation. Tutorial Texts in Optical Engineering Volume TT115; Ed. Spie Press, Bellingham, Washington USA,p. 390.

  16. Mosca RC, Ong AA, Albasha O, Bass K, Arany P (2019) Photobiomodulation therapy for wound care: a potent, noninvasive, photoceutical approach. Adv Skin Wound Care 32(4):157–167. https://doi.org/10.1097/01.ASW.0000553600.97572.d2

    Article  PubMed  Google Scholar 

  17. de Lucas B, Pérez LM, Bernal A, Gálvez BG (2020) Ultrasound therapy: experiences and perspectives for regenerative medicine. Genes 11(1086):2–20. https://doi.org/10.3390/genes11091086

    Article  CAS  Google Scholar 

  18. Yadollahpour A, Mostafa J, Samaneh R, Zohreh R (2014) Ultrasound therapy for wound healing: a review of current techniques and mechanisms of action. J Pure Appl Microbiol 8(5):4071–4085

    Google Scholar 

  19. Leng X, Shang J, Gao D, Wu J (2018) Low-intensity pulsed ultrasound promotes proliferation and migration of HaCaT keratinocytes through the PI3K/AKT and JNK pathways. Braz J Med Biol Res 51(12):e7862. https://doi.org/10.1590/1414-431X20187862

    Article  PubMed  PubMed Central  Google Scholar 

  20. Goyal M, Kothiyal S (2021) Efficacy of deep tissue laser therapy in pressure ulcer healing in patient with quadriplegia: case report. J Physiother Res 11(3):593–598. https://doi.org/10.17267/2238-2704rpf.v11i3.3784

    Article  Google Scholar 

  21. Macedo SPR, Mota MSA, Fagundes CF, de Souza MR, Navarro RS (2021) Effects of photobiomodulation in the treatment of pressure ulcers: integrative review. Res Soc Dev 10(2):e32810212597. https://doi.org/10.33448/rsd-v10i2.12597

    Article  Google Scholar 

  22. Silva JRM, Fernandes MAL, Neiva LM (2021) Comparative analysis of the effects of low power laser on the healing of skin lesions: a systematic review. Braz J Health Rev 4(3):13949–13960. https://doi.org/10.34119/bjhrv4n3-330

    Article  Google Scholar 

  23. Lu Q, Yin Z, Shen X, Li J, Su P, Feng M, Xu X, Li W, He C, Shen Y (2021) Clinical effects of high-intensity laser therapy on patients with chronic refractory wounds: a randomized controlled trial. BMJ Open 11:e045866. https://doi.org/10.1136/bmjopen-2020-045866

    Article  PubMed  PubMed Central  Google Scholar 

  24. Romanelli M, Piaggesi A, Scapagnini G, Dini V, Janowska A, Iacopi E, Scarpa C, Fauverghe S, Bassetto F (2017) EUREKA study - The evaluation of real-life use of a biophotonic system in chronic wound management: an interim analysis. Drug Des Dev Ther 11:3551–3558. https://doi.org/10.2147/DDDT.S142580

    Article  CAS  Google Scholar 

  25. Polak A, Taradaj J, Nawrat-Szoltysik A, Stania M, Dolibog P, Blaszczak E, Zarzeczny R, Juras G, Franek A, Kucio C (2016) Reduction of pressure ulcer size with high-voltage pulsed current and high-frequency ultrasound: a randomized trial. J Wound Care 25(12):742–754. https://doi.org/10.12968/jowc.2016.25.12.742

    Article  CAS  PubMed  Google Scholar 

  26. Ruh AC, Frigo L, Cavalcanti MFXB, Svidnicki P, Vicari VN, Lopes-Martins RAB, Leal ECP, De Isla N, Diomede F, Trubiani O, Favero GM (2018) Laser photobiomodulation in pressure ulcer healing of human diabetic patients: gene expression analysis of inflammatory biochemical markers. Lasers Med Sci 33(1):165–171. https://doi.org/10.1007/s10103-017-2384-6

    Article  PubMed  Google Scholar 

  27. Bortoli I, Prado AL, Kroth A (2016) A efetividade do laser associado a diferentes tipos de curativos na cicatrização de úlceras de pressão. 16 (1), Evidência, Ciência e Biotecnologia 45–58. https://doi.org/10.18593/eba.v16i1.9774

  28. Chaves MEA, Silva FS, Soares VPC, Ferreira RAM, Gomes FSL, Andrade RM, Pinotti M (2015) Evaluation of healing of pressure ulcers through thermography: a preliminary study. Res Biomed Eng 31(1):3–9. https://doi.org/10.1590/2446-4740.0571

    Article  Google Scholar 

  29. Chaves MEA, Piancastelli ACC, Araujo AR, Pinotti M (2014) Effects of low-power light therapy on wound healing. An Bras Dermatol 89(4):616–623

    Article  PubMed  PubMed Central  Google Scholar 

  30. Fitzpatrick RB (2008) PEDro: A physiotherapy evidence database. Med Ref Serv Q 27(2):188–197. https://doi.org/10.1080/02763860802114397

    Article  Google Scholar 

  31. Delavary BM, Van Der Veer WM, Van Egmond M, Niessen FB, Beelen RHJ (2011) Macrophages in skin injury and repair. Immunobiology 216(7):753–762. https://doi.org/10.1016/j.imbio.2011.01.001

    Article  CAS  Google Scholar 

  32. Arora M, Harvey LA, Glinsky JV, Nier L, Lavrencic L, Kifley A, Cameron ID (2020) Electrical stimulation for treating pressure ulcers. Cochrane Database Syst Rev 2020(1). https://doi.org/10.1002/14651858.CD012196.pub2

  33. Coltro PS, Ferreira MC, Batista BPSN, Nakamoto HA, Milcheski DA, Tuma Júnior P (2010) Tratamento cirúrgico das feridas complexas: experiência da cirurgia plástica no Hospital das Clínicas da FMUSP TT - Surgical treatment of complex wounds: experience of plastic surgery in the “Hospital das Clínicas – FMUSP”. Rev. Med. (Säo Paulo), 89(3/4), 153–157. http://www.revistas.usp.br/revistadc/article/view/46290/49946

  34. Das Neves LMS, Guirro ECO, Albuquerque FLA, Marcolino AM (2016) Effects of high-voltage electrical stimulation in improving the viability of musculocutaneous flaps in rats. Ann Plast Surg 77(4):e50–e54. https://doi.org/10.1097/SAP.0000000000000621

    Article  CAS  Google Scholar 

  35. Korelo RIG, Oliveira JJJ, Souza RSA, Hullek RF, Fernandes LC (2013) Gerador de alta frequência como recurso para tratamento de úlceras por pressão: estudo piloto. Fisioterapia Em Movimento 26(4):715–724. https://doi.org/10.1590/s0103-51502013000400002

    Article  Google Scholar 

  36. Chen C, Hou WH, Chan ES, Yeh ML, Lo HL (2014) Phototherapy for treating pressure ulcers. Cochrane Database Syst Rev 11(7):CD009224. https://doi.org/10.1002/14651858.CD009224.pub2

    Article  Google Scholar 

  37. Al-Wattar WM, Abdulluh BH, Mahmmod AS (2013) Irradiation effect of 780–805nm diode laser on wound healing in mice. J Bagh College Dentistry 25(1):48–52

    Article  Google Scholar 

  38. Hendler KG, Canever JB, de Souza LG, das Neves LMS, Fonseca MCR, Kuriki HU, Aguiar Junior AS, Barbosa RI, Marcolino AM (2021) Comparison of photobiomodulation in the treatment of skin injury with an open wound in mice. Lasers Med Sci 36:1845–1854. https://doi.org/10.1007/s10103-020-03216-7

    Article  PubMed  Google Scholar 

  39. Silveira PCL, Ferreira KB, Rocha FR, Pieri BLS, Pedroso GS, De Souza CT, Nesi RT, Pinho RA (2016) Effect of low-power laser (LPL) and light-emitting diode (LED) on inflammatory response in burn wound healing. Inflammation 39(4):1395–1404. https://doi.org/10.1007/s10753-016-0371-x

    Article  CAS  PubMed  Google Scholar 

  40. Brauncajs M, Ksiąszczyk K, Lewandowska-Polak A, Gorzela K, Grzegorczyk J (2018) Impact of low-level laser therapy on the dynamics of pressure ulcer-induced changes considering an infectious agent and cathelicidin LL-37 concentration: a preliminary study. Adv Dermatol Allergol 35(6):582–586. https://doi.org/10.5114/ada.2018.77609

    Article  Google Scholar 

  41. Andrade FSSD, Clark RMO, Ferreira ML (2014) Efeitos da laserterapia de baixa potência na cicatrização de feridas cutâneas. Revista Do Colegio Brasileiro de Cirurgioes 41(2):129–133. https://doi.org/10.1590/s0100-69912014000200010

    Article  PubMed  Google Scholar 

  42. Greatrex-White S, Moxey H (2015) Wound assessment tools and nurses’ needs: an evaluation study. Int Wound J 12(3):293–301. https://doi.org/10.1111/iwj.12100

    Article  PubMed  Google Scholar 

  43. Santo PFE, de Almeida SA, Silveira MM, Salomé GM, Ferreira LM (2013) Use of the Pressure Ulcer Scale for Healing tool to evaluate the healing of chronic leg ulcers. Rev Bras Cir Plásti 28(1):133–141

    Google Scholar 

  44. Iizaka S, Kaitani T, Sugama J, Nakagami G, Naito A, Koyanagi H, Konya C, Sanada H (2013) Predictive validity of granulation tissue color measured by digital image analysis for deep pressure ulcer healing: a multicenter prospective cohort study. Wound Repair Regen 21(1):25–34. https://doi.org/10.1111/j.1524-475X.2012.00841.x

    Article  PubMed  Google Scholar 

  45. Bates-Jensen BM, McCreath HE, Harputlu D, Patlan A (2020) Reliability of the Bates-Jensen wound assessment tool for pressure injury assessment: the pressure ulcer detection study. HHS Public Access 27(4):386–395. https://doi.org/10.1111/wrr.12714

    Article  Google Scholar 

  46. Kavros SJ, Liedl DA, Boon AJ, Miller JL, Hobbs JA, Andrews KL (2008) Expedited wound healing with noncontact, low-frequency ultrasound therapy in chronic wounds: a retrospective analysis. Adv Skin Wound Care 21(9):416–423. https://doi.org/10.1097/01.ASW.0000323546.04734.31

    Article  PubMed  Google Scholar 

  47. Beheshti A, Shafigh Y, Parsa H, Zangivand AA (2014) Comparison of high-frequency and MIST ultrasound therapy for the healing of venous leg ulcers. Adv Clin Exp Med 23(6):969–975. https://doi.org/10.17219/acem/37353

    Article  PubMed  Google Scholar 

  48. Cullum N, Nelson EA, Flemming K, Sheldon T (2001) Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess 5(9). https://doi.org/10.3310/hta5090

Download references

Author information

Authors and Affiliations

  1. Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil

    Aline Santos Vieceli, Juruciara Cristiano Martins, Ketlyn Germann Hendler, Rafael Inacio Barbosa, Heloyse Uliam Kuriki & Alexandre Marcio Marcolino

  2. Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil

    Aline Santos Vieceli, Juruciara Cristiano Martins, Ketlyn Germann Hendler, Ana Paula Tavares Santos, Lais Mara Siqueira das Neves, Rafael Inacio Barbosa, Heloyse Uliam Kuriki & Alexandre Marcio Marcolino

Authors
  1. Aline Santos Vieceli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juruciara Cristiano Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ketlyn Germann Hendler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Paula Tavares Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lais Mara Siqueira das Neves
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rafael Inacio Barbosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Heloyse Uliam Kuriki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alexandre Marcio Marcolino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexandre Marcio Marcolino.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Registration number

The present study was approved by the PROSPERO and is registered under CRD42020178792 and can be accessed at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=178792.

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vieceli, A.S., Martins, J.C., Hendler, K.G. et al. Effectiveness of electrophysical agents for treating pressure injuries: a systematic review. Lasers Med Sci 37, 3363–3377 (2022). https://doi.org/10.1007/s10103-022-03648-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-022-03648-3

Keywords

Search

Navigation