The effect of therapeutic ultrasound on pressure ulcers.

Pressure ulcers (also called pressure sores, bed sores or decubitus ulcers) are sores on the body caused by pressure or rubbing. They usually happen to immobile people, on bony parts of their bodies, such as hips, heels and elbows.

Low levels of ultrasound (not enough to generate heat) are sometimes used to treat pressure ulcers. It is not clear how ultrasound might affect healing, and ultrasound waves may have a positive or negative impact on the blood flow around the sore. The review with three trials involving 146 people found that there is very little evidence from trials on the effects of ultrasound on pressure ulcers.

Authors' conclusions: 

There is no evidence of benefit of ultrasound therapy in the treatment of pressure ulcers. However, the possibility of beneficial or harmful effect cannot be ruled out due to the small number of trials, some with methodological limitations and small numbers of participants. Further research is needed.

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Background: 

Pressure ulcers have been recorded as occurring in 5 to 32% of patients admitted to a UK District General Hospital (the precise rate depends on case-mix) and 4 to 7% in the community. They represent a major burden of sickness and reduced quality of life for patients and their carers, and are costly to health service providers.

Pressure ulcers are treated by using wound dressings, relieving pressure on the wound, by treating concurrent conditions which may delay healing, and by the use of physical therapies such as electrical stimulation, laser therapy and ultrasound.

Objectives: 

To assess the effect of therapeutic ultrasound on the healing of pressure ulcers.

Search strategy: 

For this update we searched the Cochrane Wounds Group Specialised Register (April 2008) , The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 2, 2008, Ovid MEDLINE (1950 to April Week 3 2008), Ovid EMBASE (1980 to 2008 Week 16) and Ovid CINAHL (1982 to April Week 3 2008).

Selection criteria: 

Randomised controlled trials (RCTs) comparing therapeutic ultrasound with sham ultrasound or standard treatment.

Data collection and analysis: 

Two authors independently checked the result of the search to identify relevant RCTs. Details of eligible studies were extracted and summarised using a data extraction sheet. Attempts were made to obtain missing information by contacting authors. Data extraction was checked by a second author. Meta-analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar.

Main results: 

Three trials involving 146 people were included. Two RCTs compared ultrasound therapy with sham ultrasound and the third compared a combination of ultrasound and ultraviolet light with laser and with standard treatment.

Neither of the two RCTs comparing ultrasound with sham found a significant difference in healing rates. The trials were pooled, in the absence of significant heterogeneity. There was no evidence of benefit associated with the use of ultrasound in the treatment of pressure ulcers.

In the three-arm comparison there was no statistically significant difference in ulcers healed.

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