Reduction of pressure ulcer size with high-voltage pulsed current and high-frequency ultrasound: a randomised trial.

OBJECTIVE: International guidelines recommend the use of ultrasound (US) and electrical stimulation (ES) for treating chronic and recurrent pressure ulcers (PUs). The methodology of these procedures, however, still needs elaboration and confirmation by clinical studies. This parallel-group, randomised, single-blind, prospective, controlled clinical trial was conducted to determine whether by using high-frequency ultrasound (HFUS) and high-voltage monophasic pulsed current (HVMPC), the rate of change in the area of older patients' PUs can be accelerated. METHOD: Patients were randomly assigned to receive either: standard wound care (SWC) involving supportive care and topical treatments; SWC+US (1MHz; 0.5 W/cm2; 20%; 1-3 minutes/cm2); or SWC+ES (HVMPC, 154 µs, 100 pps, 100 V, 250 µC/sec, 50 minutes/day). US and ES were administered once a day, 5 days a week. The primary outcome was change in PU surface area measured against baseline after 6 weeks of treatment with SWC, SWC+US, and SWC+ES. RESULTS: We recruited 77 patients, aged 60-95 years (80% aged over 70 years of age), with 88 Category II, III and IV PUs were enrolled in the study. The percentage reduction in the surface area of PUs at the end of treatment was significantly greater in the SWC+US group (mean ± standard deviation, 77.48±11.59 %; p=0.024) and the SWC+ES group (76.19±32.83%; p=0.030) versus the control group (48.97±53.42%). The SWC+ES group also had a significantly greater proportion of PUs that decreased in area by at least 50% or closed than the control group (p=0.05 and 0.031, respectively). The SWC+US and SWC+ES groups were not statistically significant different regarding treatment results. Clinical side effects were not recorded. CONCLUSION: The results show that HFUS and HVMPC are comparable regarding their effectiveness in reducing the size of PUs in older people. DECLARATION OF INTEREST: The authors have nothing to disclose. All research activities were funded by the Academy of Physical Education, Katowice, Poland.

Early and long-term results of physical methods in the treatment of venous leg ulcers: randomized controlled trial.

OBJECTIVE: To estimate early and long-term results of physical methods in the treatment of venous leg ulcers. METHOD: In group A after surgical operation, 40 patients were treated with the high-voltage stimulation (HVS) (100 µs, 100 Hz, 100 V) and drug therapy. In group B after operation, 37 patients were treated with ultrasound (0.5 W/cm(2), 1 MHz) and drug therapy. In group C after operation, 33 patients were treated with low-level laser therapy (LLLT) (810 nm, 65 mW) and drug therapy. In group D after operation, 35 patients were treated with the compression stockings (25-31 mmHg) and drug therapy. In group E after operation, 37 patients were only treated with drug therapy. Group F consisted of 32 patients, conservatively treated with the HVS and drug therapy. Group G consisted of 20 patients, conservatively treated with ultrasound and drug therapy. Group H consisted of 21 patients, conservatively treated with LLLT and drug therapy. Group I consisted of 30 patients, conservatively treated with compression and drug therapy. Group J consisted of 27 patients only treated with drug therapy. RESULTS: Both short and long term parameters showed that compression therapy is the most efficient in ulcer healing. The electrical and ultrasound methods are less effective. The laser therapy ared useless. CONCLUSION: Superficial venous surgery in addition to compression therapy is the most efficient treatment of venous leg ulcers. The compression therapy should be continued both surgically and conservatively treated patients with healed ulcers. In special cases after superficial venous surgery (isolated superficial reflux) compression therapy could be applied only to the time of ulcer closure without continuing it longer. HVS and ultrasound therapy are useful methods in conservative treatment of venous leg ulcers. For surgically-treated patients these physical therapies are efficient only in superficial plus deep reflux cases. HVS and ultrasound can be alternative methods, but are less effective in recurrence risk. LLLT is not an efficient physical method in treatment of venous leg ulcers.

The use of therapeutic ultrasound in venous leg ulcers: a randomized, controlled clinical trial.

OBJECTIVES: To estimate the usefulness of therapeutic ultrasound for healing of venous leg ulcers. METHODS: Eighty-one patients were included in this study. Patients in groups 1 and 2 were treated surgically. Patients in groups 3 and 4 were treated conservatively. Patients in groups 1 and 3 were additionally treated with the ultrasound (1 MHz, 0.5 W/cm(2)) once daily, six times a week for seven weeks. RESULTS: Comparison of the number of complete healed wounds indicated statistically significant differences between groups 1 and 4 (P = 0.03), 2 and 4 (P = 0.03), 3 and 4 (P = 0.03) in favour of groups 1, 2 and 3. Comparison of the other parameters also demonstrated more efficient therapy effects in groups 1, 2 and 3 than in group 4. There were no statistical differences in all examined parameters between groups 1, 2 and 3 (P > 0.05). CONCLUSIONS: The ultrasound is an efficient and useful method only in conservatively treated venous leg ulcers. There are no special reasons for application of the ultrasound in surgically treated patients. A well-conducted surgical operation is much more effective for a healing process than conservative pharmacological procedures.

Application of various power densities of ultrasound in the treatment of leg ulcers.

AIM: The objective of our study was to determine which ultrasound power density (0.5 W/cm(2) or 1 W/cm(2)) is more effective at reducing the area and volume of leg ulceration. METHODS: A total of 65 patients with venous ulcers were randomly divided into three groups: A, B and C. In group A, 22 patients were treated with ultrasound rated at 1 W/cm(2) and with compressive therapy. In group B, 21 patients were treated with ultrasound rated at 0.5 W/cm(2) and with compressive therapy. In both groups the patients were treated with a pulsed wave of a duty cycle of 1/5 (impulse time=2 ms, pause time=8 ms) and frequency of 1 MHz. The 22 patients in group C (control group) were subjected to topical pharmacological treatment. RESULTS: We found a statistically significant reduction of the ulcer area, volume and linear dimensions in all three groups of patients. The ulcer area reduction rate was highest in group B. The volume reduction rate in group B was higher than in group A only. The rate of reduction of suppurate area was highest in group B. CONCLUSION: We have demonstrated that ultrasound rated at 0.5 W/cm(2) causes greater and faster changes in the healing process than ultrasound rated at 1 W/cm(2).

[Early results of patient rehabilitation after anterior cruciate ligament reconstruction]. / Wczesne wyniki usprawniania leczniczego chorych po rekonstrukcji wiezadla krzyzowego przedniego.

In the Orthopedic Department of the Upper-Silesian Rehabilitation Center "Repty" in Ustron 54 patients have been rehabilitated after a plasty of the anterior cruciate ligament and transplantation of 1/3 middle part of the patellar ligament with two osseous blocks at each end. The rehabilitation was conducted according to the scheme worked out in our department. The results of the rehabilitation were assessed by the objective and subjective methods (for example the goniometric pendulum test, the modified Lysholm's scale, the WAS questionnaire). The patients had been divided randomly into two comparative study groups that were subject to exactly the same rehabilitation scheme, but one of the group was additionally provided with the impulsive magnetic field therapy. A satisfactory improvement was observed in both groups of patients. There was no significant advantage of additional treatment with the impulsive magnetic field.

[Digital goniometry "Spasmometr GC-2"]. / Goniometr cyfrowy "Spasmometr GC-2".

The review of modern application of goniometric assessment in rehabilitation of patients with movement organs system disorders is done by the authors. The construction and principle of operation of digital goniometer, applied to pendulum testing of lower extremities with pathologic changed muscle tone, are described. An electro-optical transducer transmits the digitized time-dependent function of an angle between the thigh and leg axes of subject via an interface to the special computer programme. The function is registered, some coefficients describing extremity motion in joint are determined and the patient is assigned to the proper rehabilitation group by the composed programme. Normal values of the pendulum test coefficients in the asymptomatic subjects are performed.