Ont Health Technol Assess Ser. 2017 Nov 8;17(14):1-106. eCollection 2017.
Pressure injuries (bedsores) are common and reduce quality of life. They are also costly and difficult to treat. This health technology assessment evaluates the effectiveness, cost-effectiveness, budget impact, and lived experience of adding electrical stimulation to standard wound care for pressure injuries.
We conducted a systematic search for studies published to December 7, 2016, limited to randomized and non-randomized controlled trials examining the effectiveness of electrical stimulation plus standard wound care versus standard wound care alone for patients with pressure injuries. We assessed the quality of evidence through Grading of Recommendations Assessment, Development, and Evaluation (GRADE). In addition, we conducted an economic literature review and a budget impact analysis to assess the cost-effectiveness and affordability of electrical stimulation for treatment of pressure ulcers in Ontario. Given uncertainties in clinical evidence and resource use, we did not conduct a primary economic evaluation. Finally, we conducted qualitative interviews with patients and caregivers about their experiences with pressure injuries, currently available treatments, and (if applicable) electrical stimulation.
Nine randomized controlled trials and two non-randomized controlled trials were found from the systematic search. There was no significant difference in complete pressure injury healing between adjunct electrical stimulation and standard wound care. There was a significant difference in wound surface area reduction favouring electrical stimulation compared with standard wound care.The only study on cost-effectiveness of electrical stimulation was partially applicable to the patient population of interest. Therefore, the cost-effectiveness of electrical stimulation cannot be determined. We estimate that the cost of publicly funding electrical stimulation for pressure injuries would be $0.77 to $3.85 million yearly for the next 5 years.Patients and caregivers reported that pressure injuries were burdensome and reduced their quality of life. Patients and caregivers also noted that electrical stimulation seemed to reduce the time it took the wounds to heal.
While electrical stimulation is safe to use (GRADE quality of evidence: high) there is uncertainty about whether it improves wound healing (GRADE quality of evidence: low). In Ontario, publicly funding electrical stimulation for pressure injuries could result in extra costs of $0.77 to $3.85 million yearly for the next 5 years.
压疮（褥疮）很常见，会降低生活质量。其治疗成本高昂且难度较大。本卫生技术评估旨在评估在压力性损伤的标准伤口护理中添加电刺激的有效性、成本效益、预算影响及实际体验。
我们系统检索了截至2016年12月7日发表的研究，限于随机和非随机对照试验，这些试验考察了电刺激加标准伤口护理与单纯标准伤口护理对压力性损伤患者的有效性。我们通过推荐分级评估、制定和评价（GRADE）来评估证据质量。此外，我们进行了经济文献综述和预算影响分析，以评估安大略省电刺激治疗压疮的成本效益和可负担性。鉴于临床证据和资源使用存在不确定性，我们未进行初步经济评估。最后，我们对患者和护理人员进行了定性访谈，了解他们在压力性损伤、现有治疗方法（如适用，还有电刺激）方面的经历。
通过系统检索发现了9项随机对照试验和2项非随机对照试验。辅助电刺激与标准伤口护理在压疮完全愈合方面无显著差异。与标准伤口护理相比，电刺激在减少伤口表面积方面有显著差异。唯一一项关于电刺激成本效益的研究部分适用于感兴趣的患者群体。因此，无法确定电刺激的成本效益。我们估计，未来5年为压力性损伤的电刺激提供公共资金的成本每年将为77万至385万美元。患者和护理人员报告称，压力性损伤很麻烦，降低了他们的生活质量。患者和护理人员还指出，电刺激似乎缩短了伤口愈合时间。
虽然电刺激使用安全（GRADE证据质量：高），但对于其是否能改善伤口愈合存在不确定性（GRADE证据质量：低）。在安大略省，未来5年为压力性损伤的电刺激提供公共资金每年可能会导致额外成本77万至385万美元。
