A Comparative Study of The Efficacy of Photobiomodulation and Electrical Stimulation on Healing of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis

Abstract

Context: Diabetic foot ulcers (DFUs) represent a prevalent complication of uncontrolled diabetes. Physical modalities like electrical stimulation (ES) and photobiomodulation (PBM) demonstrate significant potential in treating DFUs. Objectives: This study aimed to systematically review the literature and perform a meta-analysis comparing PBM and ES for reducing DFU size. Data Sources: We conducted an extensive search for relevant studies by systematically exploring various international databases, including Medline (through PubMed), Web of Science, Cochrane, Scopus, and Pedro. The search was not limited by time, extending until April 29th, 2024, and was restricted to studies published in English. Study Selection: Two independent researchers participated in the search and screening of sources, and a third researcher resolved any discrepancies in case of conflicting opinions. The initial search yielded 478 articles, of which 225 remained after removing duplicates. After screening titles and abstracts, 31 full-text articles were assessed for eligibility. Ten studies were excluded due to inadequate data, lack of relevant intervention, or being non-randomized or pilot studies. Data Extraction: Twenty-one studies were included in the systematic review and meta-analysis. Results: Twenty-one studies were included. The standardized mean change for PBM was 1.79 (95% CI 0.18 - 3.39), and for ES, it was 0.36 (95% CI -0.33 - 1.06). Both PBM and ES significantly reduced DFU size compared to baseline. Although the difference between treatments was not statistically significant (P = 0.095), PBM demonstrated a clinically relevant larger effect size than ES. No adverse effects were reported for PBM, while ES was associated with minor skin irritation or burns in some cases. Conclusions: Both PBM and ES, as adjuvant treatments, significantly decrease DFU size compared to standard care alone. The PBM’s larger effect size suggests potentially greater clinical efficacy, despite non-significant statistical differences. However, further high-quality studies are needed to confirm these findings.