Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Local Wound Care - Adjunctive Therapies
Recommendation Level of Evidence
3.6a  Refer to physiotherapy for a course of treatment with electrotherapy for Stage III and IV pressure ulcers that have proved unresponsive to conventional therapy. Electrical stimulation may also be useful for recalcitrant Stage II ulcers.


  • Etiology of the wound;
  • Client´s general health status, preference, goals of care and environment;
  • Lifestyle;
  • Quality of life;
  • Location of the wound;
  • Size of the wound, including depth and undermining;
  • Pain;
  • A dressing that will loosely fill wound cavity;
  • Exudate: type and amount;
  • Risk of infection;
  • Risk of recurrence;
  • Type of tissue involved;
  • Phase of the wound healing process;
  • Frequency of the dressing change;
  • Comfort and cosmetic appearance;
  • Where and by whom the dressing will be changed;
  • Product availability; and
  • Adjunctive therapies.
3.6b  Chronic pressure ulcers may be treated by:
  • Electrical stimulation (Level of Evidence Ib)
  • Ultraviolet light C (Level of Evidence IIa)
  • Warming therapy (Level of Evidence Ib)
  • Growth factors (Level of Evidence Ib)
  • Skin equivalents (Level of Evidence IV)
  • Negative pressure wound therapy (Level of Evidence IV)
  • Hyperbaric oxygen (Level of Evidence IV)

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