Griffin et al. 1991
USA
PEDro=7
RCT
N=20

Population: Age = 10-74 yrs; Time since injury = 4-1820 wks; Duration of ulcer = 1-116 wks.
Treatment: Patients with pelvic (sacral/coccygeal or gluteal/ischial) ulcers received high voltage pulsed direct current (HVPC) or placebo HVPC for one hour a day for 20 consecutive days.  All patients received equivalent dressing changes. Wounds were mechanically debrided as necessary.  “Efforts” were made to relieve pressure, but this was not described.
Outcome Measures: Pressure Ulcer Status.

1. Percentage of change decrease in the wound surface area (WSA) exhibited by the HVPC group was greater than placebo group at day 5 (p=0.03), day 15 (p=0.05) and day 20 (p=0.05).

Adegoke & Badmos 2001
Nigeria
PEDro=6
RCT
N=7

Population: Age = 21-60 yrs; Mean ulcer surface area = 15.8 mm; Ulcer location: trochanter & sacrum.
Treatment: Stimulation with interrupted direct current (IDC) and nursing care or placebo IDC and nursing care; 3-45 minute treatments for 4 weeks.
Outcome Measures: Surface area of pressure ulcers.

1. Surface area of pressure ulcers of IDC group decreased by 22.2% versus 2.6% in placebo IDC group.
2. Most of the decrease in surface area occurred during the first two weeks of the study (IDC group 13.3% change 15.8%; placebo IDC group 15.1% change 1.9%).

Baker et al. 1996
USA
PEDro=4
RCT
N=80

Population: Age = 17-76 yrs; Gender: males = 66, females = 14; Severity of injury: complete, incomplete; Total number of wounds = 192.
Treatment: Stimulation of A (asymmetric biphasic), vs. B (symmetric biphasic) vs. microcurrent (MC) group originally thought to incorporate stimulation below effective level became the 3rd treatment group when some early therapeutic effect was noted. All remained on their stimulation protocols until their ulcers healed, the MD intervened or subject withdrew from study. Control group received sham for 4 wks then were entered into either A or B groups. Electrical stimulation treatment for all subjects consisted of 1.5 hrs of stimulation 5 days/wk.
Outcome Measures: Pressure ulcer status.

1. No statistical differences were noted between the initial or discharge ulcer areas or in the mean healing rates among the four treatment groups.
2. Comparing the descriptive data by classifying them as good or poor healing responses failed to identify any statistically significant differences between the 2 groups.
3. When looking at the good response group, the group A protocol was most effective as compared to the MC and C protocols (p<0.05). No significant differences were found between B protocol and other treatments.
4. Those in the control group who had wounds healed by either protocol A or B showed that the healing rate was greater (43.3% Δ/week) than it was during the control period (9.7% Δ/week).

Karba et al. 1997
Slovenia
Downs & Black score=20
Prospective controlled trial
N=50

Population: SCI
Treatment: SCI patients with pressure ulcers of at least 500mm3 and stage 3 or 4 were divided into three groups: DC+ group receiving positive stimulation electrode overlaid on ulcer; DC+/- group received the same stimulation but two electrodes were placed on healthy skin across the wound.; SHAM group had electrodes placed on the wound but no current.
Outcome Measures: Relative rate of healing

1. The DC+ group reported the greatest relative healing rate per day (7.4%, p=0.028) while the other two groups remained at similar rates (DC+/-=4.8%, SHAM=4.2%).

Stefanovska et al. 1993
Slovenia
Downs & Black=14
Prospective Controlled Trial
N=150

Population: Not described
Treatment: Currents were applied across the wounds by a pair of self-adhesive skin electrodes. DC group (N = 18) treated with direct currents (600µA) for two hours daily. AC group (N = 82) were treated with low frequency pulsed currents for two hours daily. CO group (N = 50) received “conventional” treatment (not described) for the first month.
Outcome Measures: Pressure Ulcer Status.

1. The healing rate for the AC group (N = 42) was significantly better than the other two groups DC (N = 12), CO (N = 34) p=0.003, after excluding those with very deep, superficial or long-term wounds.