The effects of electrical stimulation on diabetic ulcers of foot and lower limb: A systematic review

Abstract

Diabetic foot ulcer (DFU) is a life‐threatening condition affecting a third of diabetic patients. Many adjuvant therapies aimed at improving the healing rate (HR) and accelerating healing time are currently under investigation. Electrical stimulation (ES) is a physical‐based therapy able to increase cells activity and migration into wound bed as well as inhibiting bacterial activity. The aim of this paper was to collect and analyse findings on the effects of ES used in combination with standard wound care (SWC) in the treatment of diabetic foot ulceration compared with SWC alone. A systematic review was performed to synthesise data from quantitative studies from eight databases. Article quality was assessed using the Crowe critical appraisal tool. Seven articles out of 560 publications met the inclusion criteria. A meta‐analysis was not performed due to the heterogeneity of the studies and the results were narratively synthetised. Findings showed that HR appears to be higher among diabetic ulcers treated with ES; however, the reliability of these findings is affected by the small sample sizes of the studies. Furthermore, four studies are considered as moderate or high risk of bias. The evidence to suggest the systematic usage of ES in the treatment of DFUs is still insufficient.

Physical therapy in diabetic foot ulcer: Research progress and clinical application

“…The theory suggests that continuous COI is a prerequisite for cell migration and wound healing. 99 In contrast, hyperglycemia in DFU patients retards wound healing by inhibiting COI and decreasing the activity of cells involved in the healing cascade. ES is a non-invasive, inexpensive, and easy-to-use physical therapy that mimics and enhances the COI to re-establish skin cell migration.…”

“…ES is a non-invasive, inexpensive, and easy-to-use physical therapy that mimics and enhances the COI to re-establish skin cell migration. 99 ES also increases local blood flow to the skin, which aids in the exchange of substances between the wound and the blood, thereby speeding up wound healing. 100,101 ES is superior to traditional antibacterial medications that promote wound healing because they do not cause bacterial resistance.…”

“…COI is an endogenous electric field, and electrotaxis will cause skin cells to move to the center of the electric field (Figure 3). The theory suggests that continuous COI is a prerequisite for cell migration and wound healing 99 . In contrast, hyperglycemia in DFU patients retards wound healing by inhibiting COI and decreasing the activity of cells involved in the healing cascade.…”

The Potential of Electrical Stimulation and Smart Textiles for Patients with Diabetes Mellitus

“…For example, many patients with diabetes suffer from neuropathy or angiopathy in particular of the lower limbs or the diabetic foot syndrome. These conditions may potentially benefit from transcutaneous electrical nerve stimulation 7 8 9 10 11 12 . In addition, many patients exhibit sensory impairments that promote the development of foot ulceration and negatively affect balance control and gait (Peters, 2016; Ziegler, 2022).…”

“…First, it may improve wound healing by increasing blood flow through enhancement of capillary density by increased angiogenesis 45 46 . Second, it may improve the migration of macrophages, fibroblasts and endothelial cells in the wound, thus facilitating the healing process of the wound, which is often impaired in patients with diabetes 9 . Third, although still debated, it may attenuate bacterial proliferation and disrupt bacterial membrane, thus reducing infection 9 .…”