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A COMPARATIVE STUDY OF THE EFFECTS OF VIBRATION AND 

ELECTRICAL STIMULATION THERAPIES ON THE ACCELERATION OF 

WOUND HEALING IN DIABETIC ULCERS 

Yunita Sari*, Saryono Saryono*, Eman Sutrisna**, Hartono Hartono*** 

* Department of Nursing, Jenderal Soedirman University, Purwokerto, Indonesia 

** Department of Medical Science, Jenderal Soedirman University, Purwokerto, Indonesia 

*** Department of Physics Science, Jenderal Soedirman University, Purwokerto, Indonesia  

E-mail: yunita-tky@umin.ac.jp/sasa.yunita@gmail.com 

ABSTRACT 

Introduction: Diabetic ulcers accompanied by ischemia is difficult to treat. Such ulcers require therapy that can improve the 

blood flow. Previous studies have revealed that two therapies could improve blood flow and accelerate the healing of 
diabetic ulcers; vibration and electrical stimulation (ES). However, it is unknown which of these two therapies is best at 

accelerating wound healing in diabetic ulcers. The purpose of this study was to compare both therapies in relation to 

accelerating the wound healing of diabetic ulcers. Methods: This study was an experimental study involving diabetic rats. 

The rats were divided into two groups: vibration and ES. Vibration and ES were applied for 10 minutes per day for 7 days. 

Wound size, inflammation, intensity of fibroblast infiltration, area of necrosis and degree of re-epithelialisation were 

compared. The difference in wound size was analysed using an independent t-test, while the histological data were analysed 

using a Mann-Whitney U-test. Results: On day 5 onwards, there was a thin slough in the ES group which was not present in 

the vibration group. Day 4 onwards and the wound size was significantly smaller in the vibration group than in the ES group. 
The intensity of inflammation was significantly less, and the degree of fibroblast infiltration was significantly higher in the 

vibration group compared with the ES group. Re-epithelialisation was more advanced in the vibration group than the ES 

group. Conclusions: Our study revealed that wound healing in diabetic ulcers following vibration was better than after ES. 

We suggest that nurses should use vibration rather than ES in clinical settings. 

Keywords: complementary therapy, diabetic ulcer, electrical stimulation, vibration, wound healing 

 

INTRODUCTION 

Indonesia has the tenth highest 

proportion of people with diabetes mellitus 

(DM) in the world (Shaw, Sicree and Zimmet, 

2010). It is predicted that Indonesia will 

become number six by 2030 (Shaw, Sicree and 

Zimmet, 2010). Soewondo, Ferrario and 

Tahapary (2013) revealed that the prevalence 

of patients with DM in Indonesia had 

increased by 11 % over 19 years, although this 

figure is likely to be higher since there are 

many unreported cases (Yusuf et al., 2016).  

Diabetes mellitus causes many 

complications. Patients have a risk of limb 

amputation at a rate that is 40 times higher 

than people without DM (Brechow et al., 

2013). After amputation, patients with DM 

also have a higher risk of limb re-amputation 

and rate of mortality (Moulik, Mtonga and Gill, 

2003; Izumi et al., 2006). Armstrong, Wrobel 

and Robbins  (2007) showed that the 

prevalence of deaths due to diabetic foot 

ischemia was higher than that due to cancer.  

Considering the impact of diabetic 

ulcers on patients, a therapy that accelerates 

wound healing is urgently required. Wu et al., 

2007 revealed that diabetic ulcers that heal 

with difficulty are accompanied by impaired 

blood flow (ischemia). 

The presence of ischemia impairs the 

wound healing process, especially the 

angiogenetic phase, thus a therapy that 

improves blood flow would be of great benefit, 

including the use of drugs which act as 

vasodilators that improve blood flow or induce 

angiogenesis such as prostaglandins or basic 

fibroblast growth factor (Addison et al., 1972; 

Lees, 1994). However, the continuous 

administration of these drugs causes side 

effects such as cramping, the vasoconstriction 

of blood vessels and the acceleration of 

osteogenesis (Nagase et al., 2007). Because 

most patients with diabetic foot ulcers also 

have other complications due to high blood 

glucose, a therapy that has minimal side 

effects is not invasive and is comfortable for 

patients is required. 

Previous studies have shown that two 

complementary therapies that are safe for 

application to patients are vibration and 

electrical stimulation (ES). A previous study 

revealed that a low vibration frequency can 

improve blood flow (Nakagami et al., 2007), 

and accelerate healing of stage I pressure 

ulcers (Arashi et al., 2010), deep tissue injury 



Jurnal Ners Vol. 12 No. 2 Oktober 2017: 253-260 

254 

(Sari, et al., 2015) and diabetic ulcers (Sari, 

Sutrisna and Hartono, 2016). Sari et al., (2015) 

revealed that the reduction of hypoxia and 

reduction of activation of matrix metallo-

proteinase-2 and matrix metalloproteinase-9 

are the mechanisms that are responsible for the 

acceleration of wound healing following 

vibration. 

Studies reveal that ES has been 

utilised for many health purposes because it 

can improve blood flow. Humans create a type 

of electricity called bioelectricity. Following 

an injury to the skin, a low current flows 

between the skin and underlying tissue, which 

is called the current of injury. This is 

important during the wound healing process 

(Kim, Cho and Lee, 2014). The electric current 

which is used in ES is a low current 

(microAmpere, μA). 

Thus, the low current of ES therapy 

reflects the bioelectric current created by the 

body (Ud-Din and Bayat, 2014) . Results of 

studies both in vitro and in vivo reveal that ES 

improves the healing process by promoting 

keratinocyte migration, improving wound 

perfusion, stimulating collagen synthesis (Kim, 

Cho and Lee, 2014), and inducing 

angiogenesis (Liebano and Machado, 2014). 

(Liebano and Machado, 2014). A previous in 

vitro study revealed that ES could also reduce 

inflammation (Cho et al., 2000). In results 

similar to the effect of vibration, previous 

studies have also shown that ES accelerates 

wound healing in pressure, ischemic and 

diabetic ulcers (Eriksson et al., 1981; Goldman 

et al., 2003; Koel and Houghton, 2014). 

 Based on the above studies, both 

vibration and ES could improve wound 

healing. However, up to the present, there is 

no study that compares the effectiveness of the 

two complementary therapies, therefore, which 

therapy is better for accelerating wound 

healing of diabetic ulcer is still unknown.   

MATERIALS AND METHODS 

Research Design 

This was an experimental study 

utilising post-test only, using a control group 

design approach. 

Electrical Stimulation Device (Figure 1) 

Electrical stimulation consisted of two 

main parts, the electrodes and power supply. 

The electrodes served as a distributor of 

electrical current to the skin and were 

constructed from corrosion-resistant metal that 

could easily be attached to the skin. The power 

supply provided electric current to both 

electrodes. The current generated was a square 

wave of electrical pulses whose amplitude and 

frequency could be varied (Sari, Sutrisna and 

Hartono, 2017). 

The electrodes were attached to the 

skin as shown in Figure 2. Based on previous 

research, ES was applied for 10 minutes every 

day for 7 days (20 Hz, 320 µs, 50 µA) (Sari, 

Sutrisna and Hartono, 2017). 

 

1. Electrical stimulation device  

 

Figure 2. The application of ES in rat skin 

 

Figure 3. Rat was placed on the vibrating 

device. The wound is at the centre 

of the vibrating device.  



A Comparative Study of the Effects of Vibration... (Yunita Sari et al.) 

255 

Vibration Device 

The vibration device which was used 

in this study was originally constructed by our 

research team (Sari, Sutrisna and Hartono, 

2016). In brief, the vibration bed consisted of 3 

vibrating motors and its frequency can be 

varied by changing the velocity. The 

application of the use of vibration bed for the 

rat can be seen in Figure 3. The rats were 

given an application of vibration for 10 

minutes once a day for 7 days.   

Animal  

This study used male Wistar rats aged 

12-14 weeks. The rat’s body weight was in the 

range of 190-220 grams. The rats had free 

access to food and drink. The protocol of this 

study was approved by the research committee 

ethics for an animal study, of the Faculty of 

Medicine, Jenderal Soedirman University 

(1208/KEPK/III/2017). 

The rats were divided into two groups, 

vibration-treated and electrical stimulation-

treated. Every day, the wounds were washed 

with saline in both groups prior to being 

covered with a film dressing.  

Induction of Rats 

The rats were acclimatised for 7 days 

before the induction of diabetes by injection of 

Alloxan Monohydrate (Sigma Aldrich, USA) 

at a dose of 90 mg/kg. Blood was drawn from 

the tail vein 4 days after induction to assess 

whether the blood glucose concentration had 

increased. The rats were considered diabetic 

when their blood glucose was greater than 250 

mg/dl. The rats were shaved the day prior to 

wounding. The rats were anesthetised with 

Ketamile (25-30 mg/kg body weight) during 

the shaving and wounding procedures. 

The procedure of wounding was according to 

the previous publication (Sari et al., 2015a) 

The diameter of each wound was 1 cm, 

extending to the Panniculus carnosus. The 

wounds were cleaned with normal saline, dried 

with gauze then covered with a parafilm 

dressing. The wound was monitored daily 

from day 0 to 7 and recorded with a digital 

camera. 

Tissue Staining 

The rats were sacrificed on day 7 

using an overdose of ketamile. The tissue 

samples were fixed in 10% formalin then 

processed and embedded into paraffin. The 

samples were sectioned and then stained with 

a hematoxylin and eosin (H&E). Sections were 

observed using a light microscope. The 

inflammation and infiltration of inflammatory 

cells were indicated by blue staining in the 

H&E sections. 

Wound Size 

The size of the wound was measured 

by using ImageJ software from the National 

Health Institute. The wound area was 

determined based on the inner wound margins 

(Ueda et al., 2010) The relative wound areas 

were determined as (day n area – day 0 area) / 

(day 0 area). (Ueda et al., 2010) 

Reepithelialisation 

Reepithelialisation was indicated by 

the presence of  new epithelial tissue  in the 

epidermis layer. Reepithelialisation was 

observed with a light microscope. The result of 

the study was described qualitatively.  

Statistical Analysis 

Statistical analysis was performed by 

SPSS software, version 16. The data of the 

wound size was analysed by an independent t-

test.  The histological result was analysed by a 

Mann-Whitney U-test. The value of  p < 0,05 

was considered to be significant.   

RESULTS 

The result of the macroscopical 

findings could be seen in Figure 4. On day 0, 

the visual appearance of the wound was 

similar in both groups. On day 1 to day 3, the 

wound base in both groups started to be filled 

with granulation tissue. On day 3, the wound 

size in the vibration group tended to be smaller 

Table 1. Intensity of inflammation and 

fibroblast between vibration and ES 

group 

Groups PMNs Fibroblas 

Vibration 2* 3* 

Electrical 

stimulation 

3 2 

Values indicated median score 

Rating scale : 0 = absent, 1= occasional, 2 = 

moderate, 3 = abundant, >3 = very abundant 

* P< 0.05 

PMNs = polymorphonuclear neutrophils 



Jurnal Ners Vol. 12 No. 2 Oktober 2017: 253-260 

256 

compared with the ES group. On day 5, the 

granulation tissue in both groups was 

increased. However, there was a thin layer of 

slough in the ES group, which was not present 

in vibration group. On day 7, the thin layer of 

the slough was still present in the ES group.  

The difference of the wound size 

between two groups could be seen in Figure 5. 

There was no significant difference in wound 

size between vibration therapy and ES from 

day 0 to day 3. However, the wound size in the 

vibration group was significantly smaller than 

in the ES group on day 4 to day 7 (P=0,011 on 

day 4, P=0.025 on day 5, P=0.005 on day 6, 

P=0.0001 on day 7).  

The microscopical difference between 

the vibration and ES group in the epidermis 

and dermis layers can be seen in Figure 6. The 

intensity of inflammation in both the epidermis 

and dermis layer in the vibration group was 

less compared to the inflammation in the ES 

group.  The intensity of the fibroblasts was 

higher in the vibration group than in the ES 

group. The difference in the histological 

findings can be seen in Table 1. The intensity 

of inflammation was significantly less in the 

vibration compared with the ES group 

(P=0,034), and the fibroblast intensity was 

higher in the vibration compared with the ES 

group (P=0,045). 

DISCUSSION 

This study is the first study in the 

literature that compares vibration and 

electrical stimulation in accelerating the 

wound healing of diabetic ulcers.  In this study, 

we found that wounds heal better if treated 

with vibration therapy compared with 

electrical stimulation. 

The previous study revealed that ES 

could reduce inflammation, improve blood 

flow, reduce the bacterial burden, reduce pain 

and edema, decrease muscle spasms, and 

improve TGF-β1, collagen-I, and muscle 

 

Figure 4. Macroscopical findings of the wounds treated with vibration (upper picture) and Electrical  

stimulation (lower picture) (bar = 1 cm) 

 

Figure 5. The comparison of the wound size between the wounds treated with vibration and 

electrical stimulation (* P< 0.05, **P< 0.01) 



A Comparative Study of the Effects of Vibration... (Yunita Sari et al.) 

257 

contraction (Demir, Balay and Kirnap, 2004; 

Sebastian et al., 2011; Kim, Cho and Lee, 

2014; Torkaman, 2014). 

Recent research by the author has 

shown that compared with the standard 

treatment, wounds treated with ES showed a 

reduction in inflammation and an increase in 

re-epithelialisation (Sari, Sutrisna and Hartono, 

2017). A reduction in inflammation following 

ES in diabetic ulcers might be due to the 

ability of ES to enhance phagocytosis (Cho et 

al., 2000). The improvement of 

reepithelialization might be due to the ability 

of ES to promote keratinocyte migration (Kim, 

Cho and Lee, 2014). 

Based on previous studies, vibration 

could also accelerate the healing of diabetic 

ulcers, such as in pressure ulcers stage I, deep 

tissue injuries, and diabetic ulcers (Arashi et 

al., 2010; Sari, Sanada, et al., 2015; Sari, 

Sutrisna and Hartono, 2016). Vibration 

therapy that can accelerate the healing of 

diabetic ulcer is a vibration which is applied at 

a low frequency. If the vibration is applied at a 

high frequency, it will cause tissue damage 

(Sari, Sutrisna and Hartono, 2016). A high 

frequency of vibration might cause an 

excessive increase of reactive oxygen species 

and nitric oxide that causes the 

vasoconstriction of blood vessels (Hughes et 

al., 2009). 

In this study, the author used a 

vibration of 40 Hz and ES with a frequency of 

20 Hz, pulse width of 320 Hz at a current of 50 

µA. These values were chosen after previous 

studies by the author, and other researchers 

found that wounds healed using those ranges 

of frequency and currents (Torkaman, 2014; 

Sari, Sutrisna and Hartono, 2017). The 

previous study revealed that a vibration below 

50 Hz could accelerate the wound healing of 

chronic ulcers (Arashi et al., 2010; Sari, et al., 

2015). The author investigated a vibration 

frequency range and determined that a 

frequency of 40 Hz accelerated the healing of 

diabetic ulcers (Sari, Sutrisna and Hartono, 

2016). In relation to ES, the author also found 

that the frequency of 20 Hz, the pulse width of 

320 Hz and a current of 20 μA could 

accelerate the healing of diabetic ulcers (Sari, 

Sutrisna and Hartono, 2017). 

In this study, we found that wound 

healing in diabetic ulcers using vibration was 

better than using ES. The wound sizes were 

smaller when treated with vibration and 

showed a greater reduction in inflammation 

compared with the wounds treated using ES. 

However, the mechanism for this difference 

remains unknown. In this study, the vibration 

was experienced by the entire body, and so it 

is possible that blood flow might increase 

systemically and not only to the wound area. 

However, blood flow is likely to increase only 

in the wound area during ES, since the 

electrodes were placed directly on the wound. 

In patients with DM, increased blood flow 

around the body is important since high blood 

glucose frequently causes plaque that can 

result in impaired blood flow. Another study is 

needed to elucidate the mechanism as to why 

 

Figure 6. The histological findings of the 

epidermis and dermis layer 

between the vibration and ES 

groups. Hematoxylin and Eosyn 

staining in the epidermis layer 

(upper part) and dermis (lower 

part) between vibration and 

electrical stimulation (magnifi-

cation of 400X) 

 

Figure 7. Re-epithelialisation between the 

vibration and ES group. Re-

epithelialisation was longer in the 

vibration group than in electrical 

stimulation group (arrow line 

indicates length of reepitheliali-

sation, magnification of 100X) 

 



Jurnal Ners Vol. 12 No. 2 Oktober 2017: 253-260 

258 

the wound healed better in vibration compared 

with in ES.   

In this study, all of the animals with 

diabetic ulcers survived during the observation 

of wound healing. However, ES can 

sometimes cause skin tearing. It is, therefore, 

reasonable to suggest that vibration therapy is 

safer than ES. 

The results of this study are very 

important since it is the first study that 

establishes that vibration accelerates wound 

healing in diabetic ulcers to a greater extent 

than ES. Nurses should consider using 

complementary therapies such as vibration to 

accelerate the healing of diabetic ulcers instead 

of using ES.  

CONCLUSIONS 

This study is the first study in the 

literature to investigate the comparison of the  

effect of vibration therapy and electrical 

stimulation therapy in accelerating the wound 

healing of diabetic ulcers. In this study, we 

revealed that wounds treated with vibration 

therapy healed better than by ES therapy. 

Besides, this is the first study in the 

literature that compares the effect of vibration 

therapy with electrical stimulation therapy in 

relation to the wound healing of diabetic ulcers. 

We have demonstrated that the wounds treated 

with vibration therapy healed better than by 

ES therapy, and so we suggest that nurses in 

clinical settings use complementary vibration 

therapy instead of ES when treating wounds.  

In this study, we used animals since we 

wanted to investigate the healing of the 

wounds in diabetic ulcers in deep tissue. In the 

future, we will compare the effects of vibration 

and ES in human subjects.  

Acknowledgment 

This study was funded by the 

Penelitian Unggulan Perguruan Tinggi grant 

from the Ministry of Research, Technology 

and Higher Education. The researcher would 

like to thank Wawan Setiawan and Genti 

Larasati for their assistance during the animal 

experiments.  

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