Can Photobiomodulation improve healing of category II-III pressure ulcers in frail older adults? A quasi-experimental 24-month follow-up study

BACKGROUND: Frail older adults are particularly susceptible to pressure ulcer development due to complex health conditions and functional decline. Pressure ulcers category II and III involve partial- and full-thickness skin loss, and current treatment options often yield suboptimal outcomes. The study evaluated the effects of adjunctive photobiomodulation compared with standard-of-care in frail older adults, with category II and III pressure ulcers. The objectives were to assess: 1) ulcer healing 2) healing time; 3) factors associated with healing, and 4) ulcer recurrence following photobiomodulation. METHODS: Quasi-experimental study with two prospective intervention groups and matched registry-based control groups, conducted in accordance with TREND guidelines. Baseline differences analysed using Independent Samples T-test, Independent Samples Mann-Whitney U test or Pearson chi-square test. Times to healing evaluated using Kaplan-Meier analysis and log-rank tests. Age-stratified multivariable Cox proportional hazards models were applied to identify healing-associated factors. Ulcer recurrences were analysed descriptively. PARTICIPANTS AND SETTING: Intervention groups comprised frail older adults (≥70 years) receiving municipal home healthcare: category II (n = 39) and category III (n = 37). Photobiomodulation was administered twice weekly, using GaAs laser (904 nm) and AlGaInP laser (635 nm). Control groups treated with standard-of-care were identified from the Swedish national registry RiksSår for ulcer treatment: category II (n = 117), and category III (n = 111). RESULTS: The photobiomodulation groups demonstrated higher proportions of healed ulcers and significantly shorter healing times (p < 0.001). Median healing times were 33 and 70 days for the category II and III ulcers, respectively, compared with 153 and 195 days in the control groups. Ulcer recurrence within 24 months following photobiomodulation was 0% for category II and 6,7% for category III. CONCLUSIONS: Photobiomodulation may be an effective treatment for pressure ulcers in frail older adults, substantially accelerating healing, and reducing recurrence, with potential to lessen patient burden and improve outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT07520825.