European Journal of Oncology Nursing 18 (2014) 585e590

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European Journal of Oncology Nursing

journal homepage: www.elsevier.com/locate/ejon

Complex decongestive therapy and taping for patients with

postmastectomy lymphedema: A randomized controlled study
€
Nihan Ozünlü Pekyavaş a, *, Volga Bayrakcı Tunay b, Türkan Akbayrak b, Serap Kaya b,
Metin Karataş a
a
Baskent University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Baglıca 06810, Ankara, Turkey
b
Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Sıhhiye 06410, Ankara, Turkey

a b s t r a c t
Keywords: Purpose: The purpose of our study was to investigate the effects of Kinesio Taping® Application with
Kinesio Taping® application Complex Decongestive Therapy (CDT) in patients with lymphedema.
Lymphedema
Materials and Methods: 45 patients were randomly divided into 3 groups (CDT including Bandage, CDT
Complex decongestive therapy
Breast cancer
including Bandage þ Kinesio Tape®, CDT including Kinesio Tape® without bandage). Assessments
Exercise included the severity of the symptoms such as pain, discomfort, heaviness, tension, stiffness and
weakness. Bilateral circumference measurements were done for evaluation of the edema.
Results: Symptoms were decreased in all three groups (p < 0.05). CDT was found effective only during
treatment in arm volume (p < 0.05). Kinesio Taping® applied with CDT had effect of decreasing edema
after 10 days of treatment period (p < 0.05) and for control period (p < 0.05). Only the application of
Kinesio Taping® group also had significant decrease at edema (p < 0.05).
Conclusion: Kinesio Taping® Application along with CDT may have a better effect on decreasing lym-
phedema which can stimulate the reduction of edema for long term effects.
© 2014 Elsevier Ltd. All rights reserved.

Introduction Complex Decongestive Therapy (CDT) or Decongestive

Lymphedema is a swelling of the soft tissues that results from
the accumulation of protein-rich fluid in the extracellular spaces. It
caused by decreased lymphatic transport capacity and/or increased
lymphatic load (International Society of Lymphology (2009)).
Upper extremity lymphedema occurred after mastectomy is a
common complication of breast cancer treatment. Both surgery
and/or radiotherapy, involving lymph drainage routes of the breast
and axillary areas, are implicated in the development of upper
extremity lymphedema (Tsai et al., 2009; Ware and Sherbourne,
1992; Willams, 2006). Lymphedema results in swelling of the
arm, hand, and trunk which can lead to limb pain, heaviness, and
altered sensation. These symptoms can result in functional limita-
tions of the affected limb and psychosocial distress can arise sec-
ondary to both symptoms and poor limb cosmesis (Kim et al., 2010).
* Corresponding author. Tel.: þ90 312 2466673; fax: þ90 312 2466674.
E-mail addresses: nihan_2002@hotmail.com (N.O. € Pekyavaş), volgamel@yahoo.
com (V.B. Tunay), takbayrak@yahoo.com (T. Akbayrak), serapky@yahoo.com
(S. Kaya), metink@baskent-ank.edu.tr (M. Karataş).
Lymphatic Therapy is a common management for lymphedema. A
program combining skin care, manual lymphatic drainage, exercise,
and compression therapy (multilayer bandage or garment) is
recognized as the best practice in lymphedema management (Kim
et al., 2010; Lasinski, 2013; Liao et al., 2012).
Manuel Lymphatic Drainage (MLD) is a major component of
CDT. Within the network of initial lymphatics in the dermis, lymph
normally moves in various directions across the skin and down
through pre-collector and collector vessels towards lymph nodes.
MLD can be used to redirect lymph across the plexus of initial
lymphatics towards healthy lymph nodes, often across the water-
shed areas between lymphatic territories of the skin and via the
intercostal and parasternal lymphatics of the trunk. The initial
lymphatics respond to the rhythmic movement of the skin under
the therapist's hands, opening to allow fluid to enter the system.
MLD also influences the contractile function of larger collector
lymphatics, enhancing lymph flow and creating a suction effect
that pulls lymph from distal areas toward the lymph nodes
(Williams, 2006). Skin care is also an important component of CDT.
Edematous areas should be kept clean, dry and moisturized with a

http://dx.doi.org/10.1016/j.ejon.2014.06.010
1462-3889/© 2014 Elsevier Ltd. All rights reserved.
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suitable bland emollient. General advice should be given to patients
on observing their skin (Williams, 2006).
Exercise is the other important component of the CDT. Lymph
flow can be enhanced by activities such as walking, arterial pulsa-
tion, arteriolar vasomotion, intestinal peristalsis, muscle move-
ment, exercise, massage or respiration. Exercise is a general
provider of all enhancing activities (Shim et al., 2003) and exercises
may facilitate venous and lymphatic flow (Hayes et al., 2009; Ya-
Hui et al., 2012). Kim et al. (2010) stated that for the treatment of
patients with breast cancererelated lymphedema, active resistive
exercise with complex decongestive therapy did not cause addi-
tional swelling, and it significantly reduced proximal arm volume
and helped improve quality of life (Kim et al., 2010).
Compression bandaging made with short stretch bandages is
also one of the major components of CDT. King et al. (2012) re-
ported that within the initial treatment phase of a CDT protocol for
acquired, breast cancer-related lymphedema, compression
bandaging may lead to greater volume reduction but worse upper
extremity functional status (higher Disability of Arm and Shoulder
Questionnaire scores) as compared to compression garments (King
et al., 2012). A multilayer bandage can only be stretched a little
and is usually used to maintain the volume reduction from manual
lymphatic drainage by the help of exercise. It provides mild
pressure during resting and creates higher pressure during muscle
contraction to prevent skin extension. The lymphatics are com-
pressed between the muscle and the bandage, causing them to be
manually pumped. The variable pressure over the skin created by
muscle contraction is identical to the effect obtained after a
massage, which increases the lymph flow. The bandage should be
kept on as long as possible, even during the night (Tsai et al.,
2009).
In lymphedema management, Kinesio Taping® Lymphatic
Correction Method is also used to assist the removal of edema by
directing fluid towards a less congested lymphatic pathway and
lymph node. This is accomplished by the lift effect and elasticity of
Kinesio Taping® material. The lifting of superficial skin decreases
pressure and opens initial lymphatics, while the tape also creates a
massaging action during active motion. This effect is very impor-
tant especially in patients with sensitive skin to pressure. The effect
of Kinesio Taping® on muscle also improves the efficiency of the
deeper lymphatics by allowing maximum contraction and relaxa-
tion of a muscle (Kase et al., 2003).
According to the literature there are lots of studies those
investigating the effects of CDT in lympedema treatment (Shim
et al., 2003; Szuba et al., 2000; Tsai et al., 2009; Ya-Hui et al.,
2012) however there is no randomized controlled study compared
the effects of CDT, CDT plus Kinesio Tape® and CDT without
bandage (skin care þ MLD þ exercise) plus Kinesio Tape® in lym-
pedema treatment after mastectomy.
Materials and methods
Research design
The study protocol was approved by the Hacettepe University
Ethics Committee (HEK 12/227-16), and all participants provided
written consent. 45 patients with grade 2 and 3 lymphedema were
randomly divided into 3 groups. The CDT including MLD,
compression bandage skin care and theurapeutic exercises were
applied to the first group. In the second group, CDT was combined
with Kinesio Taping® Lymphatic Correction Technique. This lymph
technique was applied to the skin under the compression
bandaging. In the third group CDT without bandaging was com-
bined with and Kinesio Taping® Lymphatic Correction Technique.
After 10 treatment sessions, compression garments were provided
to all patients. Patients were also instructed to continue their ex-
ercises at home. All patients were assessed by an experienced
physiotherapist and the treatments were done by another educated
lymphedema therapist in order to provide single blind structure of
the study.
The patients were randomly assigned to the one of the three
groups using an online random allocation software program
(GraphPad Software QuickCalcs, GraphPad Software Inc., La Jolla,
California, USA).
Participants
Forty five patients who admitted to Başkent University Hospital,
Ankara, Turkey with the complaints of edema, pain, limitations in
daily living activities, discomfort, heaviness, tension, stiffness,
numbness and were diagnosed with grade 2 and 3 lymphedema
participated in the study. Participants were included if they had
post-mastectomy upper extremity lymphedema. All participants
had infiltrating ductal carcinoma as cancer type. None of the pa-
tients had limited shoulder range of motion. 45 patients were
divided into 3 groups randomly but the groups did not show ho-
mogeneity according to the sociodemographic characteristics
except Body Mass Index (BMI) and time since surgery. Time since
surgery was between 6 and 8 years and statistically homogeny
between groups (p ¼ 0.483). All patients had received a pharma-
cologic treatment of Chemotherapy or Chemotherapy þ
Radiotherapy but had developed lymphedema in 6e8 years.
Exclusion criteria for this study were if subject; a) had grade 1 or 4
lympedema, b) had cardiac and kidney problems, c) had an allergy
to adhesive tape, d) had acute infection in any part of their body, e)
had malign metastasis to any organs, f) orthopedic problems
affecting upper extremity.
Assessments
Patients were assessed before, at the end of the treatment
(10th day) and at control period (1 month after the end of
treatment). Assessments included the severity of the
lymphedema-related symptoms such as pain, limitations in daily
living activities, discomfort, heaviness, tension, stiffness and
numbness which were evaluated by Visual Analog Scale (VAS).
VAS is a 10 cm line with no marks along them, anchored with the
words “no pain” on one hand, and “the most severe pain” on the
other. Participants were simply instructed to place a mark along
the line at a level representing the intensity of their pain,
discomfort, heaviness, tension, stiffness and numbness, limita-
tions of daily living activities. Also patient satisfaction during
night and daily living from the treatment, itching and wound
formation caused by treatment were assessed with VAS at the
end of treatment (Tsai et al., 2009).
For the evaluation of volume reduction, circumferential mea-
surements in centimeters on bilateral upper extremities at 5 cm
intervals from wrist to axilla were used. These circumference
measurements were then used to calculate the volume of the arms
with Frustum Formula (Kaulesar Sukul et al., 1993).
In addition, quality of life was evaluated by Short-Form 36 (SF-
36). The SF-36, developed by Ware and Sherbourne (1992), consists
of a multi-item scale which assesses eight health concepts each
between 2 and 10 questions: physical functioning (PF), role limi-
tations due to physical problems (RP), bodily pain (BP), general
health perception (GH), vitality (VT), social functioning (SF), role
limitations due to emotional problems (RE), and mental health
(MH). Lower scores describe limitations in quality of life (Ware and
Sherbourne, 1992).
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Fig. 1. Kinesio Tape® lymphatic correction method.

Treatments

Treatment intervention was given during the 10 days treatment

period. The first group received CDT every treatment session, which
included skin care, 30-min manual lymphatic drainage, application
of a short-stretch multilayer compression bandage, and a 20-min
remedial exercise program. The second group also received CDT
including MLD, compression bandage, skin care and exercise pro-
gram but application of Kinesio Tape® Lymphatic Correction
Method was done under the bandage (Fig. 1). The third group
received CDT including MLD, skin care and remedial exercise pro-
gram but Kinesio Tape® Lymphatic Correction Method was used
instead of a bandage application. Each group received five sessions
per week in the 2-week intervention period. Each patient was
treated on a daily basis and all treatments were applied every day.
The MLD was standardized with the same protocol for
lymphatic drainage to the anterior trunk, posterior trunk and
affected arm, always moving fluid from the affected side toward the
unimpaired side. The exercise program included relaxation,
breathing, stretching, pumping and strengthening exercises (Ko
et al., 1998). After lymphatic drainage either the short-stretch
bandage or the Kinesio Tape® Lymphatic Correction Method was
applied by the physiotherapist. The bandage or Kinesio Tape® was
applied every day. During the follow-up phase of 4 weeks, patients
in both groups were instructed to maintain skin care, self-
Fig. 2. Flow chart of the study.
lymphatic drainage, exercise program, and to use their compres-
sion garments. The patients were educated to stay away from heavy
housework or jobs, and were asked to wear their compression
garments regularly.
Statistical analysis
Kruskal Wallis test and ChieSquare test were used to analyze
the homogeneity of groups in sociodemographic parameters. A
linear mixed model was used to evaluate the change of the three
groups across the three assessment time points for each dependent
measure separately. The factors of interest were group (CDT,
CDT þ Kinesio Tape® and CDT without bandage þ Kinesio Tape®)
and time (before treatment, after treatment and control period).
Patient satisfaction was evaluated only at the end of therapeutic
intervention and was analyzed with Kruskal Wallis Test. All sta-
tistical analysis was set a priori at an alpha level of p  0.05. If
significance was found post-hoc analysis with a Bonferroni
correction for multiple comparisons was used to determine dif-
ferences between specific factors. All analysis was performed using
SPSS v 18 (IBM, Armonk, NY, USA).

Table 1
Sociodemographic characteristics of participants.

1. Group (n) (Bandage) 2. Group (n) 3. Group (n) p

(Bandage þ Kinesio tape) (Kinesiotape)

Age (year) 49.6 ± 10.5 58 ± 8.5 56.5 ± 9.4 .056a

BMI (kg/m2) 29.9 ± 4.7 30.6 ± 6.6 31.0 ± 4.0 .717a
Time since Surgery (year) 6.7 ± 1.5 8.5 ± 3.9 6.9 ± 2.6 .483a
Type of Surgery (%) MRM þ AD 53.3(8) 46.7(7) 73.3(11) .000b*
PM 6.7(1) 6.7(1) 0(0)
PM þ AD 26.7(4) 40.0(6) 20.0(3)
RM þ AD 13.3(2) 6.7(1) 6.7(1)
Type of Treatment Taken (%) Chemotherapy 40.0(6) 73.3(11) 53.3(8) .000b*
Chemotherapy þ Radiotherapy 60.0(9) 26.7(4) 46.7(7)

*p < 0.05.
BMI: Body Mass Index.
MRM: Modified Radical Mastectomy.
AD: Axillary Dissection.
PM: Partial Mastectomy.
RM: Radical Mastectomy.
*p < 0.05.
a
Kruskal Wallis Test.
b
ChieSquare Test.
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Table 2
The mean differences in arm volume. pain. lymphedema-related symptoms and SF-36 score parameters between three groups.

1. Group (Bandage) 2. Group (Bandage þ Kinesio tape)

Baseline Values BT-AT X ± SE (pb) AT-C X ± SE (pb) BT-C X ± SE (pb) Baseline Values BT-AT X ± SE (pb)
(X ± SE) (X ± SE)

Lymphedema 921.15 ± 629.21 313.90 ± 111.58 (.023*) 44.48 ± 64.76 (1.00) 358.38 ± 108.22 (.052) 1303.67 ± 987.54 373.29 ± 115.79 (.008*)
Volume (ml)
Pain (cm) 1.92 ± 2.26 .78 ± .53 (.449) .64 ± .60 (.884) 1.42 ± .57 (.053) 2.57 ± 3.14 1.00 ± .55 (.237)
Limitations of daily 3.25 ± 2.45 1.14 ± .73 (.387) 1.25 ± .45 (.029*) 2.39 ± .69 (.004*) 2.76 ± 2.71 1.53 ± .76 (.154)
living activities (cm)
Discomfort (cm) 5.35 ± 4.04 2.03 ± .70 (.018*) 1.82 ± .97 (.209) 3.85 ± 1.00 (.001*) 3.88 ± 3.81 1.50 ± .72 (.137)
Heaviness (cm) 3.64 ± 3.31 1.89 ± .64 (.016*) .60 ± .33 (.228) 2.50 ± .72 (.004*) 3.38 ± 3.42 1.96 ± .66 (.017*)
Tension (cm) 3.21 ± 3.36 1.85 ± .72 (.045*) .35 ± .28 (.670) 2.21 ± .77 (.022*) 3.00 ± 3.72 1.34 ± .75 (.249)
Stiffness (cm) 3.68 ± 3.51 1.86 ± .86 (.110) .35 ± .28 (.641) 2.22 ± .92 (.063) 3.80 ± 3.77 2.34 ± .89 (.037*)
Numbness (cm) 1.60 ± 2.58 .57 ± .34 (.328) .89 ± .47 (.195) .32 ± .36 (1.00) 1.46 ± 1.94 .42 ± .36 (.748)
SF-36.p 48.11 ± 9.78 2.54 ± 1.05 (.062) .00 ± .00 2.54 ± 1.05 (.062) 44.54 ± 9.20 .05 ± 1.09 (1.00)
SF-36.m 41.23 ± 11.66 3.71 ± 1.41 (.037*) .00 ± .00 3.71 ± 1.41 (.037*) 48.15 ± 9.13 3.80 ± 1.46 (.040*)

BT: Before Treatment.

AT: After Treatment.
C: Control Period.
SF-36.p: Short Form 36 Physical Parameters.
SF-36.m: Short Form 36 Mental Parameters.
*p < 0.05.
X ± SE: Mean ± Standard Error.
£: Comparison of three groups (Greenhouse- Geisser).
b: Coımparison of three time factors.
BT-AT: Difference between Before Treatment and After Treatment.
AT-C: Difference between After Treatment and Control Period.
BT-C: Difference between Before Treatment and Control Period.

Results
The power analysis indicated that 15 participants for each group
were needed with 80% power and a 5% type 1 error. The power
analysis of our study showed a power of 80% with discomfort as the
primary outcome.
Forty five patients with the mean age of 49.6 ± 10.5 years and
the mean body mass index of 29.9 ± 4.7 kg/m2 participated in this
study. Sociodemographic characteristics of participants are shown
in Table 1. The flow-chart in Fig. 2 shows allocation of patients to
treatment groups. The differences between the bilateral arm vol-
ume estimates based on Frustum model and pain, lymphedema-
related symptoms and quality of life scores of three groups are
presented in Table 2. No significant difference was found between
three groups in all measurement parameters as pain, limitations in
daily living activities, discomfort, heaviness, stiffness and numb-
ness, quality of life (p > 0.05), but significant difference was found
between time factors in all groups (p < 0.05). Participants' re-
sponses to the bandage or Kinesio Tape® after treatment are shown
in Table 3. No significant difference was found between three
groups in all measurement parameters as patient satisfaction from
the treatment at night and daily activities, itching and wound for-
mation at the end of treatment (p > 0.05).
Discussion
In this study we investigated the effects of CDT, CDT plus Kinesio
Tape® and CDT without bandage (skin care þ MLD þ exercise) plus
Kinesio Tape® in lymphedema treatment after mastectomy and
found similar effects on decreasing lymphedema and symptoms
and increasing quality of life.
In comparison of the three application methods at the param-
eter of arm volume, compression bandaging along CDT and CDT
without bandage plus Kinesio Tape® groups only had a decreasing
effect during treatment period but Kinesio Taping® applied under
compression bandaging had a decreasing effect both during the
treatment and at the control period of 4 weeks.
It could be said that CDT plus Kinesio Tape® application brings
longevity to the effect of lymphedema treatment. The reason for
this may be that Kinesio Taping® Lymphatic Correction Method
creates channeling at lymphatic circulation by lifting the epidermis
and increasing the volume of dermis which contains lymphatic
vessels and compression of bandage creates press effect on the
extracellular fluid (Kase et al., 2003). Tsai et al. (2009) studied about
Kinesio Taping® in patients with lymphedema and has recruited
forty-one patients with unilateral breast-cancer-related lymphe-
dema who were randomly into two groups as CDT and modified
CDT. Skin care, 30-min manual lymphatic drainage, 1-h pneumatic
compression therapy, application of a short-stretch bandage or
Kinesio Tape® for each group, and a 20-min physical therapy ex-
ercise were given during every treatment session. Patient evalua-
tion items included physical therapy assessment, limb size, and
water composition of the upper extremity, lymphedema-related
symptoms, quality of life, and patients' acceptance to the bandage
or tape. They stated that Kinesio Tape® could replace the bandage in
CDT and could be an alternative for patients with breast-cancer-
related lymphedema who had poor compliance with the bandage.
They also stated that within the groups, patients in both groups
experienced improvement in some of the outcome variables which
is parallel to our findings (Tsai et al., 2009). As we investigate the
mean differences between the volumes of bilateral arms, Kinesio
Tape® application along with CDT has made the highest improve-
ment compared to other groups. This could be explained as Kinesio
Tape® Lymphatic Correction Method Application has made the
channeling and compression bandaging had the extra effect of
pumping the fluid away from the affected area.
The abnormal sensation of heaviness is also found to be
decreased in all groups with treatment and at control period
because of the decreased amount of fluid at subcutaneous tissue.
There are many studies investigating the effects of CDT and
treatment sessions are at the range of 3e26 days long (Holtgrefe,
2006; Liao et al., 2004; Szuba et al., 2000; Yamamoto and
Yamamoto, 2000). In our study, the treatment period was chosen
as 10 days because the patients could visit the clinic for 10 days paid
by social insurance. Having treatment for only 10 days could be a
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3. Group (Kinesio tape) p£

AT-C X ± SE (pb) BT-C X ± SE (pb) Baseline Values BT-AT X ± SE (pb) AT-C X ± SE (pb) BT-C X ± SE (pb)
(X ± SE)

174.64 ± 67.21 (.040*) 547.94 ± 112.31 (.000*) 983.72 ± 821.06 358.21 ± 111.58 (.008*) 20.83 ± 64.76 (1.00) 379.04 ± 108.22 (.010*) .308

.84 ± .62 (.557) 1.84 ± .59 (.011*) 3.28 ± 2.46 1.42 ± .53 (.033*) 1.14 ± .60 (.199) 2.57 ± .57 (.000*) .723
.46 ± .47 (1.00) 2.00 ± .72 (.026*) 5.03 ± 3.05 2.64 ± .73 (.003*) 1.21 ± .45 (.035*) 3.85 ± .69 (.000*) .252

1.03 ± 1.01 (.934) 2.53 ± 1.03 (.058) 6.75 ± 3.16 3.42 ± .70 (.000*) 1.92 ± .97 (.166) 5.35 ± 1.00 (.000*) .291
.65 ± .34 (.198) 2.61 ± .75 (.004*) 5.46 ± 2.89 3.64 ± .64 (.000*) .35 ± .33 (.871) 4.00 ± .72 (.000*) .202
.46 ± .29 (.394) 1.80 ± .80 (.094) 4.57 ± 3.90 2.96 ± .72 (.001*) .32 ± .28 (.816) 3.28 ± .77 (.000*) .383
.84 ± .29 (.019*) 3.19 ± .95 (.006*) 5.87 ± 3.73 3.95 ± .86 (.000*) .50 ± .28 (.254) 4.45 ± .92 (.000*) .234
.57 ± .48 (.732) 1.00 ± .37 (.034*) 3.64 ± 3.41 .14 ± .34 (1.00) .92 ± .36 (.043*) .78 ± .47 (.308) .466
.00 ± .00 .05 ± 1.09 (1.00) 41.01 ± 10.67 .55 ± 1.05 (1.00) .00 ± .00 .55 ± 1.05 (1.00) .230
.00 ± .00 3.80 ± 1.46 (.040*) 47.77 ± 10.27 .80 ± 1.41 (1.00) .00 ± .00 .80 ± 1.41 (1.00) .249

Table 3
Participants' responses to the bandage or Kinesio tape after treatment.

1. Group 2. Group 3. Group pb X2

(Bandage) X ± SD (Bandage þ Kinesio tape) X ± SD (Kinesiotape) X ± SD

Patient satisfaction from the treatment at night (cm) 6.66 ± 4.35 3.33 ± 4.74 7.06 ± 4.44 .139 3.946
Patient satisfaction from the treatment at daily living (cm) 6.33 ± 4.16 4.50 ± 4.88 6.90 ± 3.71 .716 .668
Itching (cm) 5.80 ± 4.07 5.66 ± 3.35 5.13 ± 3.20 .831 .369
Wound formation caused by treatment (cm) 3.80 ± 4.26 2.90 ± 2.30 3.83 ± 4.03 .978 .045

*p < 0.05 b: Kruskal Wallis Test X ± SD: Mean ± Standard Deviation.

stimulant for the lymphatic circulation as the treatment could be
longer to see better effects.
Many researchers discussed the various physiological symptoms
of lymphedema. Williams et al. (2002) used 11 lymphedema-
related symptoms such as sensations of pain, discomfort, heavi-
ness, fullness, bursting, hardness, heat, cold, numbness, weakness
and tingling to evaluate the effects of intervention (Williams et al.,
2002). In our findings the intensity of pain at the effected arm had
significant decrease with Kinesio Tape® applications in Group 2 and
3, Kinesio Tape® has the effect of lifting the skin with creating
convolutions which enlarges the area of dermis and inhibits the
free nerve endings (Kase et al., 2003; Tsai et al., 2009).
Different application techniques of Kinesio Tape® is said to have
physiological effects including decreasing pain or abnormal
sensation, supporting the movement of muscles, removing
congestion of lymphatic fluid or hemorrhages under the skin, and
correcting misalignment of joints (Tsai et al., 2009).
According to Tsai et al. (2009), during the intervention period,
participants in the bandage group frequently complained that
wearing a bandage was very inconvenient, and it served as a
reminder to them that they were sick and handicapped. After
substituting a compression garment for the bandage in the follow-
up period, they might feel much better. On the contrary, for patients
in the tape group, they had to wear a compression garment instead
of the relatively more comfortable Kinesio Tape®. This might cause
them to feel uncomfortable (Tsai et al., 2009). In contrast in our
study, we have seen that all treatment groups have a very positive
effect on lymphedema-related limitations in daily living activities.
SF-36 scoring is divided into two parameters including SF-36.p
for physical parameters such as physical functioning (PF), role limi-
tations due to physical problems (RP), bodily pain (BP), general
health perception (GH) and SF-36.m for mental parameters such as
vitality (VT), social functioning (SF), role limitations due to emotional
problems (RE), and mental health (MH) (http://www.sf-36.org/
demos/SF-36.html) (last accessed: 11.02.2014). SF-36.m scores of
group 1 and 2 are found to be increased at treatment and control
periods. This could mean that compression bandage used in CDT has
a positive effect on patient mentality for the effect of treatment.
The cost of materials of the bandage application (group 1) and
Kinesio Tape® application (group 3) were similar in 10 days treat-
ment period. The treatment of Kinesio Tape® application along with
compression bandaging doubles the cost of the materials. If the
treatment period was extended to more than 10 days, the cost of
Kinesio Tape® would be higher than bandage application because
Kinesio Tape® is a one-time use product, but the bandage can be
reused. A cost effectiveness analysis might be considered in clinical
practice. The time-cost of Kinesio Tape® application is better than
compression bandaging treatment. Kinesio Tape® application is
faster and pre-cut tapes can be found in order to decrease the time
spent. However we have to remain in mind that Kinesio Tape® can
make an allergic reactions in sensitive skins.
The limitation of the study is that patients may not have done
the exercises at home or may not have worn the compression
garments properly during the control period and this could effect
our findings.
Conclusion
Kinesio Taping® applied with CDT (skin care þ MLD þ
compression bandaging þ exercise) may have positive effect on
decreasing the symptoms related to lymphedema. Also It might be
said that CDT plus Kinesio Tape® application brings longevity to the
effect of lymphedema treatment. We may recommend this method
as an alternative technique in the treatment of suitable lymphe-
dema patients. Further research may be needed with larger sample
sizes.
Conflict of interest
None declared.
Role of the funding source
None declared.
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N.O.

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