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Therapeutic ultrasound for pressure sores.

BACKGROUND
Pressure sores have been recorded as occurring in 4-10% of patients admitted to a UK District General Hospital (the precise rate depends on case-mix) and in an unknown proportion of patients 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 sores can be 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 effectiveness of the use of therapeutic ultrasound in the treatment of pressure sores.


SEARCH STRATEGY
The Cochrane Wounds Groups search strategy was used (see Scope) to search for randomised controlled trials (RCTs) of therapeutic ultrasound for the treatment of pressure sores up to December 1999.


SELECTION CRITERIA
Randomised controlled trials comparing therapeutic ultrasound with sham ultrasound or other (standard) treatment.


DATA COLLECTION AND ANALYSIS
Results of searches were scrutinised by one reviewer to identify possible RCTs and full reports of these were obtained. 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 reviewer. Meta-analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar.


MAIN RESULTS
A total of 3 eligible RCTs were identified. Two RCTs compared ultrasound therapy with sham 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 sores. In the three-arm comparison there was a significant increase in the weekly healing rates associated with the ultrasound/ultraviolet combination compared with laser but no statistically significant difference between ultrasound/ultraviolet and control.


REVIEWER'S CONCLUSIONS
The results suggest no apparent evidence of a benefit of ultrasound therapy in the treatment of pressure sores. However the possibility of a beneficial or a harmful effect cannot be ruled out due to the small number of trials with methodogical limitations and small numbers of participants.