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Research Report

Effect of Taping on Spinal Pain and


Disability: Systematic Review and
Meta-Analysis of Randomized Trials
Carla Vanti, Lucia Bertozzi, Ivan Gardenghi, Francesca Turoni,
Andrew A. Guccione, Paolo Pillastrini
C. Vanti, PT, MSc, OMT, Depart-
ment of Biomedical and Neuro-
Background. Taping is a widely used therapeutic tool for the treatment of logical Sciences, University of
musculoskeletal disorders, nevertheless its effectiveness is still uncertain. Bologna, Bologna, Italy.
L. Bertozzi, PT, MSc, Department
Purpose. The purpose of this study was to conduct a current review of random- of Biomedical and Neurological
ized controlled trials (RCTs) concerning the effects of elastic and nonelastic taping on Sciences, University of Bologna.
spinal pain and disability.
I. Gardenghi, PT, Department of
Biomedical and Neurological Sci-
Data Sources. MEDLINE, CINAHL, EMBASE, PEDro, Cochrane Central Register ences, University of Bologna.
of Controlled Trials (CENTRAL), Scopus, ISI Web of Knowledge, and SPORTDiscus
databases were searched. F. Turoni, PT, Department of Bio-
medical and Neurological Sci-
ences, University of Bologna.
Study Selection. All published RCTs on symptomatic adults with a diagnosis of
specific or nonspecific spinal pain, myofascial pain syndrome, or whiplash-associated A.A. Guccione, PT, PhD, DPT,
FAPTA, Department of Rehabilita-
disorders (WAD) were considered. tion Science, College of Health
and Human Services, George
Data Extraction. Two reviewers independently selected the studies and Mason University, Fairfax,
extracted the results. The quality of individual studies was assessed using the PEDro Virginia.
scale, and the evidence was assessed using GRADE criteria. P. Pillastrini, PT, MSc, Department
of Biomedical and Neuromotor
Data Synthesis. Eight RCTs were included. Meta-analysis of 4 RCTs on low back Sciences, University of Bologna,
pain demonstrated that elastic taping does not significantly reduce pain or disability Via Albertoni, 15 Bologna
40138, Italy. Address all corre-
immediately posttreatment, with a standardized mean difference of —0.31 (95%
spondence to Dr Pillastrini at:
confidence interval=—0.64, 0.02) and —0.23 (95% confidence interval=—0.49, paolo.pillastrini@unibo.it.
0.03), respectively. Results from single trials indicated that both elastic and nonelastic
[Vanti C, Bertozzi L, Gardenghi I,
taping are not better than placebo or no treatment on spinal disability. Positive results
et al. Effect of taping on spinal
were found only for elastic taping and only for short-term pain reduction in WAD or pain and disability: systematic
specific neck pain. Generally, the effect sizes were very small or not clinically review and meta-analysis of ran-
relevant, and all results were supported by low-quality evidence. domized trials. Phys Ther.
2015;95:493–506.]
Limitations. The paucity of studies does not permit us to draw any final © 2015 American Physical Therapy
conclusions. Association
Published Ahead of Print:
Conclusion. Although different types of taping were investigated, the results of November 20, 2014
this systematic review did not show any firm support for their effectiveness. Accepted: November 13, 2014
Submitted: December 23, 2013

Post a Rapid Response to


this article at:
ptjournal.apta.org

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Effect of Taping on Spinal Pain and Disability

N eck pain (NP) and low back


pain (LBP) among adults in
the United States are com-
mon, costly, and, in some instances,
and adhesive tapes, among which
Kinesio Tex tape (Kinesio Holding
Corp, Albuquerque, New Mexico)11
is likely the most well-known. Rigid
tic intervention in the treatment of
musculoskeletal pathology. Clinical
interest also is growing, as demon-
strated by the fact that the education
chronic.1 Although the natural his- taping was the first type of taping regarding KT has had a marked
tory of these conditions appears to used, and it is still adopted as an increase in recent years. Since its
be favorable and self-limiting,2 rates adjunct for treatment of musculo- inception, 50,000 individuals have
of recurrence3,4 and risk for chronic- skeletal injuries. The rationale for been trained in this method, about
ity appear high for both of these its mechanism of action is that it half of whom are physical therapists
musculoskeletal disorders. 5,6 Fur- protects muscles and joints by (Dorothy Cole; personal communica-
thermore, NP and LBP are especially enhancing proprioception and pro- tion; June 4, 2013).
frequent during the most productive viding support.12 In contrast, Dr
years of a person’s life, causing a Kenzo Kase, a Japanese chiroprac- Despite the magnitude of KT’s cur-
large number of lost workdays and tor, invented a new form of tape and rent popularity and increasing use in
lost productivity, and may precipi- technique for therapeutic taping in clinical practice, substantial uncer-
tate permanent disability. 7 In order the 1970s that later developed into a tainty continues to exist regarding its
to decrease this social burden of dis- method called “Kinesiotaping” (KT), true merit, mainly due to insufficient
ability, interventions with demon- which required an elastic type of and inconsistent supporting evi-
strated efficacy for specific out- tape (ie, Kinesio Tex tape).11 This dence. The limited scientific infor-
comes are essential.8 tape was different from traditional mation available has been obtained
rigid tape used mainly in athletics. Its mostly from reports, case series
Among the conservative therapeutic elasticity allows a clinician to stretch studies, and individual anecdotal
interventions adopted by physical it up to 130%–140% of its original patient experiences. Even though
therapists and other health care pro- length before application, and it can more clinical trials have been under-
viders, taping is one of the most be worn for several days without taken in recent years to examine the
commonly used in the prevention removal. These properties arguably efficacy of KT, systematic reviews
and treatment of sports injuries and a make it a useful tool following injury and meta-analyses published on this
variety of clinical conditions, includ- and during rehabilitation.12,13 issue so far10,15,17–23 have reached
ing spinal pain.9,10 Several types of conclusions that do not align com-
tapes are available, each with its own pletely with each other. Consider-
Various therapeutic benefits have
mechanical characteristics as well as ing, for example, only those reviews
been proposed for KT, including its
theorized aims and techniques of published between 2012 and
ability to support fascia, muscles,
2014,10,15,17,18,21–23 opinions range
application. Tapes fall into 2 broad and joints and to decrease pain and
from no apparent clinical benefit18,22
categories: the nonelastic or rigid inflammation by improving lym- to modest impact on outcome,15,17,23
tapes and the elastic nonadhesive phatic and blood circulation without with some agreement that the evi-
restricting the range of motion dence is insufficient10,15 to warrant
Available With (ROM) of the affected part, unlike unequivocal recognition as a thera-
This Article at traditional rigid taping techniques, peutic option on the basis of the evi-
ptjournal.apta.or which restrict movement.10,12,14,15
g dence.21,22 Furthermore, other limi-
Murray and Husk16 have further tations of previous reviews may
• eFigure: Flow Diagram of
suggested another mechanism of have influenced their findings and
Studies Through the
action (ie, enhanced proprioception conclusions, such as aggregating
Different Phases of the
Review through increased stimulation of the results pertaining not only to spinal
cutaneous mechanoreceptors). pain but also to other different con-
• eTable 1: PEDro Score
ditions,18 introducing inclusion and
• eTable 2: Minimal Clinically In recent years, accompanied by exclusion criteria in search strategies
Important Difference Results heightened public awareness with that potentially resulted in publica-
• eAppendix 1: Search Strategy its high-profile presence at the Lon- tion bias (eg, requiring availability of
for PubMed/MEDLINE don Olympics in 2012 and the Euro- full version in English10,15,18,19 and
• eAppendix 2: Quality pean Football Championship,17 a restricting publication date 21), and
Assessment and Summary of growing number of research studies allowing the methodological quality
Findings for All Outcomes and have explored KT to evaluate the of randomized controlled trials
Comparisons effects of this conservative therapeu- (RCTs) to serve as a basis for further
analysis in the review.10 It also is

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Effect of Taping on Spinal Pain and Disability
important to note that no previous evant literature reviews and indexes more than 3 months.24,25 In the
systematic reviews or meta-analyses of peer-reviewed journals. absence of this explicit description,
have evaluated the effects of forms pain was considered acute, sub-
of taping other than KT. Two reviewers (I.G., F.T.) indepen- acute, or chronic when the investi-
dently applied the predetermined gators themselves categorized an
For all of these reasons, we recog- inclusion and exclusion criteria to individual’s pain in those terms.26
nized the need for an up-to-date and select potentially relevant trials, ini- Trials were excluded if any of the
specific systematic review and meta- tially identified based on title and participants received a diagnosis
analysis to determine a more accu- abstract. Full-text copies of relevant such as myelopathy, fracture, infec-
rate estimation of the efficacy of elas- trials were then obtained and inde- tion, dystonia, tumor, inflammatory
tic and nonelastic taping and their pendently evaluated by the review- disease, or osteoporosis.27
impact on pain and disability in ers. Disagreements were resolved
patients with spinal pain. This system- through discussion among the Types of interventions. Among
atic review expands upon previous reviewers, with input of 2 other all of the types of conservative inter-
studies10,15,17–23 by considering differ- authors (C.V., P.P.). ventions used by physical therapists
ent types of taping, explicitly targeting for the treatment of spinal pain, only
a particular population of interest, and Study Selection elastic or nonelastic taping was con-
focusing on specific characteristics of Types of studies. We included sidered in our analysis. Studies con-
RCTs as inclusion criteria. published RCTs without any restric- cerning other interventions or taping
tions on publication date or lan- used in association with therapeutic
Method guage. Among RCTs, only trials with exercise or physical therapy proce-
Data Sources and Searches a control or comparison group were dures without any explicit investiga-
Our literature search aimed to iden- considered as eligible. These trials tion on the distinct effects of each pro-
tify all available studies that evalu- included: (1) intervention versus pla- cedure were excluded. Finally, trials
ated the effect of taping in relieving cebo or sham treatment, (2) inter- were excluded if the prevention of
pain and reducing disability in peo- vention versus no-taping interven- spinal pain was the main clinical pur-
ple with spinal pain. Records were tion or comparator (eg, self-care, pose of the study intervention.
identified by searching multiple liter- advice, continuing with ordinary and
ature databases, including MEDLINE, recreational activities), and (3) inter- Types of outcome measures. To
Cumulative Index to Nursing and vention versus standard practice (eg, be eligible for inclusion, a study had
Allied Health Literature (CINAHL), wait list or usual care). A further cri- to assess pain with a visual analog
EMBASE, Physiotherapy Evidence terion for designating a study as an scale (VAS), a numerical pain rating
Database (PEDro), Cochrane Central eligible “comparison” trial was the scale, or patient self-report as an out-
Register of Controlled Trials comparison of taping plus another come measure. Disability was con-
(CENTRAL), Scopus, ISI Web of intervention versus this same inter- sidered an outcome measure if the
Knowledge, and SPORTDiscus, from vention (eg, taping and therapeutic chosen instrument measured the
their inception to June 2014. The exercise versus therapeutic exer- impact of spinal pain on everyday
search terms used were “taping,” cise) in a comparably matched life beyond work or leisure-time
“kinesio,” “kinesiotape,” and “kine- group. Quasi-RCTs and nonrandom- activities. If more than one instru-
siotaping.” These key words were ized controlled trials were excluded. ment or measure of an outcome of
identified after preliminary literature interest was reported within the
searches and by cross-checking them Types of participants. The partic- same study, only one was considered
against previous relevant systematic ipants in selected studies had to be for the pooled estimate in the meta-
reviews.10,18 The search strategy symptomatic adults (18 years of age analysis. We chose the outcome mea-
used for searching the MEDLINE or older) with a diagnosis of acute, sure that would most likely provide
database through PubMed is pre- subacute, or chronic specific or the most conservative estimate of
sented in eAppendix 1 (available at nonspecific spinal pain, myofascial the effect of taping on the outcome
ptjournal.apta.org). This strategy pain syndrome (MPS), or whiplash- due to the magnitude of the pain
was modified and adapted for each associated disorder (WAD). Pain was or disability. For example, in the case
searched database. Additional categorized as “acute” when it was of pain, we selected the measure
records were searched through evident from the text that partici- that most nearly corresponded to
other sources to complement the pants experienced it for less than 1 “What is your worst pain?” to be
databases’ findings, including man- month, as “subacute” between 1 used in our analysis. Trials investi-
ual research of reference lists of rel- and 3 months, and as “chronic” for gating the effect of taping on pres-

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Effect of Taping on Spinal Pain and Disability
sure pain threshold or pressure reviews.31–33 Trials were not Data Synthesis and Analysis
pain tolerance, electromyographic excluded on the basis of quality. Data were synthesized using a meta-
signals, ROM, proprioception, or analytic method based on a random-
strength or endurance of spinal Clinical Relevance Assessment effects model because this approach
muscles were excluded. Similarly, Two expert physical therapists weights studies by the inverse of
health-related quality of life, patient (C.V., P.P.) assessed the clinical rel- the variance and incorporates heter-
satisfaction, global perceived effect, evance of the extracted studies by ogeneity into the model.41 All effect
work-related measures, depression, evaluating whether the patients and sizes were computed using Hedges’
and other psychosocial measures interventions were described pre- g statistic because it incorporates a
were not considered in our analyses. cisely enough to allow inferences small sample bias correction. 42 Pro-
When possible, we extracted study about the clinical applicability of Meta V.2.0 software43 (Internovi by
findings at baseline, after interven- the results and clinical relevance of Scarpellini Daniele s.a.s. Cesena
tion, and at every reported follow- the measured outcome. The ques- [FC], Italy) was used for the statis-
up. Follow-up data were recorded tions used to assess the clinical rele- tical analyses. Standardized mean
at short-term (defined as less than vance were: (1) Are the patient char- differences (SMDs) with 95% con-
3 months following the date of acteristics and treatment settings fidence intervals (95% CIs) were
randomization), intermediate-term described well enough to decide calculated for continuous data. The
(between 3 and 12 months), and whether they are comparable to SMD was used because different
long-term (12 months or more) time those you see in your own practice? measures were adopted by each
periods.28 If more than one follow- (2) Are all of the interventions study to address the same clinical
up set of data was present within the described well enough to allow you outcome. To interpret effect size cal-
same category of timing of an to provide the same to your own culated with SMD, we used Cohen44
outcome measure, only one set was patients? and (3) Were clinically rel- as a guide to identify small (0.20),
considered. evant outcomes measured? With medium (0.50), or large (0.80)
regard to this last question, the effects. Calculation of effect size was
Data Extraction and Quality experts identified the minimal clini- based first on the best possible data
Assessment cally important difference (MCID) (ie, final means, standard deviations,
Two authors (I.G., F.T.) indepen- for each measurement scale and for and sample sizes of intervention and
dently conducted data extraction. each outcome by referencing the lit- control groups). Selected studies for
Two other authors (C.V., P.P.) were erature. Specifically, they selected which these or other crucial data
consulted in the case of persisting 30% of change in back pain mea- were not directly reported, or
disagreement. Reviewers were not sured with the VAS,34 a 10-point obtainable by contacting authors,
blinded to information regarding the change in back disability on the 100- were not included in the review.
authors, journal of origin, or out- point Oswestry Disability Index
comes for each article reviewed. (ODI),35 or a 2-point change in back A qualitative analysis to evaluate the
Using a standardized form, data disability on the 24-point Roland- overall quality of the evidence was
extraction addressed participants, Morris Disability Questionnaire planned28 and independently con-
types of intervention, follow-up (RMDQ)34,35 as the MCID. Moreover, ducted by 2 authors (I.G., L.B.) using
times, clinical outcome measures, they selected 20% of change in NP as the GRADE approach.45 We used an
and findings that were reported. measured with a VAS,36 25% of adapted version of the criteria advo-
These data are detailed in the Table. change in NP measured with a cated by the Cochrane Back Review
Methodological quality of studies numerical rating scale,37 and a 3.5- Group.46 The quality of evidence
was assessed using the PEDro scale, point change on the 50-point Neck was downgraded by one level for
which has been shown to be reli- Disability Index37,38 as the MCID. A each of 3 factors we encountered:
able29 and valid30 for rating the qual- reference for the MCID of the limitations in the design (eg, >25%
ity of RCTs. Two independent asses- Constant-Murley Scale score, which of participants from studies with
sors (G.M., G.C.) obtained or was used by Lee et al39 to mea- low-quality methods, PEDro score
extracted the score for each trial sure neck disability, could not be <6 points), inconsistency of results
from the PEDro database when avail- located.40 Using these specific MCID (eg, Š75% of participants reported
able. Trials with a rating of at least values, the question of whether the findings in the same direction), and
6/10 on the PEDro scale were con- evidence was sufficient for clinical imprecision (eg, total number of par-
sidered as having high quality, con- recommendations was made. ticipants <300 for each outcome).
sistent with previous systematic We did not assess publication bias
with funnel plots, as too few studies

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Table.
April 2015

Characteristics of Included Studiesa

PEDro Outcome Measures and


Participants b Score Interventionb Follow-upb,c Reported Results b
Parreira et al,
201456 9 Ctrl group: sham KT (1) Pain–NRS (0–10) Pain (between-groups MD=—0.4 points; 95% CI=—1.3, 0.4)
148 patients with chronic nonspecific Exp group: standardized KT (2) Disability–RMDQ (0–24) and disability (—0.3 points; 95% CI=—1.9, 1.3) did not
LBP (>12 wk) Taping application modality: - Follow-up at 0/2 mo significantly decrease after the intervention
Mean age=50.5 y Ctrl group: I-shaped kinesiotape over each erector spinae No significant between-group differences were observed at
Exp group, n=74* muscle with no tension (0% tension) and with the follow-up
Ctrl group, n=74* treated muscle in a nonstretched position Authors’ conclusion: KT applied with stretch to generate
Exp group: I-shaped kinesiotape over each erector spinae convolutions in the skin was no more effective than simple
muscle with 10%–15% of tension (paper-off tension) application of the tape without tension for the outcomes
with the treated muscles in stretched position measured
Type of tape used: Kinesio Tex tape
Renewal of taping: twice per week (tape maintained in
situ for 2 d)
Duration: 4 wk

Bae et al, 201355 7 Ctrl group: placebo taping (1) Pain–VAS (0–10) Pain significantly decreased (P<.05) within both groups after
20 patients with chronic nonspecific Exp group: standardized KT (2) Disability–ODI (0–100) the intervention
LBP (>12 wk) Exp and Ctrl groups: both groups received ordinary - Follow-up at 0 mo Disability significantly decreased in Ctrl group (P<.05) and
Mean age=52.5 y physical therapy with hot pack, ultrasound, and TENS more significantly decreased in Exp group (P<.01) after
Exp group, n=10* to the L1–2 and L4–5 areas for 40 min each time, 3 the intervention
Ctrl group, n=10* times per week Authors’ conclusion: KT applied to patients with chronic LBP
Taping application modality: reduced their pain and disability
Ctrl group=one inelastic I-strip was attached transversely
to the lumbar area with the maximum pain
Exp group=4 blue I-strips were stretched and
overlappingly attached to the lumbar area with the
maximum pain in a star shape

Effect of Taping on Spinal Pain and Disability


Type of tape used: kinesiotape, width=5 cm,
thickness=0.5 mm
Renewal of taping: at each intervention 3 times per
Volume 95 Number 4 Physical Therapy f 497

week
Duration: 12 wk
Castro-Sánchez et al, 201250 9 Ctrl group: sham KT (1) Pain–VAS (0–10) Pain (between-groups MD=1.1 cm; 95% CI=0.3, 1.9) and
60 patients with chronic nonspecific Exp group: standardized KT (2) Disability–ODI (0–100), disability (on ODI score: 4 points; 95% CI=2, 6; on RMDQ
LBP (>12 wk) Taping application modality: RMDQ (0–24) score: 1.2 points, 95% CI=0.4, 2.0) significantly decreased
Mean age=48.5 y Ctrl group: single I-strip of the same tape applied - Follow-up at 0/1 mo more in Exp group vs Ctrl group after the intervention
Exp group, n=30* transversely immediately above the point of maximum Significant between-groups difference maintained only for
Ctrl group, n=30, 29* lumbar pain pain (1.0 cm; 95% CI=0.2, 1.7) at follow-up
Exp group: 4 blue I-strips placed at 25% tension Authors’ conclusion: KT reduced disability and pain in people
overlapping in a star shape (the central part adheres with chronic nonspecific LBP, but these effects may be too
before the ends) over the point of maximum pain in small to be clinically worthwhile
the lumbar area
Type of tape used: Kinesio Tex tape, width=5 cm,
thickness=0.5 mm
Renewal of taping: no one for both groups (tape
maintained in situ for 7 d)
(Continued)
Duration: 1 wk
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498 f Physical Therapy Volume 95 Number 4

Effect of Taping on Spinal Pain and Disability


Table.
Continued

PEDro Outcome Measures and


Participants b Score Interventionb Follow-upb,c Reported Results b
Chen et al, 201251 9 Ctrl group: placebo taping (1) Pain–VAS (0–100) Worst pain significantly decreased more in Exp group vs Ctrl
43 patients with subacute nonspecific Exp group: functional fascial taping average/worst** group after the intervention (P=.02)
LBP (>6 wk) Exp and Ctrl groups: A manual that contained back (2) Disability–ODI (0–100) No significant difference between groups in worst pain at
Mean age=43.2 y care and a standardized simple trunk flexion exercise - Follow-up at 0/1/2.5 mo any stages of follow-up (P>.05)
Exp group, n=21* was given to all participants. The trunk flexion exercise No significant differences between groups in disability and
Ctrl group, n=22* was applied to reinforce the stretching effect of the average pain at all time periods (P>.05)
taping. Authors’ conclusion: functional fascial taping reduced worst
Taping application modality: pain in patients with nonacute nonspecific LBP during the
Ctrl group: strips with no tension over the painful area treatment phase; no mid-term differences in pain or
on the lower back function were observed
Exp group: strips with tension in a direction assessed by
the therapist (generally 3 taping directions were
applied); the direction of tape application was
determined with the skin distraction test that resulted
in maximal pain reduction on trunk flexion
Type of tape used: 3–5 tape layers with rigid strapping
tape MK38
Renewal of taping: daily for both groups
Duration: 2 wk

Paoloni et al, 201152 7 Ctrl group: 30 min of therapeutic group exercises 3 (1) Pain–VAS (0–10) Pain significantly decreased in both groups after the
26 patients with chronic LBP times per week (relaxation techniques as well as (2) Disability–RMDQ (0–24) intervention (P<.0001)
(>12 wk) stretching and active exercises for the abdominal, - Follow-up at 0 mo Disability decreased in both groups after the intervention,
Mean age=62.4 y lumbar, and thoracic back extensor, psoas, ischiotibial, although the difference with baseline values was significant
Exp group, n=13* and pelvic muscles) only for the Ctrl group (P=.01)
Ctrl group, n=13* Exp group: KT + therapeutic exercise (same as for Ctrl Authors’ conclusion: KT is able to reduce pain in patients
group) with chronic LBP shortly after its application; its effects
Exp and Ctrl groups: patients were encouraged to persist over a short follow-up period
keep practicing at home after the end of the group
sessions
Taping application modality: patients were asked to
bend forward during the taping procedure (no tension
was used other than that required to cover the back in
bending position)
Exp group: 3 stripes over the lumbar area between T12
and L5 spinous processes; one stripe was placed over
the midline, along a line corresponding to the spinous
process, and the other 2 stripes were placed on the
right and left erector spinae muscles (4 cm from the
first stripe)
Type of tape used: 20×5 cm Kinesiotape KT545,
longitudinal elasticity of 40%
Renewal of taping: every 3 d for Exp group
April 2015

(Continued)
Duration: 4 wk
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Table.
April 2015

Continued

PEDro Outcome Measures and


Participants b Score Interventionb Follow-upb,c Reported Results b

Kavlak et al,201253 7 Ctrl group: Classic therapy that comprised ultrasound, (1) Pain–VAS (0–100) Pain (P<.05) and disability (P<.001) significantly decreased
40 patients with acute, subacute, or interferential current, hot pack, and massage applied to resting/activity/night within all 3 groups after the intervention
chronic NP (cervical disk the neck and midscapular regions. The duration of the (2) Disability–NDI (0–50) No significant differences between groups for pain and
herniation, cervical spondylosis, or neck massage was 10 min, and it consisted of stroking - Follow-up at 0 mo disability after the intervention (P>.05)
cervical radiculopathy) and kneading motions to relax the muscles (erector Authors’ conclusion: KT may be helpful as an alternative
Mean age=49.4 y spinae, levator scapulae, and trapezius). Cervical flexion, treatment for neck pain
Exp group, n=20* extension, lateral flexion, rotation, and strengthening
Ctrl group, n=20* exercises were given to patients as an exercise program.
Exp group: KT + classic therapy (same as for Ctrl group)
Exp and Ctrl groups: exercise program to be performed
at home
Taping application modality: Exp group: The origin of
the KT shaped Y was placed while the patient’s head was
in a neutral position and he or she was instructed to
perform neck flexion. After the medial tail of the KT was
adhered in this position, the patient was instructed to
perform rotation in combination with neck flexion, and
the lateral tail of KT was adhered in this position. The
administration was repeated on the other side.
Type of tape used: kinesiotape
Renew of taping: daily for Exp group
Duration: 3 wk (15 sessions)

Lee et al, 201239 6 Ctrl group: Stabilization exercises twice per week for (1) Pain–VAS (0–100) Pain significantly decreased in both groups after the
32 patients with MPS (upper the scapular and shoulder girdle muscles. A duty cycle (2) Disability–CMS, intervention (P<.05)
trapezius muscle) of 1:3 was adopted, and each exercise was performed activities of daily living No significant differences between groups for pain after the

Effect of Taping on Spinal Pain and Disability


Mean age=47.6 y for 10 s, followed by rest for 30 s. The patients subscale (0–20) intervention (P>.05)
Exp group, n=16* performed 3 sets of 10 repetitions of each exercise and - Follow-up at 0 mo In the assessment of disability using the CMS, the Ctrl group
Ctrl group, n=16* rested for 3 min after each set. The stabilization showed no significant differences on the activities of daily
Volume 95 Number 4 Physical Therapy f 499

exercises for the scapular muscles were isometric living subscale (P>.05), whereas the Exp group showed a
contractions (scapular elevation, depression, upward statistically significant difference (P<.05)
and downward rotation, protraction and retraction). Significant differences between groups on the activities of
The stabilization exercises for the shoulder girdle were daily living subscale (P<.05)
performed while the patient extended his or her elbow Authors’ conclusion: applying nonelastic taping before
joints, flexed his or her shoulder joints at 90°, and held stabilization exercises is more effective at relieving pain in
a rod with both hands in the supine position together patients with MPS in the upper trapezius muscle than
with the therapist while being instructed to maintain treatment that uses only stabilization exercises
the posture against the provided resistance.
Exp group: nonelastic tape application + stabilization
exercises (same as for Ctrl group)
Taping application modality:
Exp group: the taping was applied to the 1/3 point on
the medial side of the clavicle with the 12th thoracic
vertebra completely extended to maintain retraction
and depression of the scapula
Type of tape used: not reported
Renewal of taping: taping applied before stabilization
exercises and removed immediately after them (twice a (Continued)
week) for Exp group
Duration: 4 wk
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Effect of Taping on Spinal Pain and Disability


Table.
Continued

PEDro Outcome Measures and


Participants b Score Interventionb Follow-upb,c Reported Results b
Gonzáles-Iglesias et al, 200954 8 Ctrl group: placebo KT (1) Pain–NPRS (0–10) Pain greatly and significantly decreased in Exp group vs Ctrl
41 patients with acute WAD (within Exp group: standardized therapeutic KT - Follow-up immediately group immediately postintervention and at 24-h follow-up
40 d after a motor vehicle Taping application modality: postintervention (0 mo) (P<.001)
accident) Ctrl group: 2 I-strips applied with no tension; the first and 24 h after the Authors’ conclusion: Patients with acute WAD receiving an
Mean age=32.5 y (blue) strip was placed over the spinous processes of intervention (1 d) application of KT, applied with proper tension, exhibited
Exp group, n=21* the cervical and thoracic spines, and the second (black) statistically significant improvements in pain levels
Ctrl group, n=20* strip was placed perpendicular over the midcervical immediately following application of the kinesiotape and
region. The cervical spine of the participants was at a 24-h follow-up. However, these improvements were
placed in a neutral position. small and may not be clinically meaningful.
Exp group: The first layer was a blue Y-strip placed at
approximately 15%–25% tension over the posterior
cervical extensor muscles and applied from the
insertion to origin (from the dorsal region [T1–T2] to
the upper cervical region [C1–C2]). Each tail of the first
(blue) strip (Y-strip, 2-tailed) was applied with the
patient’s neck in a position of cervical contralateral side
bending and rotation. The overlying second (black)
strip was a space-tape (opening) placed perpendicular
to the Y-strip over the midcervical region (C3–C6),
with the patient’s cervical spine in flexion to apply
tension to the posterior neck structures.
Type of tape used: Kinesio Tex tape, width=5 cm,
thickness=0.5 mm
Renewal of taping: none
Duration: 1 d (1 session)
a
LBP=low back pain, Ctrl=control, Exp=experimental, KT=Kinesiotaping, MD=mean difference, CI=confidence interval, NRS=numerical rating scale, NPRS=numerical pain rating scale, RMDQ=Roland-
Morris Disability Questionnaire, VAS=visual analog scale, ODI=Oswestry Disability Questionnaire, NDI=Neck Disability Index, MPS=myofascial pain syndrome, NP=neck pain, WAD=whiplash-associated
disorder, TENS=transcutaneous electrical nerve stimulation. *Participants whose data were analyzed. **Only pain at worst was considered for data pooling.
b
Only data of considered sample groups and their respective interventions are reported.
c
Follow-up time is intended from postintervention onward.
April 2015
Effect of Taping on Spinal Pain and Disability
were included in the meta-analysis. excluded for various reasons (eFig- Quality and Clinical Relevance
We also did not assess indirectness, ure, available at ptjournal.apta.org), Assessment
as this review encompasses specific resulting in 8 studies selected for The methodological quality of the
population, type of intervention, and this review.39,50 –56 Only one dis- studies was assessed with the PEDro
outcome measures. Two reviewers agreement between assessors scale. Two evaluators independently
judged whether these factors were occurred, and it was resolved by a rated all of the studies included in
present for each outcome. Single meeting held in consultation with the review using the PEDro scale.
randomized studies (with fewer than 2 other authors (C.V., P.P.). Six Then, they compared their evalua-
300 participants) were considered studies50,52–57 concern elastic tap- tion with the published PEDro
inconsistent and imprecise (that is, ing, and the other 2 studies 39,51 con- scores, when available, and reached
sparse data) and provided “low- cern nonelastic taping. Overall, the an agreement in the other cases by a
quality evidence.” This rating could 8 included studies, conducted in meeting in consultation with 2 other
be further downgraded to “very low- Europe (Italy, Spain), Australia, authors (C.V., P.P.). All studies that
quality evidence” if there were also South America (Brazil), and Asia reached the minimum score (6/10)
limitations in design.47,48 We applied (Turkey, Korea), were published were considered to have good qual-
the following definitions of quality of from 2009 to 2014, with only 25% of ity, with a range from 6/10 to 9/10
the evidence49: them being published before 2012. and an average higher than this
The number of patients who were threshold (mean score=7.75).
 High quality—further research is
enrolled and completed baseline
unlikely to change our confidence
assessments was 409 (range=20 – The worst scored criterion of quality
in the estimate of effect. There are
148), with a mean sample size of 51 was the blinding of physical thera-
no known or suspected reporting
participants. The mean age of the pists, as all of the studies failed to
biases; all domains fulfilled.
study participants was approxi- obtain a positive score. This find-
 Moderate quality—further research
mately 48 years (range=32.5– 62.4). ing is not surprising given that clini-
is likely to have an important
The majority of the participants cian blinding is not possible for the
impact on our confidence in the
were female (n=277; 68%). type of treatment performed. Simi-
estimate of effect and might change
larly, the other criterion receiving a
the estimate; one of the domains
Five studies concerned LBP, and 3 low score was the blinding of the
was not fulfilled.
studies concerned NP. All of the patients regarding the treatment.
 Low quality—further research is
studies on LBP referred to people However, it should be noted that
likely to have an important impact
with chronic and nonspecific LBP. this patient blinding was not scored
on our confidence in the estimate
With respect to studies on NP, one of favorably in most of the studies
of effect and is likely to change the
them was related to chronic nonspe- because this information was omit-
estimate; 2 of the domains were not
cific NP,39 one to acute NP,54 and the ted. Blinding of assessors and con-
fulfilled.
third to specific NP53 (Table). Four cealed allocation of patients to
 Very low quality—we are uncertain
selected trials were judged by the groups were satisfied in 5 of 8
about the estimate; 3 of the
reviewers to be clinically homoge- studies, and data analysis accord-
domains were not fulfilled.
neous,50,52,55,56 and meta-analysis ing to the intention-to-treat method
A GRADE profile was completed for was performed (Figs. 1 and 2). How- achieved positive results in 7 of 8
each pooled estimate and for single ever, meta-analysis for pain and dis- studies. The best scored criteria on
trials comparing KT and placebo ability at short term was not exe- which all studies obtained a favor-
intervention. cuted for the same studies50,52,55–56 able score were those related to the
or for the other 4 studies.39,51,53,54 statistical analysis of the results, the
Results For these studies, effect sizes and randomization of participants in the
We identified 5,531 studies through associated 95% CIs for the individual groups, the initial comparability of
database searching. No additional trials were calculated and were pre- the most important prognostic fac-
eligible studies were identified sented in a forest plot grouped tors, and finally the evaluation of at
through other sources. After remov- according to treatment, followed by least one outcome measured on at
ing duplicates and screening titles outcomes and follow-ups (Figs. 3, 4, least 85% of patients (eTab. 1, avail-
and abstracts of all remaining unique and 5). The evaluation of evidence able at ptjournal.apta.org).
articles, 23 full-text articles needed quality was made for each compari-
to be assessed to verify their eligi- son outcome using the GRADE Concerning clinical relevance, no
bility for inclusion in the present results (eAppendix 2, available at differences between experimental
study. Ultimately, 15 of them were ptjournal.apta.org). and control groups were found.

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Effect of Taping on Spinal Pain and Disability

Figure 1.
Forest plot of comparison: elastic taping versus sham/placebo or no treatment for people with low back pain (outcome: pain in the
immediate posttreatment period). ES=effect size, 95% CI=95% confidence interval, IV=inverse variance.

Only Chen and colleagues’ study51 Outcomes of elastic taping medium and significant (g=—0.78;
on nonelastic taping yielded results versus sham/placebo or no 95% CI=—1.30, —0.25). In the study
in the experimental group that treatment for people with LBP. that assessed pain 2 months after the
attained the threshold MCID for Four high-quality studies50,52,55,56 on intervention,56 the effect size of tap-
short-term pain and disability reduc- the PEDro scale assessed pain in the ing was small and not significant
tion, differently from placebo (eTab. immediate posttreatment period; 1 (g=—0.20; 95% CI=—0.52, 0.12)
2, available at ptjournal.apta.org). study50 had a 1-month follow-up, and (Fig. 3). In summary, using GRADE
1 study56 had a 2-month follow-up. criteria, there is low-quality evidence
Outcomes of Treatment for Meta-analysis was performed (Fig. 1) that elastic taping versus sham/
People With LBP only for the 4 studies that assessed placebo or no treatment provides
Figures 1, 2, 3, and 4 present the pain immediately after the inter- no significant improvement in pain
follow-up study findings for pain and vention.50,52,55,56 Overall (random- intensity immediately posttreatment
disability with respect to the effect effects model) effect size of elastic and at 2-month follow-up, and there
size for 95% CI values of the inter- taping versus sham/placebo or no is a low-quality evidence that elastic
vention outcomes. Four studies con- treatment was small and not signifi- taping reduces pain at 1 month
cern elastic taping,50,52,55,56 and 1 cant (g=—0.31; 95% CI=—0.64, follow-up.
study concerns nonelastic taping.51 0.02). In the study that assessed pain
at 1 month after the intervention, 50 Four high-quality studies50,52,55,56 on
the effect size of elastic taping was the PEDro scale assessed disability in

Figure 2.
Forest plot of comparison: elastic taping versus sham/placebo or no treatment for people with low back pain (outcome: disability in
the immediate posttreatment period). ES=effect size, 95% CI=95% confidence interval, IV=inverse variance.

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Effect of Taping on Spinal Pain and Disability

Figure 3.
Results of single included trials on the effects of elastic taping versus sham kinesiotaping at short term in people with low back pain.
Treatment effects favoring taping: assigned negative Hedges’ g standardized mean difference (SMD) values. Results in bold type
represent statistically significant comparisons based on the 95% confidence interval (95% CI) of the SMD. Values presented in forest
plots are effect size (ES) of the SMD and 95% CI. Mean (SD) §=mean and standard deviation measured at baseline, mean
(SD)*=mean and standard deviation measured posttreatment, ST*=short term (1-month follow-up), ST§=short term (2-month
follow-up), NRS=numerical rating scale, VAS=visual analog scale, ODI=Oswestry Disability Questionnaire, RMDQ=Roland-Morris
Disability Questionnaire.

the immediate posttreatment period; vention,56 the effect size of taping 95% CI=—1.01, 0.18) at 1-month
1 study50 had a 1 month follow-up was small and not significant (g= follow-up (Fig. 4). In summary, using
(with 2 different measurement —0.20; 95% CI=—0.52, 0.12) (Fig. 3). GRADE criteria, there is low-quality
scales), and 1 study56 had a 2-month evidence that nonelastic taping ver-
follow-up. Meta-analysis (Fig. 2) was In summary, using GRADE criteria, sus placebo reduces pain at post-
performed only for the 4 studies there is low-quality evidence that treatment follow-up and provides no
that assessed disability immediately elastic taping versus sham/placebo significant improvement at 1-month
after intervention.50,52,55,56 Overall or no treatment provides no signifi- follow-up.
(random-effects model) effect size of cant improvement in disability in the
elastic taping versus sham/placebo immediate posttreatment period and One high-quality study51 on the
or no treatment was small and at 1- and 2-month follow-ups. PEDro scale assessed disability both
not significant (g=—0.23; 95% CI= in the immediate posttreatment
—0.49, 0.03). In the study that Outcomes of nonelastic taping period and at 1-month follow-up.
assessed disability at 1 month after versus placebo for people with The effect size of taping versus pla-
the intervention (with 2 different LBP. One high-quality study51 on cebo was medium and not signifi-
measurement scales),50 the effect the PEDro scale assessed pain both cant (g=—0.59; 95% CI=—1.19,
size was small (g=—0.37; 95% CI= immediately posttreatment and at 1- 0.01) immediately posttreatment,
—0.88, 0.14) when disability was month follow-up. The effect size of and it was small and not significant
assessed with the ODI and very small taping versus placebo was medium (g=—0.33; 95% CI=—0.93, 0.26) at
(g=—0.04; 95% CI=—0.54, 0.47) and significant (g=—0.72; 95% 1-month follow-up (Fig. 4). In sum-
when disability was assessed with CI=—1.33, —0.12) in the immediate mary, using GRADE criteria, there is
the RMDQ. In the study that assessed posttreatment period, and it was low-quality evidence that nonelastic
disability at 2 months after the inter- small and not significant (g=—0.42; taping versus placebo provides no

Figure 4.
Results of single included trials on the effects of nonelastic taping versus placebo for people with low back pain. Treatment effects
favoring taping: assigned negative Hedges’ g standardized mean difference (SMD) values. Results in bold type represent statistically
significant comparisons based on the 95% confidence interval (95% CI) of the SMD. Values presented in forest plots are effect size
(ES) of the SMD and 95% CI. IPT=immediate posttreatment (0-month follow-up), ST=short term (1-month follow-up),
NRS=numerical rating scale, VAS=visual analog scale.

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Effect of Taping on Spinal Pain and Disability

Figure 5.
Results of single included trials on the effects of taping versus placebo or no treatment in people with neck pain (NP). Treatment
effects favoring taping assigned negative Hedges’ g standardized mean difference (SMD) values. Results in bold type represent
statistically significant comparisons based on the 95% confidence interval (95% CI) of the SMD. Values presented in forest plots are
effect size (ES) of the SMD and 95% CI. Mean (SD) §=mean and standard deviation measured at baseline. Mean (SD)*=mean and
standard deviation measured posttreatment, IPT=immediate posttreatment (0-month follow-up), VAS=visual analog scale,
NPRS=numerical pain rating scale, NDI=Neck Disability Index, CMS=Constant-Murley Scale.

significant improvement in disability Outcomes of treatment with small and not significant (g=—0.08;
at posttreatment follow-up and at 1- elastic tape versus no treatment 95% CI=—0.75, 0.60) (Fig. 5).
month follow-up. for people with specific NP
(cervical disk herniation, cervical One study39 assessed disability
Outcomes of Treatment for spondylosis, or cervical immediately posttreatment. The
People With NP radiculopathy). One study53 effect size of taping versus no treat-
The follow-up study findings for pain assessed pain in the immediate post- ment was small and not significant
and disability with respect to the treatment period. The effect size of (g=—0.42; 95% CI=—1.10, 0.27)
effect size with 95% CI for inter- taping versus no treatment was (Fig. 5).
vention outcomes are presented in medium and significant (g=—0.66;
Figure 5. Three studies analyzed 95% CI=—1.28, —0.03) (Fig. 5). In summary, using GRADE criteria,
NP39,53,54: 1 related to nonspecific there is very low-quality evidence
chronic NP,39 1 related to acute One study53 assessed disability in the (from one trial) that nonelastic tap-
NP,54 and 1 related to specific NP.53 immediate posttreatment period. ing versus no treatment provides no
Two studies concern elastic tap- The effect size of taping versus no significant reduction in pain or dis-
ing,53,54 and 1 study concerns non- treatment was small and not signifi- ability in the immediate posttreat-
elastic taping.39 cant (g=—0.19; 95% CI=—0.80, ment period.
0.42) (Fig. 5).
Outcomes of treatment with Discussion
elastic tape versus placebo for In summary, using GRADE criteria, We searched the scientific evidence
people with NP (WAD). One there is low-quality evidence (from for the effect of elastic and nonelas-
study54 assessed pain in the immedi- one trial) that elastic taping versus tic taping on the 2 outcomes that are
ate posttreatment period. The effect no treatment reduces pain in the commonly considered as relevant in
size of taping versus placebo was immediate posttreatment period. spinal conditions: pain and disability.
large and significant (g=—1.04; 95% No significant improvement in dis- Eight RCTs concerned the effect of
CI=—1.68, —0.39) (Fig. 5). ability was found at posttreatment several types of taping on pain and
follow-up. disability for LBP and NP. Meta-
In summary, using GRADE criteria, analysis of RCTs on LBP demon-
there is low-quality evidence from Outcomes of treatment with strated that elastic taping did not sig-
one trial that elastic taping versus nonelastic taping versus no nificantly reduce pain and disability
placebo reduces pain in the immedi- treatment for people with immediately posttreatment com-
ate posttreatment period. nonspecific chronic NP. One pared with sham/placebo or no treat-
study39 assessed pain immediately ment. Both elastic and nonelastic
posttreatment. The effect size of tap- taping did not provide significant
ing versus no treatment was very improvement in spinal disability.
Conflicting results emerged from sin-

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Effect of Taping on Spinal Pain and Disability
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