Mr Dale Edwick1,2,3,4, Dr Dana Hince5, Dr Tiffany Grisbrook6, Ms Robyn Murphy7, Mr Jeremy Rawlins2,8, Professor Fiona Wood1,2,9, Associate Professor Dale Edgar1,2,3,4,9
1Fiona Wood Foundation, Murdoch, Australia, 2State Adult Burns Unit – Fiona Stanley Hospital, Murdoch, Australia, 3School of Physiotherapy – The University of Notre Dame Australia, Fremantle, Australia, 4Burn Injury Research Node – The University of Notre Dame Australia, Fremantle , Australia, 5Institute of Health Research – The University of Notre Dame Australia, Fremantle, Australia, 6School of Physiotherapy and Exercise Science – Curtin University of Technology, Bentley, Australia, 7ActivLife Technologies Pty Ltd, Niddrie, Australia, 8Department of Plastic and Maxillofacial Surgery – Royal Perth Hospital, Perth, Australia, 9Burn Injury Research Unit – The University of Western Australia, Crawley, Australia
Background: Electrical stimulation (E-stim) has been shown to improve wound healing in chronic wounds. It is yet to be demonstrated to assist in acute burn wounds.
Aim: The aim of this study was to determine if E-stim improves acute burn wound healing. The hypothesis tested was: in patients with acute burn wounds, applying E-stim will increase phase angle (PA) compared to routine care.
Methods: A within patient randomised control study of patients presenting to the State Adult Burns Unit with burns to multiple limbs. One affected limb was randomised by coin toss to receive E-stim and routine dressings. The other wound received routine care only. Wounds were planned to receive stimulation for 10-14 days for more than 20 hours/day (30V, 6-12 Hz, 200µs pulse width). Serial localised bioimpedance spectroscopy (BIS) PA measures were recorded for both wounds. The results were analysed using multi-level mixed effects regressions.
Results: Analysis on 27 patients (21 males) demonstrated PA at 50kHz increased at a faster rate in the stimulated wound (stimulation x time interaction, p=0.0083). Stimulated wound PA increase was 0.052°/day (10.42% increase from baseline) (95% CI -0.005 to 0.11, p=0.078) compared to control PA increase of 0.022°/day (2.69% increase) (95% CI -0.038 to 0.082, p=0.476). Stimulated wound impedance at zero frequency (R0, impedance of extracellular fluid) increased at a faster rate (stimulation x time interaction, p=0.015), indicating an increased oedema reduction rate.
Conclusion: E-stim may provide an adjunct therapy to acute burn wound healing. BIS demonstrates potential to measure acute burn wound healing.
Dale has been a Senior Physiotherapist in the State Adult Burns Unit at Fiona Stanley Hospital in Western Australia for the last 5 years. As part of his role as Clinical Research Fellow with the Fiona Wood Foundation, he is undertaking a PhD through the School of Physiotherapy at The University of Notre Dame Australia. His research is investigating proactive management of oedema following hand and minor burn injury, including the use of bioimpedance spectroscopy as an outcome measure.