Biophysical Agents in the Treatment of Chronic Wounds

According to the National Institute of Nursing Research (NINR), five million Americans are affected by chronic wounds each year. Chronic wounds are those that do not show measurable progress in wound healing with standard nursing care in 30 days. Individuals with diabetes, disability, and the elderly are among those at highest risk.

Wounds may occur due to excessive pressure [pressure injury (PI)/pressure ulcer (PU)], vascular compromise, venous or arterial insufficiency, or as a result of chronic diseases, such as diabetic/neuropathic wounds. Wound manifestations may also be expressed in individuals with and recovering from COVID-19 due to vascular and ischemic involvement and PI/PU related to limited mobility. Chronic wounds may cause pain and may negatively impact an individual’s mobility, function, and independence. Biophysical agents including electrical stimulation, electromagnetic energy (diathermy), and ultrasound may be a beneficial treatment approach to accelerate healing of
chronic wounds.

Research supports the use of biophysical agents in the treatment of chronic wounds.

• The European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance’s Prevention and Treatment of Pressure Ulcers/Injuries: International Guideline Third Edition, recommends electrical stimulation in the treatment of pressure injuries/ulcers and awards an “A” for strength of supporting evidence. (Kottner et al., 2019)
• CMS has a National Coverage Determination (NCD) for the use of electrical stimulation and electromagnetic therapy (shortwave diathermy) for the treatment of chronic wounds. (CMS, 2020)
• 22 well-designed randomized clinical trials and 10 high-quality systematic reviews support that electrical stimulation therapy can stimulate faster wound size reduction and/or produce a greater number of closed wounds compared to similar patients receiving standard wound care or sham e-stim. (Houghton, 2017)
• In four trials, Pulsed electromagnetic field (PEMF) groups demonstrated improved wound healing compared to the control groups. (Kwan et al., 2019)
• Both high-volt electrical stimulation and ultrasound are promising methods for wound healing, and both electrotherapy modalities have been demonstrated to support the healing of pressure ulcers. (Bora et al., 2017)

Several biophysical agent treatment protocols may be used to accelerate healing in chronic wounds.

References:
Bora, K.P., Gurcay, E., Karaahmet, O.Z., & Cakci, A. (2017). High-voltage Electrical Stimulation Versus Ultrasound in the Treatment of Pressure Ulcers. Advanced Skin Wound Care. 30(12), 565-570.
https://doi.org/10.1097/01.ASW.0000526606.72489.999
Centers for Medicare & Medicaid Services (CMS). (2003) Coverage Determination Electrical Stimulation & (2004) Coverage Determination Electromagnetic Therapy. Retrieved November 2, 2020,
https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=131&ncdver=3&bc=BAABAAAAAAAA&
Houghton, P. (2017). Electrical stimulation therapy to promote healing of chronic wounds: a review of reviews. Chronic Wound Care Management and Research. 4, 25-44. https://doi.org/10.2147/CWCMR.S1013233
Kottner, J., Cuddigan, J., Carville, K., Balzer, K., Berlowitz, D., Law, S., Litchford, M., Mitchell,P., Moore, Z., Pittman, J., Sigaudo-Roussel, D., Chang, Y.Y., & Haesler, E. (2019). Prevention and Treatment of Pressure
Ulcers/Injuries: Quick Reference Guide 2019. http://www.internationalguideline.com/guideline
Kwan, R.L., Lu, S., Choi, H.M., Kloth, L.C., & Cheing, G.L. (2019). Efficacy of Biophysical Energies on Healing of Diabetic Skin Wounds in Cell Studies and Animal Experimental Models: A Systematic Review.
International Journal of Molecular Sciences. 20(2), 368, https://doi.org/10.3390/ijms20020368