The purpose of this study is to determine the effectiveness of transcutaneous nerve stimulation (TENS) on healing of pressure ulcers in community-based older adults. Specifically, the study will aim to: (1) compare the rate of healing of pressure ulcers treated with conventional therapy and those treated with conventional therapy augmented with TENS, and (2) compare the rate of wound healing and the presence of specific patient variables and ulcer condition variables. The sample will consist of 40 subjects, 60 years of age and older, who have at least one pressure ulcer that has been resistant to healing for at least two months. Subjects will be obtained from a rural, midwest community-based dermatology clinic through referral from their attending physician and will be randomly assigned to one of two treatment groups. The experimental group will receive topical treatment to their ulcer consisting of course gauze dampened in normal saline and covered with a cotton filled dressing. In addition, their ulcer will be treated with TENS administered with electrodes applied to the ulcer edge three times a day for 30 minutes. The control group will receive the same topical treatment to their ulcer, but their TENS treatment will consist of """"""""sham"""""""" TENS. Subjects will be followed for 8 weeks or until their ulcer heals. Rate of healing will be determined by weekly measurements of wound circumference, surface area, volume, depth and surface characteristics. Ulcer circumference, surface area, volume and depth will be measured with stereophotography, a method of remote three-dimensional measurement using stereoscopic pairs of photographs that are analyzed using a computerized image processor to calculate the desired measurements. Ulcer surface characteristics, including amount and quality of exudate and ulcer surface appearance, will be determined by direct observation and by photography. Specific patient variables will be assessed include: sex, age, medical history and medications, level of continence, mobility and activity, mental status, general physical status, level of oxygen supply to the ulcer, oxygen carrying capacity of the blood, immune competence and nutritional status. Ulcer condition variables will include documentation of: length of time the ulcer has been present, stage of the ulcer, presence of clinical indicators of wound infection and wound culture results. A group by time repeated measures analysis of variance will be used to examine differences in rate of healing between treatment groups. A Friedman two-way analysis of variance will be applied to determine differences in ulcer surface characteristics between the treatment groups. Within treatment groups, patient and ulcer condition variables will be correlated with differences in measures of rate of healing.
