Evidence

As promised, we are back and ready to share the evidence behind HVS. If you have tried searching for good research for HVS use, you may have had the same problem we did: many of the research articles available are old (decades) and the majority use animal subjects. As you know, randomized control trials (RCT) are the highest quality evidence and we discovered that there aren't many recent RCT which use human subjects. We also realized pretty quickly that many of the research articles had poor design. There were too many variables not controlled for in numerous studies which has blurred the evidence and support behind HVS.  Am I right? Well, do not worry. We have spent countless hours looking for quality research on your behalf. Believe us when we say there is supporting research, you just have to find it!

Peters et al., 2001

·         Randomized, double-blind, placebo-controlled pilot study examining the dose and effect of HVS on diabetic foot ulcers

·         Treatment parameters

o   50V x 80Hz x 10 mins + 50V x 8Hz x 10 mins + 40 mins break

o   The HVS device ran at night for 8 hours in hopes of increasing patient compliance

·         Results

o   65% of patients using HVS had their ulcers heal compared to 35% of the control group after 12 weeks

o   Healing also increased as a function of treatment time

Houghton et al., 2003

·         examined the effects of HVS on chronic wounds due to venous and arterial insufficiency

o   subjects in the study had full thickness ulcers for >3 months

·         treatment parameters

o    intervention group: 150V x 100 Hz x 45 mins, 3x a week for 4 weeks

o   Sham treatment group

·         Results

o   HVG reduced wound surface by approx 50% of original size

o    rate of wound closure was 2x faster than that of the control group (sham treatment)

o   individuals with bilateral ulcers had faster wound closure of HVG treated ulcers compared with the sham treatment they received on the contralateral limb

Snyder et al., 2010

·         performed a systematic review on the effects of HVS on edema control in animal models

o   studies reviewed used HVS in acute trauma and used limb volume as an outcome measure

·         treatment parameters

o   most studies used 30 mins treatment + 30 mins rest for 4 hours;  frequency 120 Hz, intensity of 90% of visual motor contraction

·         results

o   small to large HVG treatment effect sizes for edema control after an acute injury, suggesting HVG to be an efficacious modality for the treatment of edema

Fitzgerald et al., 1993

·         case study on the use of HVPC for the treatment of a large infected wound of thoracic spine following surgical procedure

·         treatment parameters

o   100V x 100 Hz x 60 mins, 5x a week for 10 weeks

o   20 mins of negative polarity + 40 mins of positive polarity

·         Results

o   Sometimes, a picture is worth a thousand words

A series of photos showing the wound at the beginning of treatment, 5 weeks after treatment and 9 weeks after treatment

Mendel et al., 2010

·         Examined the effects HVS had on grade I and II lateral ankle sprains on return to sport times

·         Treatment parameters

o   Near continuous HVS for 72 hours post injury

o   Subsensory intensity, 120 Hz

·         Results

o   No difference between intervention and control groups in grade II sprains return to sport times

o   HVS delayed return to sport time in grade I sprains

·         Discussion

o   After reading these results, I bet you are wondering why I’ve chosen to include this article

Although we believe this was a poorly designed study, this does not undermine the fact that there is no miracle device which will heal various conditions. We cannot possibly expect to put an estim device on every condition and expect it to resolve without any other interventions. Estim devices are simply a tool we as physiotherapists can use to assist in the healing process. We cannot increase the rate of healing, but we can impede it, which is why we are constantly reminded to “do no harm.” Our job is to create an environment which will optimize tissue healing – that is where estim comes into play. Never forget that there is always a role for functional exercises in the rehabilitation program!

Speaking of “doing no harm,” join us next time for our post on the contraindications of HVS use.

A & M



References:

Fitzgerald, K.G. & Newsome, D. (1993). Treatment of a large infected thoracic spine wound        using high voltage pulsed monophasic current. Physical Therapy, 73(6), 355-360.PMID: 8497510

Houghton, P., Kincaid, C., Lovell, M., Campbell, K., Keast, D., Woodbury, G. & Harris, K. (2003). Effect of electrical stimulation on chronic leg ulcer size and appearance. Physical Therapy, 83(1), 17-29. PMID: 12495409

Mendel, F., Dolan, M., Fish, D., Marzo, J. & Wilding, G. (2010). Effect of high-voltage current on recovery after grades I and II lateral ankle sprains. Journal of Sport Rehabilitation, 19, 399-410. PMID: 21116009

Peters, E., Lavery, L., Armstrong, D. & Fleischli, J. (2001). Electric stimulation as an adjunct to heal diabetic foot ulcers: a randomized clinical trial. Arch Phys Med Rehabil, 82, 721- 725. PMID: 11387573

Snyder, A., Perotti, A., Lam, K. & Bay, C. (2010). The influence of high-voltage electrical stimulation on edema formation after acute injury: a systematic review. Journal of Sport Rehabilitation, 19, 436-451. PMID: 21116012