ResearchReport - Emory University · ResearchReport Post a Rapid Response to this article at: ptjournal.apta.org April 2015 Volume 95 Number 4 Physical Therapy f 493. N eck pain (NP)

Effect of Taping on Spinal Pain andDisability: Systematic Review andMeta-Analysis of Randomized TrialsCarla Vanti, Lucia Bertozzi, Ivan Gardenghi, Francesca Turoni,Andrew A. Guccione, Paolo Pillastrini

Background. Taping is a widely used therapeutic tool for the treatment ofmusculoskeletal disorders, nevertheless its effectiveness is still uncertain.

Purpose. The purpose of this study was to conduct a current review of random-ized controlled trials (RCTs) concerning the effects of elastic and nonelastic taping onspinal pain and disability.

Data Sources. MEDLINE, CINAHL, EMBASE, PEDro, Cochrane Central Registerof Controlled Trials (CENTRAL), Scopus, ISI Web of Knowledge, and SPORTDiscusdatabases were searched.

Study Selection. All published RCTs on symptomatic adults with a diagnosis ofspecific or nonspecific spinal pain, myofascial pain syndrome, or whiplash-associateddisorders (WAD) were considered.

Data Extraction. Two reviewers independently selected the studies andextracted the results. The quality of individual studies was assessed using the PEDroscale, and the evidence was assessed using GRADE criteria.

Data Synthesis. Eight RCTs were included. Meta-analysis of 4 RCTs on low backpain demonstrated that elastic taping does not significantly reduce pain or disabilityimmediately posttreatment, with a standardized mean difference of �0.31 (95%confidence interval��0.64, 0.02) and �0.23 (95% confidence interval��0.49,0.03), respectively. Results from single trials indicated that both elastic and nonelastictaping are not better than placebo or no treatment on spinal disability. Positive resultswere found only for elastic taping and only for short-term pain reduction in WAD orspecific neck pain. Generally, the effect sizes were very small or not clinicallyrelevant, and all results were supported by low-quality evidence.

Limitations. The paucity of studies does not permit us to draw any finalconclusions.

Conclusion. Although different types of taping were investigated, the results ofthis systematic review did not show any firm support for their effectiveness.

C. Vanti, PT, MSc, OMT, Depart-ment of Biomedical and Neuro-logical Sciences, University ofBologna, Bologna, Italy.

L. Bertozzi, PT, MSc, Departmentof Biomedical and NeurologicalSciences, University of Bologna.

I. Gardenghi, PT, Department ofBiomedical and Neurological Sci-ences, University of Bologna.

F. Turoni, PT, Department of Bio-medical and Neurological Sci-ences, University of Bologna.

A.A. Guccione, PT, PhD, DPT,FAPTA, Department of Rehabilita-tion Science, College of Healthand Human Services, GeorgeMason University, Fairfax,Virginia.

P. Pillastrini, PT, MSc, Departmentof Biomedical and NeuromotorSciences, University of Bologna,Via Albertoni, 15 Bologna40138, Italy. Address all corre-spondence to Dr Pillastrini at:[email protected].

[Vanti C, Bertozzi L, Gardenghi I,et al. Effect of taping on spinalpain and disability: systematicreview and meta-analysis of ran-domized trials. Phys Ther.2015;95:493–506.]

© 2015 American Physical TherapyAssociation

Published Ahead of Print:November 20, 2014

Accepted: November 13, 2014Submitted: December 23, 2013

Research Report

Post a Rapid Response tothis article at:ptjournal.apta.org

April 2015 Volume 95 Number 4 Physical Therapy f 493

Neck pain (NP) and low backpain (LBP) among adults inthe United States are com-

mon, costly, and, in some instances,chronic.1 Although the natural his-tory of these conditions appears tobe favorable and self-limiting,2 ratesof recurrence3,4 and risk for chronic-ity appear high for both of thesemusculoskeletal disorders.5,6 Fur-thermore, NP and LBP are especiallyfrequent during the most productiveyears of a person’s life, causing alarge number of lost workdays andlost productivity, and may precipi-tate permanent disability.7 In orderto decrease this social burden of dis-ability, interventions with demon-strated efficacy for specific out-comes are essential.8

Among the conservative therapeuticinterventions adopted by physicaltherapists and other health care pro-viders, taping is one of the mostcommonly used in the preventionand treatment of sports injuries and avariety of clinical conditions, includ-ing spinal pain.9,10 Several types oftapes are available, each with its ownmechanical characteristics as well astheorized aims and techniques ofapplication. Tapes fall into 2 broadcategories: the nonelastic or rigidtapes and the elastic nonadhesive

Available WithThis Article atptjournal.apta.org

• eFigure: Flow Diagram ofStudies Through the DifferentPhases of the Review

• eTable 1: PEDro Score

• eTable 2: Minimal ClinicallyImportant Difference Results

• eAppendix 1: Search Strategyfor PubMed/MEDLINE

• eAppendix 2: QualityAssessment and Summary ofFindings for All Outcomes andComparisons

and adhesive tapes, among whichKinesio Tex tape (Kinesio HoldingCorp, Albuquerque, New Mexico)11

is likely the most well-known. Rigidtaping was the first type of tapingused, and it is still adopted as anadjunct for treatment of musculo-skeletal injuries. The rationale forits mechanism of action is that itprotects muscles and joints byenhancing proprioception and pro-viding support.12 In contrast, DrKenzo Kase, a Japanese chiroprac-tor, invented a new form of tape andtechnique for therapeutic taping inthe 1970s that later developed into amethod called “Kinesiotaping” (KT),which required an elastic type oftape (ie, Kinesio Tex tape).11 Thistape was different from traditionalrigid tape used mainly in athletics. Itselasticity allows a clinician to stretchit up to 130%–140% of its originallength before application, and it canbe worn for several days withoutremoval. These properties arguablymake it a useful tool following injuryand during rehabilitation.12,13

Various therapeutic benefits havebeen proposed for KT, including itsability to support fascia, muscles,and joints and to decrease pain andinflammation by improving lym-phatic and blood circulation withoutrestricting the range of motion(ROM) of the affected part, unliketraditional rigid taping techniques,which restrict movement.10,12,14,15

Murray and Husk16 have furthersuggested another mechanism ofaction (ie, enhanced proprioceptionthrough increased stimulation of thecutaneous mechanoreceptors).

In recent years, accompanied byheightened public awareness withits high-profile presence at the Lon-don Olympics in 2012 and the Euro-pean Football Championship,17 agrowing number of research studieshave explored KT to evaluate theeffects of this conservative therapeu-

tic intervention in the treatment ofmusculoskeletal pathology. Clinicalinterest also is growing, as demon-strated by the fact that the educationregarding KT has had a markedincrease in recent years. Since itsinception, 50,000 individuals havebeen trained in this method, abouthalf of whom are physical therapists(Dorothy Cole; personal communica-tion; June 4, 2013).

Despite the magnitude of KT’s cur-rent popularity and increasing use inclinical practice, substantial uncer-tainty continues to exist regarding itstrue merit, mainly due to insufficientand inconsistent supporting evi-dence. The limited scientific infor-mation available has been obtainedmostly from reports, case seriesstudies, and individual anecdotalpatient experiences. Even thoughmore clinical trials have been under-taken in recent years to examine theefficacy of KT, systematic reviewsand meta-analyses published on thisissue so far10,15,17–23 have reachedconclusions that do not align com-pletely with each other. Consider-ing, for example, only those reviewspublished between 2012 and2014,10,15,17,18,21–23 opinions rangefrom no apparent clinical benefit18,22

to modest impact on outcome,15,17,23

with some agreement that the evi-dence is insufficient10,15 to warrantunequivocal recognition as a thera-peutic option on the basis of the evi-dence.21,22 Furthermore, other limi-tations of previous reviews mayhave influenced their findings andconclusions, such as aggregatingresults pertaining not only to spinalpain but also to other different con-ditions,18 introducing inclusion andexclusion criteria in search strategiesthat potentially resulted in publica-tion bias (eg, requiring availability offull version in English10,15,18,19 andrestricting publication date21), andallowing the methodological qualityof randomized controlled trials(RCTs) to serve as a basis for furtheranalysis in the review.10 It also is

Effect of Taping on Spinal Pain and Disability

494 f Physical Therapy Volume 95 Number 4 April 2015

http://ptjournal.apta.org/content/95/4/493/suppl/DC1





important to note that no previoussystematic reviews or meta-analyseshave evaluated the effects of formsof taping other than KT.

For all of these reasons, we recog-nized the need for an up-to-date andspecific systematic review and meta-analysis to determine a more accu-rate estimation of the efficacy of elas-tic and nonelastic taping and theirimpact on pain and disability inpatients with spinal pain. This system-atic review expands upon previousstudies10,15,17–23 by considering differ-ent types of taping, explicitly targetinga particular population of interest, andfocusing on specific characteristics ofRCTs as inclusion criteria.

MethodData Sources and SearchesOur literature search aimed to iden-tify all available studies that evalu-ated the effect of taping in relievingpain and reducing disability in peo-ple with spinal pain. Records wereidentified by searching multiple liter-ature databases, including MEDLINE,Cumulative Index to Nursing andAllied Health Literature (CINAHL),EMBASE, Physiotherapy EvidenceDatabase (PEDro), Cochrane CentralRegister of Controlled Trials(CENTRAL), Scopus, ISI Web ofKnowledge, and SPORTDiscus, fromtheir inception to June 2014. Thesearch terms used were “taping,”“kinesio,” “kinesiotape,” and “kine-siotaping.” These key words wereidentified after preliminary literaturesearches and by cross-checking themagainst previous relevant systematicreviews.10,18 The search strategyused for searching the MEDLINEdatabase through PubMed is pre-sented in eAppendix 1 (available atptjournal.apta.org). This strategywas modified and adapted for eachsearched database. Additionalrecords were searched throughother sources to complement thedatabases’ findings, including man-ual research of reference lists of rel-

evant literature reviews and indexesof peer-reviewed journals.

Two reviewers (I.G., F.T.) indepen-dently applied the predeterminedinclusion and exclusion criteria toselect potentially relevant trials, ini-tially identified based on title andabstract. Full-text copies of relevanttrials were then obtained and inde-pendently evaluated by the review-ers. Disagreements were resolvedthrough discussion among thereviewers, with input of 2 otherauthors (C.V., P.P.).

Study SelectionTypes of studies. We includedpublished RCTs without any restric-tions on publication date or lan-guage. Among RCTs, only trials witha control or comparison group wereconsidered as eligible. These trialsincluded: (1) intervention versus pla-cebo or sham treatment, (2) inter-vention versus no-taping interven-tion or comparator (eg, self-care,advice, continuing with ordinary andrecreational activities), and (3) inter-vention versus standard practice (eg,wait list or usual care). A further cri-terion for designating a study as aneligible “comparison” trial was thecomparison of taping plus anotherintervention versus this same inter-vention (eg, taping and therapeuticexercise versus therapeutic exer-cise) in a comparably matchedgroup. Quasi-RCTs and nonrandom-ized controlled trials were excluded.

Types of participants. The partic-ipants in selected studies had to besymptomatic adults (18 years of ageor older) with a diagnosis of acute,subacute, or chronic specific ornonspecific spinal pain, myofascialpain syndrome (MPS), or whiplash-associated disorder (WAD). Pain wascategorized as “acute” when it wasevident from the text that partici-pants experienced it for less than 1month, as “subacute” between 1and 3 months, and as “chronic” for

more than 3 months.24,25 In theabsence of this explicit description,pain was considered acute, sub-acute, or chronic when the investi-gators themselves categorized anindividual’s pain in those terms.26

Trials were excluded if any of theparticipants received a diagnosissuch as myelopathy, fracture, infec-tion, dystonia, tumor, inflammatorydisease, or osteoporosis.27

Types of interventions. Amongall of the types of conservative inter-ventions used by physical therapistsfor the treatment of spinal pain, onlyelastic or nonelastic taping was con-sidered in our analysis. Studies con-cerning other interventions or tapingused in association with therapeuticexercise or physical therapy proce-dures without any explicit investiga-tion on the distinct effects of each pro-cedure were excluded. Finally, trialswere excluded if the prevention ofspinal pain was the main clinical pur-pose of the study intervention.

Types of outcome measures. Tobe eligible for inclusion, a study hadto assess pain with a visual analogscale (VAS), a numerical pain ratingscale, or patient self-report as an out-come measure. Disability was con-sidered an outcome measure if thechosen instrument measured theimpact of spinal pain on everydaylife beyond work or leisure-timeactivities. If more than one instru-ment or measure of an outcome ofinterest was reported within thesame study, only one was consideredfor the pooled estimate in the meta-analysis. We chose the outcome mea-sure that would most likely providethe most conservative estimate ofthe effect of taping on the outcomedue to the magnitude of the painor disability. For example, in the caseof pain, we selected the measurethat most nearly corresponded to“What is your worst pain?” to beused in our analysis. Trials investi-gating the effect of taping on pres-




sure pain threshold or pressurepain tolerance, electromyographicsignals, ROM, proprioception, orstrength or endurance of spinalmuscles were excluded. Similarly,health-related quality of life, patientsatisfaction, global perceived effect,work-related measures, depression,and other psychosocial measureswere not considered in our analyses.When possible, we extracted studyfindings at baseline, after interven-tion, and at every reported follow-up. Follow-up data were recordedat short-term (defined as less than3 months following the date ofrandomization), intermediate-term(between 3 and 12 months), andlong-term (12 months or more) timeperiods.28 If more than onefollow-up set of data was presentwithin the same category of timingof an outcome measure, only one setwas considered.

Data Extraction and QualityAssessmentTwo authors (I.G., F.T.) indepen-dently conducted data extraction.Two other authors (C.V., P.P.) wereconsulted in the case of persistingdisagreement. Reviewers were notblinded to information regarding theauthors, journal of origin, or out-comes for each article reviewed.Using a standardized form, dataextraction addressed participants,types of intervention, follow-uptimes, clinical outcome measures,and findings that were reported.These data are detailed in the Table.Methodological quality of studieswas assessed using the PEDro scale,which has been shown to be reli-able29 and valid30 for rating the qual-ity of RCTs. Two independent asses-sors (G.M., G.C.) obtained orextracted the score for each trialfrom the PEDro database when avail-able. Trials with a rating of at least6/10 on the PEDro scale were con-sidered as having high quality, con-sistent with previous systematic

reviews.31–33 Trials were notexcluded on the basis of quality.

Clinical Relevance AssessmentTwo expert physical therapists(C.V., P.P.) assessed the clinical rel-evance of the extracted studies byevaluating whether the patients andinterventions were described pre-cisely enough to allow inferencesabout the clinical applicability ofthe results and clinical relevance ofthe measured outcome. The ques-tions used to assess the clinical rele-vance were: (1) Are the patient char-acteristics and treatment settingsdescribed well enough to decidewhether they are comparable tothose you see in your own practice?(2) Are all of the interventionsdescribed well enough to allow youto provide the same to your ownpatients? and (3) Were clinically rel-evant outcomes measured? Withregard to this last question, theexperts identified the minimal clini-cally important difference (MCID)for each measurement scale and foreach outcome by referencing the lit-erature. Specifically, they selected30% of change in back pain mea-sured with the VAS,34 a 10-pointchange in back disability on the 100-point Oswestry Disability Index(ODI),35 or a 2-point change in backdisability on the 24-point Roland-Morris Disability Questionnaire(RMDQ)34,35 as the MCID. Moreover,they selected 20% of change in NP asmeasured with a VAS,36 25% ofchange in NP measured with anumerical rating scale,37 and a 3.5-point change on the 50-point NeckDisability Index37,38 as the MCID. Areference for the MCID of theConstant-Murley Scale score, whichwas used by Lee et al39 to mea-sure neck disability, could not belocated.40 Using these specific MCIDvalues, the question of whether theevidence was sufficient for clinicalrecommendations was made.

Data Synthesis and AnalysisData were synthesized using a meta-analytic method based on a random-effects model because this approachweights studies by the inverse ofthe variance and incorporates heter-ogeneity into the model.41 All effectsizes were computed using Hedges’g statistic because it incorporates asmall sample bias correction.42 Pro-Meta V.2.0 software43 (Internovi byScarpellini Daniele s.a.s. Cesena[FC], Italy) was used for the statis-tical analyses. Standardized meandifferences (SMDs) with 95% con-fidence intervals (95% CIs) werecalculated for continuous data. TheSMD was used because differentmeasures were adopted by eachstudy to address the same clinicaloutcome. To interpret effect size cal-culated with SMD, we used Cohen44

as a guide to identify small (0.20),medium (0.50), or large (0.80)effects. Calculation of effect size wasbased first on the best possible data(ie, final means, standard deviations,and sample sizes of intervention andcontrol groups). Selected studies forwhich these or other crucial datawere not directly reported, orobtainable by contacting authors,were not included in the review.

A qualitative analysis to evaluate theoverall quality of the evidence wasplanned28 and independently con-ducted by 2 authors (I.G., L.B.) usingthe GRADE approach.45 We used anadapted version of the criteria advo-cated by the Cochrane Back ReviewGroup.46 The quality of evidencewas downgraded by one level foreach of 3 factors we encountered:limitations in the design (eg, �25%of participants from studies withlow-quality methods, PEDro score�6 points), inconsistency of results(eg, �75% of participants reportedfindings in the same direction), andimprecision (eg, total number of par-ticipants �300 for each outcome).We did not assess publication biaswith funnel plots, as too few studies



Tab

le.

Cha

ract

eris

tics

ofIn

clud

edSt

udie

sa

Par

tici

pan

tsb

PED

roSc

ore

Inte

rven

tio

nb

Ou

tco

me

Mea

sure

san

dFo

llo

w-u

pb

,cR

epo

rted

Res

ult

sb

Parr

eira

etal

,20

1456

148

pat

ient

sw

ithch

roni

cno

nsp

ecifi

cLB

P(�

12w

k)M

ean

age�

50.5

yEx

pgr

oup

,n�

74*

Ctr

lgro

up,

n�74

*

9C

trl

gro

up

:sh

amKT

Exp

gro

up

:st

anda

rdiz

edKT

Tap

ing

app

lica

tio

nm

od

alit

y:C

trlg

roup

:I-

shap

edki

nesi

otap

eov

erea

cher

ecto

rsp

inae

mus

cle

with

note

nsio

n(0

%te

nsio

n)an

dw

ithth

etr

eate

dm

uscl

ein

ano

nstr

etch

edp

ositi

onEx

pgr

oup

:I-

shap

edki

nesi

otap

eov

erea

cher

ecto

rsp

inae

mus

cle

with

10%

–15%

ofte

nsio

n(p

aper

-off

tens

ion)

with

the

trea

ted

mus

cles

inst

retc

hed

pos

ition

Typ

eo

fta

pe

use

d:

Kine

sio

Tex

tap

eR

enew

alo

fta

pin

g:

twic

ep

erw

eek

(tap

em

aint

aine

din

situ

for

2d)

Du

rati

on

:4

wk

(1)

Pai

n–N

RS(0

–10)

(2)

Dis

abil

ity–

RMD

Q(0

–24)

-Fo

llo

w-u

pat

0/2

mo

Pain

(bet

wee

n-gr

oup

sM

D�

�0.

4p

oint

s;95

%C

I��

1.3,

0.4)

and

disa

bilit

y(�

0.3

poi

nts;

95%

CI�

�1.

9,1.

3)di

dno

tsi

gnifi

cant

lyde

crea

seaf

ter

the

inte

rven

tion

No

sign

ifica

ntbe

twee

n-gr

oup

diffe

renc

esw

ere

obse

rved

atfo

llow

-up

Aut

hors

’co

nclu

sion

:KT

app

lied

with

stre

tch

toge

nera

teco

nvol

utio

nsin

the

skin

was

nom

ore

effe

ctiv

eth

ansi

mp

leap

plic

atio

nof

the

tap

ew

ithou

tte

nsio

nfo

rth

eou

tcom

esm

easu

red

Bae

etal

,20

135

5

20p

atie

nts

with

chro

nic

nons

pec

ific

LBP

(�12

wk)

Mea

nag

e�52

.5y

Exp

grou

p,

n�10

*C

trlg

roup

,n�

10*

7C

trl

gro

up

:p

lace

bota

pin

gEx

pg

rou

p:

stan

dard

ized

KTEx

pan

dC

trl

gro

up

s:bo

thgr

oup

sre

ceiv

edor

dina

ryp

hysi

calt

hera

py

with

hot

pac

k,ul

tras

ound

,an

dTE

NS

toth

eL1

–2an

dL4

–5ar

eas

for

40m

inea

chtim

e,3

times

per

wee

kT

apin

gap

pli

cati

on

mo

dal

ity:

Ctr

lgro

up�

one

inel

astic

I-st

ripw

asat

tach

edtr

ansv

erse

lyto

the

lum

bar

area

with

the

max

imum

pai

nEx

pgr

oup

�4

blue

I-st

rips

wer

est

retc

hed

and

over

lap

pin

gly

atta

ched

toth

elu

mba

rar

eaw

ithth

em

axim

ump

ain

ina

star

shap

eT

ype

of

tap

eu

sed

:ki

nesi

otap

e,w

idth

�5

cm,

thic

knes

s�0.

5m

mR

enew

alo

fta

pin

g:

atea

chin

terv

entio

n3

times

per

wee

kD

ura

tio

n:

12w

k

(1)

Pai

n–V

AS

(0–1

0)(2

)D

isab

ilit

y–O

DI

(0–1

00)

-Fo

llo

w-u

pat

0m

o

Pain

sign

ifica

ntly

decr

ease

d(P

�.0

5)w

ithin

both

grou

ps

afte

rth

ein

terv

entio

nD

isab

ility

sign

ifica

ntly

decr

ease

din

Ctr

lgro

up(P

�.0

5)an

dm

ore

sign

ifica

ntly

decr

ease

din

Exp

grou

p(P

�.0

1)af

ter

the

inte

rven

tion

Aut

hors

’co

nclu

sion

:KT

app

lied

top

atie

nts

with

chro

nic

LBP

redu

ced

thei

rp

ain

and

disa

bilit

y

Cas

tro-

Sanc

hez

etal

,20

1250

60p

atie

nts

with

chro

nic

nons

pec

ific

LBP

(�12

wk)

Mea

nag

e�48

.5y

Exp

grou

p,

n�30

*C

trlg

roup

,n�

30,2

9*

9C

trl

gro

up

:sh

amKT

Exp

gro

up

:st

anda

rdiz

edKT

Tap

ing

app

lica

tio

nm

od

alit

y:C

trlg

roup

:si

ngle

I-st

ripof

the

sam

eta

pe

app

lied

tran

sver

sely

imm

edia

tely

abov

eth

ep

oint

ofm

axim

umlu

mba

rp

ain

Exp

grou

p:

4bl

ueI-

strip

sp

lace

dat

25%

tens

ion

over

lap

pin

gin

ast

arsh

ape

(the

cent

ralp

art

adhe

res

befo

reth

een

ds)

over

the

poi

ntof

max

imum

pai

nin

the

lum

bar

area

Typ

eo

fta

pe

use

d:

Kine

sio

Tex

tap

e,w

idth

�5

cm,

thic

knes

s�0.

5m

mR

enew

alo

fta

pin

g:

noon

efo

rbo

thgr

oup

s(t

ape

mai

ntai

ned

insi

tufo

r7

d)D

ura

tio

n:

1w

k

(1)

Pai

n–V

AS

(0–1

0)(2

)D

isab

ilit

y–O

DI

(0–1

00),

RMD

Q(0

–24)

-Fo

llo

w-u

pat

0/1

mo

Pain

(bet

wee

n-gr

oup

sM

D�

1.1

cm;

95%

CI�

0.3,

1.9)

and

disa

bilit

y(o

nO

DI

scor

e:4

poi

nts;

95%

CI�

2,6;

onRM

DQ

scor

e:1.

2p

oint

s,95

%C

I�0.

4,2.

0)si

gnifi

cant

lyde

crea

sed

mor

ein

Exp

grou

pvs

Ctr

lgro

upaf

ter

the

inte

rven

tion

Sign

ifica

ntbe

twee

n-gr

oup

sdi

ffere

nce

mai

ntai

ned

only

for

pai

n(1

.0cm

;95

%C

I�0.

2,1.

7)at

follo

w-u

pA

utho

rs’

conc

lusi

on:

KTre

duce

ddi

sabi

lity

and

pai

nin

peo

ple

with

chro

nic

nons

pec

ific

LBP,

but

thes

eef

fect

sm

aybe

too

smal

lto

becl

inic

ally

wor

thw

hile

(Con

tinue

d)



Tab

le.

Con

tinue

d

Par

tici

pan

tsb

PED

roSc

ore

Inte

rven

tio

nb

Ou

tco

me

Mea

sure

san

dFo

llo

w-u

pb

,cR

epo

rted

Res

ult

sb

Che

net

al,

2012

51

43p

atie

nts

with

suba

cute

nons

pec

ific

LBP

(�6

wk)

Mea

nag

e�43

.2y

Exp

grou

p,

n�21

*C

trlg

roup

,n�

22*

9C

trl

gro

up

:p

lace

bota

pin

gEx

pg

rou

p:

func

tiona

lfas

cial

tap

ing

Exp

and

Ctr

lg

rou

ps:

Am

anua

ltha

tco

ntai

ned

back

care

and

ast

anda

rdiz

edsi

mp

letr

unk

flexi

onex

erci

sew

asgi

ven

toal

lpar

ticip

ants

.Th

etr

unk

flexi

onex

erci

sew

asap

plie

dto

rein

forc

eth

est

retc

hing

effe

ctof

the

tap

ing.

Tap

ing

app

lica

tio

nm

od

alit

y:C

trlg

roup

:st

rips

with

note

nsio

nov

erth

ep

ainf

ular

eaon

the

low

erba

ckEx

pgr

oup

:st

rips

with

tens

ion

ina

dire

ctio

nas

sess

edby

the

ther

apis

t(g

ener

ally

3ta

pin

gdi

rect

ions

wer

eap

plie

d);

the

dire

ctio

nof

tap

eap

plic

atio

nw

asde

term

ined

with

the

skin

dist

ract

ion

test

that

resu

lted

inm

axim

alp

ain

redu

ctio

non

trun

kfle

xion

Typ

eo

fta

pe

use

d:

3–5

tap

ela

yers

with

rigid

stra

pp

ing

tap

eM

K38

Ren

ewal

of

tap

ing

:da

ilyfo

rbo

thgr

oup

sD

ura

tio

n:

2w

k

(1)

Pai

n–V

AS

(0–1

00)

aver

age/

wor

st**

(2)

Dis

abil

ity–

OD

I(0

–100

)-

Foll

ow

-up

at0/

1/2.

5m

o

Wor

stp

ain

sign

ifica

ntly

decr

ease

dm

ore

inEx

pgr

oup

vsC

trl

grou

paf

ter

the

inte

rven

tion

(P�

.02)

No

sign

ifica

ntdi

ffere

nce

betw

een

grou

ps

inw

orst

pai

nat

any

stag

esof

follo

w-u

p(P

�.0

5)N

osi

gnifi

cant

diffe

renc

esbe

twee

ngr

oup

sin

disa

bilit

yan

dav

erag

ep

ain

atal

ltim

ep

erio

ds(P

�.0

5)A

utho

rs’

conc

lusi

on:

func

tiona

lfas

cial

tap

ing

redu

ced

wor

stp

ain

inp

atie

nts

with

nona

cute

nons

pec

ific

LBP

durin

gth

etr

eatm

ent

pha

se;

nom

id-t

erm

diffe

renc

esin

pai

nor

func

tion

wer

eob

serv

ed

Paol

onie

tal

,20

1152

26p

atie

nts

with

chro

nic

LBP

(�12

wk)

Mea

nag

e�62

.4y

Exp

grou

p,

n�13

*C

trlg

roup

,n�

13*

7C

trl

gro

up

:30

min

ofth

erap

eutic

grou

pex

erci

ses

3tim

esp

erw

eek

(rel

axat

ion

tech

niq

ues

asw

ella

sst

retc

hing

and

activ

eex

erci

ses

for

the

abdo

min

al,

lum

bar,

and

thor

acic

back

exte

nsor

,p

soas

,is

chio

tibia

l,an

dp

elvi

cm

uscl

es)

Exp

gro

up

:KT

�th

erap

eutic

exer

cise

(sam

eas

for

Ctr

lgr

oup

)Ex

pan

dC

trl

gro

up

s:p

atie

nts

wer

een

cour

aged

toke

epp

ract

icin

gat

hom

eaf

ter

the

end

ofth

egr

oup

sess

ions

Tap

ing

app

lica

tio

nm

od

alit

y:p

atie

nts

wer

eas

ked

tobe

ndfo

rwar

ddu

ring

the

tap

ing

pro

cedu

re(n

ote

nsio

nw

asus

edot

her

than

that

req

uire

dto

cove

rth

eba

ckin

bend

ing

pos

ition

)Ex

pgr

oup

:3

strip

esov

erth

elu

mba

rar

eabe

twee

nT1

2an

dL5

spin

ous

pro

cess

es;

one

strip

ew

asp

lace

dov

erth

em

idlin

e,al

ong

alin

eco

rres

pon

ding

toth

esp

inou

sp

roce

ss,

and

the

othe

r2

strip

esw

ere

pla

ced

onth

erig

htan

dle

fter

ecto

rsp

inae

mus

cles

(4cm

from

the

first

strip

e)T

ype

of

tap

eu

sed

:20

�5

cmKi

nesi

otap

eKT

545,

long

itudi

nale

last

icity

of40

%R

enew

alo

fta

pin

g:

ever

y3

dfo

rEx

pgr

oup

Du

rati

on

:4

wk

(1)

Pai

n–V

AS

(0–1

0)(2

)D

isab

ilit

y–RM

DQ

(0–2

4)-

Foll

ow

-up

at0

mo

Pain

sign

ifica

ntly

decr

ease

din

both

grou

ps

afte

rth

ein

terv

entio

n(P

�.0

001)

Dis

abili

tyde

crea

sed

inbo

thgr

oup

saf

ter

the

inte

rven

tion,

alth

ough

the

diffe

renc

ew

ithba

selin

eva

lues

was

sign

ifica

nton

lyfo

rth

eC

trlg

roup

(P�

.01)

Aut

hors

’co

nclu

sion

:KT

isab

leto

redu

cep

ain

inp

atie

nts

with

chro

nic

LBP

shor

tlyaf

ter

itsap

plic

atio

n;its

effe

cts

per

sist

over

ash

ort

follo

w-u

pp

erio

d

(Con

tinue

d)



Tab

le.

Con

tinue

d

Par

tici

pan

tsb

PED

roSc

ore

Inte

rven

tio

nb

Ou

tco

me

Mea

sure

san

dFo

llo

w-u

pb

,cR

epo

rted

Res

ult

sb

Kavl

aket

al,

2012

53

40p

atie

nts

with

acut

e,su

bacu

te,

orch

roni

cN

P(c

ervi

cald

isk

hern

iatio

n,ce

rvic

alsp

ondy

losi

s,or

cerv

ical

radi

culo

pat

hy)

Mea

nag

e�49

.4y

Exp

grou

p,

n�20

*C

trlg

roup

,n�

20*

7C

trlg

roup

:C

lass

icth

erap

yth

atco

mpr

ised

ultr

asou

nd,

inte

rfer

entia

lcur

rent

,hot

pack

,and

mas

sage

appl

ied

toth

ene

ckan

dm

idsc

apul

arre

gion

s.Th

edu

ratio

nof

the

neck

mas

sage

was

10m

in,a

ndit

cons

isted

ofst

roki

ngan

dkn

eadi

ngm

otio

nsto

rela

xth

em

uscl

es(e

rect

orsp

inae

,lev

ator

scap

ulae

,and

trap

eziu

s).C

ervi

calfl

exio

n,ex

tens

ion,

late

ralfl

exio

n,ro

tatio

n,an

dst

reng

then

ing

exer

cise

sw

ere

give

nto

patie

nts

asan

exer

cise

prog

ram

.Ex

pg

roup

:KT

�cl

assic

ther

apy

(sam

eas

for

Ctr

lgro

up)

Exp

and

Ctr

lg

roup

s:ex

erci

sepr

ogra

mto

bepe

rfor

med

atho

me

Tap

ing

app

lica

tion

mod

alit

y:Ex

pgr

oup:

The

orig

inof

the

KTsh

aped

Yw

aspl

aced

whi

leth

epa

tient

’she

adw

asin

ane

utra

lpos

ition

and

heor

she

was

inst

ruct

edto

perf

orm

neck

flexi

on.A

fter

the

med

ialt

ailo

fthe

KTw

asad

here

din

this

posit

ion,

the

patie

ntw

asin

stru

cted

tope

rfor

mro

tatio

nin

com

bina

tion

with

neck

flexi

on,a

ndth

ela

tera

ltai

lofK

Tw

asad

here

din

this

posit

ion.

The

adm

inist

ratio

nw

asre

peat

edon

the

othe

rsid

e.Typ

eof

tap

euse

d:

kine

siota

peR

enew

of

tap

ing

:dai

lyfo

rEx

pgr

oup

Dura

tion

:3

wk

(15

sess

ions

)

(1)

Pai

n–V

AS

(0–1

00)

rest

ing/

activ

ity/n

ight

(2)

Dis

abil

ity–

ND

I(0

–50)

-Fo

llo

w-u

pat

0m

o

Pain

(P�

.05)

and

disa

bilit

y(P

�.0

01)

sign

ifica

ntly

decr

ease

dw

ithin

all3

grou

ps

afte

rth

ein

terv

entio

nN

osi

gnifi

cant

diffe

renc

esbe

twee

ngr

oup

sfo

rp

ain

and

disa

bilit

yaf

ter

the

inte

rven

tion

(P�

.05)

Aut

hors

’co

nclu

sion

:KT

may

behe

lpfu

las

anal

tern

ativ

etr

eatm

ent

for

neck

pai

n

Lee

etal

,20

123

9

32p

atie

nts

with

MPS

(up

per

trap

eziu

sm

uscl

e)M

ean

age�

47.6

yEx

pgr

oup

,n�

16*

Ctr

lgro

up,

n�16

*

6C

trl

gro

up

:St

abili

zatio

nex

erci

ses

twic

ep

erw

eek

for

the

scap

ular

and

shou

lder

gird

lem

uscl

es.

Adu

tycy

cle

of1:

3w

asad

opte

d,an

dea

chex

erci

sew

asp

erfo

rmed

for

10s,

follo

wed

byre

stfo

r30

s.Th

ep

atie

nts

per

form

ed3

sets

of10

rep

etiti

ons

ofea

chex

erci

sean

dre

sted

for

3m

inaf

ter

each

set.

The

stab

iliza

tion

exer

cise

sfo

rth

esc

apul

arm

uscl

esw

ere

isom

etric

cont

ract

ions

(sca

pul

arel

evat

ion,

dep

ress

ion,

upw

ard

and

dow

nwar

dro

tatio

n,p

rotr

actio

nan

dre

trac

tion)

.Th

est

abili

zatio

nex

erci

ses

for

the

shou

lder

gird

lew

ere

per

form

edw

hile

the

pat

ient

exte

nded

his

orhe

rel

bow

join

ts,

flexe

dhi

sor

her

shou

lder

join

tsat

90°,

and

held

aro

dw

ithbo

thha

nds

inth

esu

pin

ep

ositi

onto

geth

erw

ithth

eth

erap

ist

whi

lebe

ing

inst

ruct

edto

mai

ntai

nth

ep

ostu

reag

ains

tth

ep

rovi

ded

resi

stan

ce.

Exp

gro

up

:no

nela

stic

tap

eap

plic

atio

n�

stab

iliza

tion

exer

cise

s(s

ame

asfo

rC

trlg

roup

)T

apin

gap

pli

cati

on

mo

dal

ity:

Exp

grou

p:

the

tap

ing

was

app

lied

toth

e1/

3p

oint

onth

em

edia

lsid

eof

the

clav

icle

with

the

12th

thor

acic

vert

ebra

com

ple

tely

exte

nded

tom

aint

ain

retr

actio

nan

dde

pre

ssio

nof

the

scap

ula

Typ

eo

fta

pe

use

d:

not

rep

orte

dR

enew

alo

fta

pin

g:

tap

ing

app

lied

befo

rest

abili

zatio

nex

erci

ses

and

rem

oved

imm

edia

tely

afte

rth

em(t

wic

ea

wee

k)fo

rEx

pgr

oup

Du

rati

on

:4

wk

(1)

Pai

n–V

AS

(0–1

00)

(2)

Dis

abil

ity–

CM

S,ac

tiviti

esof

daily

livin

gsu

bsca

le(0

–20)

-Fo

llo

w-u

pat

0m

o

Pain

sign

ifica

ntly

decr

ease

din

both

grou

ps

afte

rth

ein

terv

entio

n(P

�.0

5)N

osi

gnifi

cant

diffe

renc

esbe

twee

ngr

oup

sfo

rp

ain

afte

rth

ein

terv

entio

n(P

�.0

5)In

the

asse

ssm

ent

ofdi

sabi

lity

usin

gth

eC

MS,

the

Ctr

lgro

upsh

owed

nosi

gnifi

cant

diffe

renc

eson

the

activ

ities

ofda

ilyliv

ing

subs

cale

(P�

.05)

,w

here

asth

eEx

pgr

oup

show

eda

stat

istic

ally

sign

ifica

ntdi

ffere

nce

(P�

.05)

Sign

ifica

ntdi

ffere

nces

betw

een

grou

ps

onth

eac

tiviti

esof

daily

livin

gsu

bsca

le(P

�.0

5)A

utho

rs’

conc

lusi

on:

app

lyin

gno

nela

stic

tap

ing

befo

rest

abili

zatio

nex

erci

ses

ism

ore

effe

ctiv

eat

relie

ving

pai

nin

pat

ient

sw

ithM

PSin

the

upp

ertr

apez

ius

mus

cle

than

trea

tmen

tth

atus

eson

lyst

abili

zatio

nex

erci

ses

(Con

tinue

d)



Tab

le.

Con

tinue

d

Par

tici

pan

tsb

PED

roSc

ore

Inte

rven

tio

nb

Ou

tco

me

Mea

sure

san

dFo

llo

w-u

pb

,cR

epo

rted

Res

ult

sb

Gon

zale

s-Ig

lesi

aset

al,

2009

54

41p

atie

nts

with

acut

eW

AD

(with

in40

daf

ter

am

otor

vehi

cle

acci

dent

)M

ean

age�

32.5

yEx

pgr

oup

,n�

21*

Ctr

lgro

up,

n�20

*

8C

trl

gro

up

:p

lace

boKT

Exp

gro

up

:st

anda

rdiz

edth

erap

eutic

KTT

apin

gap

pli

cati

on

mo

dal

ity:

Ctr

lgro

up:

2I-

strip

sap

plie

dw

ithno

tens

ion;

the

first

(blu

e)st

ripw

asp

lace

dov

erth

esp

inou

sp

roce

sses

ofth

ece

rvic

alan

dth

orac

icsp

ines

,an

dth

ese

cond

(bla

ck)

strip

was

pla

ced

per

pen

dicu

lar

over

the

mid

cerv

ical

regi

on.

The

cerv

ical

spin

eof

the

par

ticip

ants

was

pla

ced

ina

neut

ralp

ositi

on.

Exp

grou

p:

The

first

laye

rw

asa

blue

Y-st

ripp

lace

dat

app

roxi

mat

ely

15%

–25%

tens

ion

over

the

pos

terio

rce

rvic

alex

tens

orm

uscl

esan

dap

plie

dfr

omth

ein

sert

ion

toor

igin

(fro

mth

edo

rsal

regi

on[T

1–T2

]to

the

upp

erce

rvic

alre

gion

[C1–

C2]

).Ea

chta

ilof

the

first

(blu

e)st

rip(Y

-str

ip,

2-ta

iled)

was

app

lied

with

the

pat

ient

’sne

ckin

ap

ositi

onof

cerv

ical

cont

rala

tera

lsid

ebe

ndin

gan

dro

tatio

n.Th

eov

erly

ing

seco

nd(b

lack

)st

ripw

asa

spac

e-ta

pe

(op

enin

g)p

lace

dp

erp

endi

cula

rto

the

Y-st

ripov

erth

em

idce

rvic

alre

gion

(C3–

C6)

,w

ithth

ep

atie

nt’s

cerv

ical

spin

ein

flexi

onto

app

lyte

nsio

nto

the

pos

terio

rne

ckst

ruct

ures

.T

ype

of

tap

eu

sed

:Ki

nesi

oTe

xta

pe,

wid

th�

5cm

,th

ickn

ess�

0.5

mm

Ren

ewal

of

tap

ing

:no

neD

ura

tio

n:

1d

(1se

ssio

n)

(1)

Pai

n–N

PRS

(0–1

0)-

Foll

ow

-up

imm

edia

tely

pos

tinte

rven

tion

(0m

o)an

d24

haf

ter

the

inte

rven

tion

(1d)

Pain

grea

tlyan

dsi

gnifi

cant

lyde

crea

sed

inEx

pgr

oup

vsC

trl

grou

pim

med

iate

lyp

ostin

terv

entio

nan

dat

24-h

follo

w-u

p(P

�.0

01)

Aut

hors

’co

nclu

sion

:Pa

tient

sw

ithac

ute

WA

Dre

ceiv

ing

anap

plic

atio

nof

KT,

app

lied

with

pro

per

tens

ion,

exhi

bite

dst

atis

tical

lysi

gnifi

cant

imp

rove

men

tsin

pai

nle

vels

imm

edia

tely

follo

win

gap

plic

atio

nof

the

kine

siot

ape

and

ata

24-h

follo

w-u

p.

How

ever

,th

ese

imp

rove

men

tsw

ere

smal

land

may

not

becl

inic

ally

mea

ning

ful.

aLB

P�lo

wba

ckp

ain,

Ctr

l�co

ntro

l,Ex

p�

exp

erim

enta

l,KT

�Ki

nesi

otap

ing,

MD

�m

ean

diffe

renc

e,C

I�co

nfide

nce

inte

rval

,N

RS�

num

eric

alra

ting

scal

e,N

PRS�

num

eric

alp

ain

ratin

gsc

ale,

RMD

Q�

Rola

nd-

Mor

risD

isab

ility

Que

stio

nnai

re,

VAS�

visu

alan

alog

scal

e,O

DI�

Osw

estr

yD

isab

ility

Que

stio

nnai

re,

ND

I�N

eck

Dis

abili

tyIn

dex,

MPS

�m

yofa

scia

lpai

nsy

ndro

me,

NP�

neck

pai

n,W

AD

�w

hip

lash

-ass

ocia

ted

diso

rder

,TE

NS�

tran

scut

aneo

usel

ectr

ical

nerv

est

imul

atio

n.*P

artic

ipan

tsw

hose

data

wer

ean

alyz

ed.

**O

nly

pai

nat

wor

stw

asco

nsid

ered

for

data

poo

ling.

bO

nly

data

ofco

nsid

ered

sam

ple

grou

ps

and

thei

rre

spec

tive

inte

rven

tions

are

rep

orte

d.c

Follo

w-u

ptim

eis

inte

nded

from

pos

tinte

rven

tion

onw

ard.



were included in the meta-analysis.We also did not assess indirectness,as this review encompasses specificpopulation, type of intervention, andoutcome measures. Two reviewersjudged whether these factors werepresent for each outcome. Singlerandomized studies (with fewer than300 participants) were consideredinconsistent and imprecise (that is,sparse data) and provided “low-quality evidence.” This rating couldbe further downgraded to “very low-quality evidence” if there were alsolimitations in design.47,48 We appliedthe following definitions of quality ofthe evidence49:

• High quality—further research isunlikely to change our confidencein the estimate of effect. There areno known or suspected reportingbiases; all domains fulfilled.

• Moderate quality—further researchis likely to have an importantimpact on our confidence in theestimate of effect and might changethe estimate; one of the domainswas not fulfilled.

• Low quality—further research islikely to have an important impacton our confidence in the estimateof effect and is likely to change theestimate; 2 of the domains were notfulfilled.

• Very low quality—we are uncertainabout the estimate; 3 of thedomains were not fulfilled.

A GRADE profile was completed foreach pooled estimate and for singletrials comparing KT and placebointervention.

ResultsWe identified 5,531 studies throughdatabase searching. No additionaleligible studies were identifiedthrough other sources. After remov-ing duplicates and screening titlesand abstracts of all remaining uniquearticles, 23 full-text articles neededto be assessed to verify their eligi-bility for inclusion in the presentstudy. Ultimately, 15 of them were

excluded for various reasons (eFig-ure, available at ptjournal.apta.org),resulting in 8 studies selected forthis review.39,50–56 Only one dis-agreement between assessorsoccurred, and it was resolved by ameeting held in consultation with2 other authors (C.V., P.P.). Sixstudies50,52–57 concern elastic tap-ing, and the other 2 studies39,51 con-cern nonelastic taping. Overall, the8 included studies, conducted inEurope (Italy, Spain), Australia,South America (Brazil), and Asia(Turkey, Korea), were publishedfrom 2009 to 2014, with only 25% ofthem being published before 2012.The number of patients who wereenrolled and completed baselineassessments was 409 (range�20–148), with a mean sample size of 51participants. The mean age of thestudy participants was approxi-mately 48 years (range�32.5–62.4).The majority of the participantswere female (n�277; 68%).

Five studies concerned LBP, and 3studies concerned NP. All of thestudies on LBP referred to peoplewith chronic and nonspecific LBP.With respect to studies on NP, one ofthem was related to chronic nonspe-cific NP,39 one to acute NP,54 and thethird to specific NP53 (Table). Fourselected trials were judged by thereviewers to be clinically homoge-neous,50,52,55,56 and meta-analysiswas performed (Figs. 1 and 2). How-ever, meta-analysis for pain and dis-ability at short term was not exe-cuted for the same studies50,52,55–56

or for the other 4 studies.39,51,53,54

For these studies, effect sizes andassociated 95% CIs for the individualtrials were calculated and were pre-sented in a forest plot groupedaccording to treatment, followed byoutcomes and follow-ups (Figs. 3, 4,and 5). The evaluation of evidencequality was made for each compari-son outcome using the GRADEresults (eAppendix 2, available atptjournal.apta.org).

Quality and Clinical RelevanceAssessmentThe methodological quality of thestudies was assessed with the PEDroscale. Two evaluators independentlyrated all of the studies included inthe review using the PEDro scale.Then, they compared their evalua-tion with the published PEDroscores, when available, and reachedan agreement in the other cases by ameeting in consultation with 2 otherauthors (C.V., P.P.). All studies thatreached the minimum score (6/10)were considered to have good qual-ity, with a range from 6/10 to 9/10and an average higher than thisthreshold (mean score�7.75).

The worst scored criterion of qualitywas the blinding of physical thera-pists, as all of the studies failed toobtain a positive score. This find-ing is not surprising given that clini-cian blinding is not possible for thetype of treatment performed. Simi-larly, the other criterion receiving alow score was the blinding of thepatients regarding the treatment.However, it should be noted thatthis patient blinding was not scoredfavorably in most of the studiesbecause this information was omit-ted. Blinding of assessors and con-cealed allocation of patients togroups were satisfied in 5 of 8studies, and data analysis accord-ing to the intention-to-treat methodachieved positive results in 7 of 8studies. The best scored criteria onwhich all studies obtained a favor-able score were those related to thestatistical analysis of the results, therandomization of participants in thegroups, the initial comparability ofthe most important prognostic fac-tors, and finally the evaluation of atleast one outcome measured on atleast 85% of patients (eTab. 1, avail-able at ptjournal.apta.org).

Concerning clinical relevance, nodifferences between experimentaland control groups were found.







Only Chen and colleagues’ study51

on nonelastic taping yielded resultsin the experimental group thatattained the threshold MCID forshort-term pain and disability reduc-tion, differently from placebo (eTab.2, available at ptjournal.apta.org).

Outcomes of Treatment forPeople With LBPFigures 1, 2, 3, and 4 present thefollow-up study findings for pain anddisability with respect to the effectsize for 95% CI values of the inter-vention outcomes. Four studies con-cern elastic taping,50,52,55,56 and 1study concerns nonelastic taping.51

Outcomes of elastic tapingversus sham/placebo or notreatment for people with LBP.Four high-quality studies50,52,55,56 onthe PEDro scale assessed pain in theimmediate posttreatment period; 1study50 had a 1-month follow-up, and1 study56 had a 2-month follow-up.Meta-analysis was performed (Fig. 1)only for the 4 studies that assessedpain immediately after the inter-vention.50,52,55,56 Overall (random-effects model) effect size of elastictaping versus sham/placebo or notreatment was small and not signifi-cant (g��0.31; 95% CI��0.64,0.02). In the study that assessed painat 1 month after the intervention,50

the effect size of elastic taping was

medium and significant (g��0.78;95% CI��1.30, �0.25). In the studythat assessed pain 2 months after theintervention,56 the effect size of tap-ing was small and not significant(g��0.20; 95% CI��0.52, 0.12)(Fig. 3). In summary, using GRADEcriteria, there is low-quality evidencethat elastic taping versus sham/placebo or no treatment providesno significant improvement in painintensity immediately posttreatmentand at 2-month follow-up, and thereis a low-quality evidence that elastictaping reduces pain at 1 monthfollow-up.

Four high-quality studies50,52,55,56 onthe PEDro scale assessed disability in

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

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





the immediate posttreatment period;1 study50 had a 1 month follow-up(with 2 different measurementscales), and 1 study56 had a 2-monthfollow-up. Meta-analysis (Fig. 2) wasperformed only for the 4 studiesthat assessed disability immediatelyafter intervention.50,52,55,56 Overall(random-effects model) effect size ofelastic taping versus sham/placeboor no treatment was small andnot significant (g��0.23; 95% CI��0.49, 0.03). In the study thatassessed disability at 1 month afterthe intervention (with 2 differentmeasurement scales),50 the effectsize was small (g��0.37; 95% CI��0.88, 0.14) when disability wasassessed with the ODI and very small(g��0.04; 95% CI��0.54, 0.47)when disability was assessed withthe RMDQ. In the study that assesseddisability at 2 months after the inter-

vention,56 the effect size of tapingwas small and not significant (g��0.20; 95% CI��0.52, 0.12) (Fig. 3).

In summary, using GRADE criteria,there is low-quality evidence thatelastic taping versus sham/placeboor no treatment provides no signifi-cant improvement in disability in theimmediate posttreatment period andat 1- and 2-month follow-ups.

Outcomes of nonelastic tapingversus placebo for people withLBP. One high-quality study51 onthe PEDro scale assessed pain bothimmediately posttreatment and at1-month follow-up. The effect size oftaping versus placebo was mediumand significant (g��0.72; 95%CI��1.33, �0.12) in the immediateposttreatment period, and it wassmall and not significant (g��0.42;

95% CI��1.01, 0.18) at 1-monthfollow-up (Fig. 4). In summary, usingGRADE criteria, there is low-qualityevidence that nonelastic taping ver-sus placebo reduces pain at post-treatment follow-up and provides nosignificant improvement at 1-monthfollow-up.

One high-quality study51 on thePEDro scale assessed disability bothin the immediate posttreatmentperiod and at 1-month follow-up.The effect size of taping versus pla-cebo was medium and not signifi-cant (g��0.59; 95% CI��1.19,0.01) immediately posttreatment,and it was small and not significant(g��0.33; 95% CI��0.93, 0.26) at1-month follow-up (Fig. 4). In sum-mary, using GRADE criteria, there islow-quality evidence that nonelastictaping versus placebo provides no

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 typerepresent statistically significant comparisons based on the 95% confidence interval (95% CI) of the SMD. Values presented in forestplots 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-monthfollow-up), NRS�numerical rating scale, VAS�visual analog scale, ODI�Oswestry Disability Questionnaire, RMDQ�Roland-MorrisDisability Questionnaire.

Figure 4.Results of single included trials on the effects of nonelastic taping versus placebo for people with low back pain. Treatment effectsfavoring taping: assigned negative Hedges’ g standardized mean difference (SMD) values. Results in bold type represent statisticallysignificant 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.



significant improvement in disabilityat posttreatment follow-up and at1-month follow-up.

Outcomes of Treatment forPeople With NPThe follow-up study findings for painand disability with respect to theeffect size with 95% CI for inter-vention outcomes are presented inFigure 5. Three studies analyzedNP39,53,54: 1 related to nonspecificchronic NP,39 1 related to acuteNP,54 and 1 related to specific NP.53

Two studies concern elastic tap-ing,53,54 and 1 study concerns non-elastic taping.39

Outcomes of treatment withelastic tape versus placebo forpeople with NP (WAD). Onestudy54 assessed pain in the immedi-ate posttreatment period. The effectsize of taping versus placebo waslarge and significant (g��1.04; 95%CI��1.68, �0.39) (Fig. 5).

In summary, using GRADE criteria,there is low-quality evidence fromone trial that elastic taping versusplacebo reduces pain in the immedi-ate posttreatment period.

Outcomes of treatment withelastic tape versus no treatmentfor people with specific NP(cervical disk herniation, cervicalspondylosis, or cervicalradiculopathy). One study53

assessed pain in the immediate post-treatment period. The effect size oftaping versus no treatment wasmedium and significant (g��0.66;95% CI��1.28, �0.03) (Fig. 5).

One study53 assessed disability in theimmediate posttreatment period.The effect size of taping versus notreatment was small and not signifi-cant (g��0.19; 95% CI��0.80,0.42) (Fig. 5).

In summary, using GRADE criteria,there is low-quality evidence (fromone trial) that elastic taping versusno treatment reduces pain in theimmediate posttreatment period.No significant improvement in dis-ability was found at posttreatmentfollow-up.

Outcomes of treatment withnonelastic taping versus notreatment for people withnonspecific chronic NP. Onestudy39 assessed pain immediatelyposttreatment. The effect size of tap-ing versus no treatment was very

small and not significant (g��0.08;95% CI��0.75, 0.60) (Fig. 5).

One study39 assessed disabilityimmediately posttreatment. Theeffect size of taping versus no treat-ment was small and not significant(g��0.42; 95% CI��1.10, 0.27)(Fig. 5).

In summary, using GRADE criteria,there is very low-quality evidence(from one trial) that nonelastic tap-ing versus no treatment provides nosignificant reduction in pain or dis-ability in the immediate posttreat-ment period.

DiscussionWe searched the scientific evidencefor the effect of elastic and nonelas-tic taping on the 2 outcomes that arecommonly considered as relevant inspinal conditions: pain and disability.Eight RCTs concerned the effect ofseveral types of taping on pain anddisability for LBP and NP. Meta-analysis of RCTs on LBP demon-strated that elastic taping did not sig-nificantly reduce pain and disabilityimmediately posttreatment com-pared with sham/placebo or no treat-ment. Both elastic and nonelastictaping did not provide significantimprovement in spinal disability.Conflicting results emerged from sin-

Figure 5.Results of single included trials on the effects of taping versus placebo or no treatment in people with neck pain (NP). Treatmenteffects favoring taping assigned negative Hedges’ g standardized mean difference (SMD) values. Results in bold type representstatistically significant comparisons based on the 95% confidence interval (95% CI) of the SMD. Values presented in forest plots areeffect size (ES) of the SMD and 95% CI. Mean (SD)§�mean and standard deviation measured at baseline. Mean (SD)*�mean andstandard 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.



gle trials because nonelastic tapingappeared to be effective on lumbarpain versus placebo only immedi-ately posttreatment, but it providedno significant reduction in cervicalpain compared with no treatment.Elastic taping appeared to be effec-tive on lumbar pain only at 1-monthfollow-up, but not immediately post-treatment or at 2-month follow-up.Single trials also indicated that elastictaping may be effective for painrelief in acute NP (WAD) and in spe-cific NP in the immediate posttreat-ment period.

On the basis of the GRADE assess-ment results, all of these findingswere supported by evidence fromvery low- to low-quality studies.Although different types of tapingwere investigated, the results of thissystematic review are similar forboth types of tape, not showing anyfirm support for their effectiveness.

The quality of the included RCTs,assessed by PEDro score, was gener-ally high, especially for LBP. Studieson LBP are homogeneous for out-come measures and age of includedparticipants. Nevertheless, only onestudy56 had a sample size greaterthan 50 participants per group,which is the minimum numberneeded to achieve “golden” and“platinum” evidence.57 No study wasfound on acute, specific, or posttrau-matic LBP; on nonspecific NP otherthan myofascial pain syndrome; oron thoracic pain. Mid- and long-termfollow-up studies have never beenconducted, and we cannot commentabout outcome measures other thanpain and disability. The conclusionfrom the few studies on taping wefound is comparable to the results ofother systematic reviews concerningthe effectiveness of KT in musculo-skeletal injuries10,15,19,22,23 and intreatment and prevention of sportsinjuries.18 Our results on elastic tap-ing effectiveness are similar to find-ings of the previous reviews, also

considering the low levels ofevidence.

In light of our results, the currentliterature does not support the use ofthis therapeutic option in spinal con-ditions, and it does not confirm thehypothesized greater effect of theelastic taping compared with non-elastic taping. Suggestions for futureresearch are to conduct high-qualitystudies with longer follow-up timesand sufficiently large and generaliz-able samples. The effects of non-steroidal anti-inflammatory drugs aspossible confounding factors alsoshould be considered. Due to associ-ated modifications of position senseand the repositioning strategies usedin people with chronic LBP and NP,the study of the effects of taping onadditional outcome measures suchas proprioception and balancewould be of interest. Additionally,the psychological dimensions of tap-ing, including patient preferences,might be investigated. Finally, as theoverall quality of the small body ofliterature on the effects of taping islow, future research may alter cur-rent estimates of effect, and strongerevidence could very well changeconfidence in our conclusions aswell as further confirm it.

Ms Vanti, Ms Bertozzi, Mr Gardenghi, MsTuroni, and Mr Pillastrini provided concept/idea/research design. Ms Vanti, Ms Bertozzi,Mr Gardenghi, Dr Guccione, and Mr Pillas-trini provided writing. Mr Gardenghi and MsTuroni provided data collection. Ms Bertozzi,Mr Gardenghi, Ms Turoni, and Dr Guccioneprovided data analysis. Ms Vanti, Ms Ber-tozzi, and Mr Pillastrini provided projectmanagement. Ms Vanti, Ms Bertozzi, DrGuccione, and Mr Pillastrini provided consul-tation (including review of manuscriptbefore submission). The authors thank GiuliaCatoni and Giulia Marcheselli for their assis-tance with the research.

DOI: 10.2522/ptj.20130619

References1 Strine TW, Hootman JM. US national prev-

alence and correlates of low back andneck pain among adults. Arthritis Rheum.2007;57:656–665.

2 van Tulder MW, Koes BW, Bouter LM.Conservative treatment of acute andchronic nonspecific low back pain: a sys-tematic review of randomized controlledtrials of the most common interventions.Spine. 1997;22:2128–2156.

3 Hestbaek L, Leboeuf-Yde C, Manniche C.Low back pain: what is the long-termcourse? A review of studies of generalpatient populations. Eur Spine J. 2003;12:149–165.

4 Luime JJ, Koes BW, Miedem HS, et al. Highincidence and recurrence of shoulder andneck pain in nursing home employees wasdemonstrated during a 2-year follow up.J Clin Epidemiol. 2005;58:407–413.

5 Quittan M. Management of back pain. Dis-abil Rehabil. 2002;24:423–434.

6 Childs JD, Cleland JA, Elliott JM, et al; forthe American Physical Therapy Associa-tion. Neck pain: clinical practice guide-lines linked to the International Classifi-cation of Functioning, Disability, andHealth from the Orthopedic Section of theAmerican Physical Therapy Association.J Orthop Sports Phys Ther. 2008;38:A1–A34.

7 Hansson EK, Hansson TH. The costs forpersons sick-listed more than one monthbecause of low back or neck problems: atwo-year prospective study of Swedishpatients. Eur Spine J. 2005;14:337–345.

8 Sackett DL, Straus S, Richardson WS, et al.Evidence-Based Medicine: How to Prac-tice and Teach EBM. 2nd ed. New York,NY: Churchill Livingstone Inc; 2000.

9 Alexander CM, Stynes S, Thomas A, et al.Does tape facilitate or inhibit the lowerfibres of trapezius? Man Ther. 2003;8:37–41.

10 Morris D, Jones D, Ryan H, Ryan CG. Theclinical effects of Kinesio® Tex taping: asystematic review. Physiother TheoryPract. 2013;29:259–270.

11 Kinesio UK. Available at: http://www.kinesiotaping.co.uk/tapingmethod.jsp.Accessed May 25, 2013).

12 Thelen MD, Dauber JA, Stoneman PD. Theclinical efficacy of Kinesio Tape for shoul-der pain: a randomized, double-blinded,clinical trial. J Orthop Sports Phys Ther.2008;38:389–395.

13 Bicici S, Karatas N, Baltaci G. Effect ofathletic taping and Kinesiotaping® onmeasurements of functional performancein basketball players with chronic inver-sion ankle sprains. Int J Sports Phys Ther.2012;7:154–166.

14 Kase K, Wallis J, Kase T. Clinical Thera-peutic Applications of the Kinesio TapingMethod. 2nd ed. Tokyo, Japan: Ken Ikai;2003.

15 Mostafavifar M, Wertz J, Borchers J. A sys-tematic review of the effectiveness ofkinesio taping for musculoskeletal injury.Phys Sportsmed. 2012;40:33–40.



http://www.kinesiotaping.co.uk/tapingmethod.jsp

http://www.kinesiotaping.co.uk/tapingmethod.jsp

16 Murray H, Husk L. Effect of kinesiotapingon proprioception in the ankle. J OrthopSports Phys Ther. 2001;31:A–37.

17 What is the current evidence for the use ofkinesio tape? A literature review. SportEXDynamics. 2012;34:24–30.

18 Williams S, Whatman C, Hume PA, SheerinK. Kinesio taping in treatment and preven-tion of sports injuries: a meta-analysis ofthe evidence for its effectiveness. SportsMed. 2012;42:153–164.

19 Bassett KT, Lingman SA, Ellis RF. The useand treatment efficacy of kinaesthetic tap-ing for musculoskeletal conditions: a sys-tematic review. N Z J Physiother. 2010;38:56–62.

20 Espejo L, Apolo MD. Revision bibliograficade la efectividad del kinesiotaping. Reha-bilitacion. 2011;45:148–158.

21 Calero PA, Canon GA. Efectos del vendajeneuromuscular: una revision bibliografica.Rev Cienc Salud. 2012;10:273–284.

22 Parreira Pdo C, Costa Lda C, Hespanhol LCJr, et al. Current evidence does not sup-port the use of Kinesio Taping in clinicalpractice: a systematic review. J Phys-iother. 2014;60:31–39.

23 Montalvo AM, Cara EL, Myer GD. Effect ofkinesiology taping on pain in individualswith musculoskeletal injuries: systematicreview and meta-analysis. Phys Sportsmed.2014;42:48–57.

24 Merskey H, Bogduk N. Classification ofChronic Pain: Descriptions of ChronicPain Syndromes and Definitions of PainTerms. Seattle, WA: IASP Press; 1994.

25 Bogduk N, McGuirk B. Medical Manage-ment of Acute and Chronic Low BackPain: An Evidence-Based Approach.Amsterdam, the Netherlands: Elsevier;2002.

26 Bertozzi L, Gardenghi I, Turoni F, et al.Effect of therapeutic exercise on pain anddisability in the management of chronicnonspecific neck pain: systematic reviewand meta-analysis of randomized trials.Phys Ther. 2013;93:1026–1036.

27 Philadelphia Panel evidence-based clinicalpractice guidelines on selected rehabilita-tion interventions for neck pain. PhysTher. 2001;81:1701–1717.

28 Furlan AD, Pennick V, Bombardier C, vanTulder M; Editorial Board, Cochrane BackReview Group. 2009 updated methodguidelines for systematic reviews in theCochrane Back Review Group. Spine.2009;34:1929–1941.

29 Maher CG, Sherrington C, Herbert RD,et al. Reliability of the PEDro scale for rat-ing quality of randomized controlled trials.Phys Ther. 2003;83:713–721.

30 de Morton NA. The PEDro scale is a validmeasure of the methodological quality ofclinical trials: a demographic study. Aust JPhysiother. 2009;55:129–133.

31 Hahne AJ, Ford JJ, McMeeken JM. Conser-vative management of lumbar disc hernia-tion with associated radiculopathy: a sys-tematic review. Spine. 2010;35:E488–E504.

32 Bleakley CM, McDonough SM, MacAuleyDC. Some conservative strategies areeffective when added to controlled mobi-lization with external support after acuteankle sprain: a systematic review. Aust JPhysiother. 2008;54:7–20.

33 Surkitt LD, Ford JJ, Hahne AJ, et al. Efficacyof directional preference management forlow back pain: a systematic review. PhysTher. 2012;92:652–665.

34 Bombardier C, Hayden J, Beaton DE. Min-imal clinically important difference—lowback pain: outcome measures. J Rheuma-tol. 2001;28:431–438.

35 Ostelo RW, Deyo RA, Stratford PW, et al.Interpreting change scores for pain andfunctional status in low back pain:towards international consensus regardingminimal important change. Spine. 2008;33:90–94.

36 Farrar JT, Young JP Jr, LaMoreaux L, et al.Clinical importance of changes in chronicpain intensity measured on an 11-pointnumerical pain rating scale. Pain. 2001;94:149–158.

37 Stratford PW, Riddle DL, Binkley JM. Usingthe Neck Disability Index to make deci-sions concerning individual patients. Phys-iother Can. Spring 1999:107–119.

38 Pool JJ, Ostelo RW, Hoving JL, et al. Mini-mal clinically important change of theNeck Disability Index and the NumericalRating Scale for patients with neck pain.Spine. 2007;32:3047–3051.

39 Lee JH, Yong MS, Kong BJ, Kim JS. Theeffect of stabilization exercises combinedwith taping therapy on pain and functionof patients with myofascial pain syn-drome. J Phys Ther Sci. 2012;24:1283–1287.

40 Ioppolo F, Tattoli M, Di Sante L, et al. Clin-ical improvement and resorption of calci-fications in calcific tendinitis of the shoul-der after shock wave therapy at 6 months’follow-up: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94:1699–1706.

41 DerSimonian R, Laird N. Meta-analysis inclinical trials. Control Clin Trials. 1986;7:177–188.

42 Hedges LV, Olkin I. Statistical Methods forMeta-Analysis. San Diego, CA: AcademicPress; 1985.

43 ProMeta software. Available at: http://www.internovi.it/software/prometa/. Ac-cessed September 23, 2013.

44 Cohen J. Statistical Power Analysis forthe Behavioural Sciences. Hilldale, NY:Lawrence Erlbaum Associates; 1988.

45 Atkins D, Best D, Briss PA, et al; for theGRADE Working Group. Grading qualityof evidence and strength of recommenda-tions. BMJ. 2004;328:1490.

46 Henschke N, Ostelo RW, van Tulder MW,et al. Behavioural treatment for chroniclow-back pain. Cochrane Database SystRev. 2010;7:CD002014.

47 Pinto RZ, Maher CG, Ferreira ML, et al.Drugs for relief of pain in patients withsciatica: systematic review and meta-anal-ysis. BMJ. 2012;344:e497.

48 Rubinstein SM, Terwee CB, AssendelftWJJ, et al. Spinal manipulative therapy foracute low-back pain. Cochrane DatabaseSyst Rev. 2012;9:CD008880.

49 Guyatt GH, Oxman AD, Vist GE, et al.GRADE: an emerging consensus on ratingquality of evidence and strength of recom-mendations. BMJ. 2008;336:924–926.

50 Castro-Sanchez AM, Lara-Palomo IC,Mataran-Penarrocha GA, et al. KinesioTaping reduces disability and pain slightlyin chronic non-specific low back pain: arandomized trial. J Physiother. 2012;58:89–95; erratum 2012;58:143.

51 Chen SM, Alexander R, Lo SK, Cook J.Effects of Functional Fascial Taping onpain and function in patients with non-specific low back pain: a pilot randomizedcontrolled trial. Clin Rehabil. 2012;26:924–933.

52 Paoloni M, Bernetti A, Fratocchi G, et al.Kinesio Taping applied to lumbar musclesinfluences clinical and electromyographiccharacteristics in chronic low back painpatients. Eur J Phys Rehabil Med. 2011;47:237–244.

53 Kavlak B, Bakar Y, Sarı Z. Investigation ofthe efficacy of different physiotherapymethods for neck pain. J MusculoskeletPain. 2012;20:4.

54 Gonzalez-Iglesias J, Fernandez-de-Las-Penas C, Cleland JA, et al. Short-termeffects of cervical kinesio taping on painand cervical range of motion in patientswith acute whiplash injury: a randomizedclinical trial. J Orthop Sports Phys Ther.2009;39:515–521.

55 Bae SH, Lee JH, Oh KA, Kim KY. Theeffects of kinesio taping on potential inchronic low back pain patients anticipa-tory postural control and cerebral cortex.J Phys Ther Sci. 2013;25:1367–1371.

56 Parreira Pdo C, Costa Lda C, Takahashi R,et al. Kinesio Taping to generate skin con-volutions is not better than sham tapingfor people with chronic non-specific lowback pain: a randomized trial. J Phys-iother. 2014;60:90–96.

57 Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise forosteoarthritis of the hip. Cochrane Data-base Syst Rev. 2009;8:CD007912.



http://www.internovi.it/software/prometa/

http://www.internovi.it/software/prometa/

Documents

ResearchReport - Emory University · ResearchReport Post a Rapid Response to this article at: ptjournal.apta.org April 2015 Volume 95 Number 4 Physical Therapy f 493. N eck pain (NP)