Services Include:
- assessment of wound status and consultation regarding factors impairing wound healing
- selection and design of a safe and comfortable wound treatment using a therapeutic modality
- creation of a program of exercises/ positioning to help circulation and aid in wound closure
- wherever possible, provision of training to the patient or the patient’s delegate on how to continue treatments at home
- facilitation of any necessary equipment rental or purchase through a local supplier
- ongoing evaluation of the wound healing and progression of the programme of treatment as appropriate
Exercises/Positioning
Many chronic leg wounds are in part due to poor blood circulation and swelling of the leg. Leg exercises help improve circulation and reduce swelling.
Prolonged or inappropriate positioning/seating surfaces for immobile individuals can lead to pressure ulcers. Treatment of these ulcers requires offloading or more appropriate seating surfaces. These factors will be evaluated and addressed.
Therapeutic Modalities
Physiotherapy involves the use of many different modalities that are shown through research to aid in the healing of soft tissues. Treatments such as electrotherapy, ultrasound, laser therapy and ultraviolet light are all safe, comfortable, non-invasive means of delivering electrical, sonic, light or thermal energy to a wound.
Electrical stimulation in particular has very strong evidence supporting its use in healing of chronic wounds including those that are infected. Electrical stimulation for this purpose is recommended in several respected guidelines on the management of ulcers including the RNAO Pressure Ulcer Guideline and the Canadian Association of Wound Care Ulcer Guidelines.
Practical Considerations
- Rental or purchase cost of equipment is the patient’s responsibility. This will vary according to the modality used.
- There must be an appropriate individual available who can be trained to administer daily treatments, i.e. the patient, a family member or a nurse.
- Certain medical conditions may preclude the use of some modalities.
Evidence Supporting the Value of Adjunctive Therapies for Chronic Wound Healing:
Agency for Health Care Policy and Research Pressure Ulcer Treatment Guidelines (reviewed 1999)
Recommendation #8 "Consider a course of treatment with electrotherapy for Stage 3 and 4 pressure ulcers that have proved unresponsive to conventional therapy."
RNAO Best Practice Guideline: Assessment and Management of Stage 1 to 4 Pressure Ulcers (2002) echoes this word for word in Recommendation 35 and, in addition, Recommendation 36 suggests the use of therapeutic ultrasound, and ultraviolet light for chronic ulcers.
There is “A” level evidence for the use of electrical stimulation in the healing of chronic wounds. There are a total of 25 published reports on the use of electrical stimulation for wound healing including 10 that are randomized clinical trials. All reported positive effects on wound healing with this modality. Ulcer types included ischemic, pressure, venous insufficiency and diabetic.
Clinical Associate for Wound Care:
Mary Jane O’Donovan B.Sc.(P.T.)
- practicing as a Registered Physiotherapist since 1983
- post-graduate training in the treatment of chronic wounds including:
Therapeutic Modalities for the Treatment of Chronic Wounds, March 2002
Treatment of Chronic wounds using Electrical Stimulation: Scientific Knowledge and Clinical Skills, September 2003
- member of the Wound Care Working Group, a multidisciplinary group working on local issues surrounding wound care in our community
