A Provider Resource

Here are practice enablers, decision support tools, useful forms, and research articles to inform clinicians using Estim to treat people with chronic wounds.

  • Estim Protocols

    Step by step processes of Estim application techniques  are available in downloadable pdf documents.

  • EStim application techniques: VIDEOS

    Narrated demonstrations of how to apply Estim using different electrodes applied in (monopolar) and around (bipolar) the wound.

  • Identifying appropriate clients for Estim

    One of the greatest challenges facing clinicians introducing Estim into wound care practices, is identifying what client and which wound are most likely to respond to Esitm and knowing when the best time to intervene.

    • Decision Tree: A decision tool has been developed by Estim Collaboration project to help patients, their caregivers, and front-line nurses identify when to use Estim.
      • Zhou Article:   A link to a recent article by K. Zhou and Colleagues at Daemen College, Amherst, NY. [E Clin. Invest. 46(12): 1017-1023, 2016] is provided.  This article demonstrates that wounds responded best to Estim when they were present for 6 months or less.
  • Contraindications & Precautions

    INDICATIONS include a list of the types of wound etiology shown to respond to Estim.

    CONTRAINDICATIONS: Medical conditions that increase the likelihood of an adverse reaction to Estim is listed.  People with conditions listed as Contraindications should avoid using Estim. People with conditions listed as PRECAUTIONS can receive Estim, however, in these circumstances Estim should be applied by an experienced Estim provider who knows what to watch for and is able to provide closer monitoring.

    • Physio Canada Article:  A resource that provides research and rationale underlying the list of conditions that need to be considered when selecting appropriate clients for therapeutic modalities including Estim treatment of wounds (termed HVPC).  This special supplement of the Journal “Physiotherapy Canada” was published by Pamela Houghton, Ethne Nussbaum, and Alison Hoens in 2010
  • Dressings that can and can’t be used with Estim
  • Useful Forms

    Consent form: A written description of the benefits and risks associated with Estim treatments

    Consult form: Questions and situations to consider during the initial assessment and considerations when setting up Estim for the first time.

    Wound Assessment Forms:

    Recommended Wound Assessment Tools

    Photographic Wound Assessment Tool 

    • Revised PWAT – this 8 item tool provides a total score between 0-32 with a score of zero signifying a completely healed/closed wound.  revPWAT was refined in 2014 and shown to have excellent reliability amongst trained wound care clinicians.  It produces equivalent outcomes whether used at the bedside or on digital wound images.  A pdf filllable version of the revised PWAT is also available for ease of use
    • Original PWAT – modified from PSST this 6 item tool has been shown to have excellent intra and inter reliabilty and able to detect change in wound status [(if the wound appears worse or better (is healing)]

    Leg Ulcer Measurement Tool (LUMT) – this tool was designed to describe and evaluate leg and foot wounds including venous and arterial wounds as well as diabetic foot wounds.  The LUMT has been shown to be responsive to changes in wound status over time (can detect wounds that are healing).

  • Reference Articles & Guidelines

    Estim References

    Clinical Practice Guidelines