The use and treatment efficacy of kinaesthetic taping for musculoskeletal conditions: a systematic review.
Abstract: Kinaesthetic taping is a new therapeutic tool, and has become increasingly popular within the sporting arena. Despite anecdotal support, there is very little evidence, within the literature, to support the use of kinaesthetic taping. A systematic review was conducted to evaluate and critique randomised controlled trials (RCTs) which have examined the therapeutic use of kinaesthetic taping, to assess its treatment efficacy for the treatment of musculoskeletal conditions. An electronic search was undertaken using the databases of Scopus, Cochrane Library, Physiotherapy Evidence Database (PEDro) and the EBSCO Health Database to identify RCTs investigating kinaesthetic tape and its effects on musculoskeletal conditions. Four studies met the inclusion criteria; however, only three studies were critiqued as the fourth was not accessible. Three independent reviewers critiqued and assessed the quality of the studies using the PEDro scale. Two of the three studies exhibited high methodological quality. One study exhibited limited methodological quality. Despite these findings, none of the three articles concluded a clinical significance for the use of kinaesthetic taping. The literature review highlights the need for more high quality RCTs to examine the use of kinaesthetic taping for the treatment of musculoskeletal disorders.

Keywords: Kinaesthetic tape, kinesio-tape, randomised controlled trials, treatment efficacy, physiotherapy, systematic review
Article Type: Report
Subject: Physical therapy (Usage)
Physical therapy (Health aspects)
Therapeutics, Physiological (Usage)
Therapeutics, Physiological (Health aspects)
Medical supplies (Usage)
Medical supplies (Health aspects)
Musculoskeletal diseases (Care and treatment)
Authors: Bassett, Kelly T.
Lingman, Stacey A.
Ellis, Richard F.
Pub Date: 07/01/2010
Publication: Name: New Zealand Journal of Physiotherapy Publisher: New Zealand Society of Physiotherapists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 New Zealand Society of Physiotherapists ISSN: 0303-7193
Issue: Date: July, 2010 Source Volume: 38 Source Issue: 2
Accession Number: 263992602
Full Text: INTRODUCTION

Taping has become a widely used rehabilitation modality for the prevention and treatment of musculoskeletal conditions (Thelen et al 2008). Kinaesthetic tape (KT) is a new therapeutic tool, and has become increasingly popular within the sporting arena. KT was developed in 1996 by Kenzo Kase, with the intention to alleviate pain (Liu et al 2007) and improve healing in soft tissues (Kahanov 2007). The growing popularity of KT can be attributed, in some respects, to anecdotal support for its therapeutic benefit. However the research surrounding KT is still in its infancy and the scientific evidence to support its use and effects is still being established (Thelen et al 2008, Zajt-Kwiatkowska et al 2007).

KT is known by a variety of brand names for example Kinesiotape; Kinesiology Tape, Acu or Aku tape, Kinesio Tex, Kinesio Elastic Tape, Kinesio-Orthopaedic Tape, athletic Tape, elastic tape and Neuroproprioceptive tape. KT is manufactured pre-stretched by 15-25% as it is applied to the backing paper (Kase 2003). It is characterised by the ability to stretch to 120-140% of its original length and, following application, recoil back towards its unstretched length (Fu et al 2007, Halseth et al 2004, Kahanov 2007). KT purportedly mimics the physical qualities of human skin as it is believed to be approximately the same weight and thickness of the epidermis along with its inherent elastic properties (Kahanov 2007, Murray 2000).

There are many proposed benefits of KT including proprioceptive facilitation (Halseth et al 2004, Jaraczewska and Long 2006, Riemann and Lephart 2002), muscle facilitation (Hammer 2006), reduced muscle fatigue (Canina et al 2008), reduced delayed-onset muscle soreness (Nosaka 1999), pain inhibition (Kahanov 2007, Kneeshaw 2002), enhanced healing such as reducing oedema, improvement of lymphatic drainage and blood flow (Kase and Hashimoto 1998, Kinesio Holding Corporation 2008, Lipinska et al 2007, Yasukawa et al 2006, Zajt-Kwiatkowska et al 2007).

As with many taping mechanisms, enhanced proprioception is a perceived benefit of KT (Murray 2000, Thelen et al 2008). It is proposed that cutaneous mechanoreceptors are stimulated by the stretch upon KT application which conveys information regarding joint movement and position (Riemann and Lephart 2002). A study conducted by Jaraczewska and Long (2006) concluded that KT provides proprioceptive feedback to achieve postural alignment and glenohumeral joint position in patients following stroke.

Muscle facilitation is another hypothesised benefit of KT and is dependent on the application of the tape. It is proposed that applying KT from the muscle origin to insertion will produce a concentric pull on the fascia, stimulating increased muscle contraction (Hammer 2006). To facilitate an eccentric or diminished contraction, believed to occur from an eccentric pull on underlying fascia, application of KT from insertion to origin is recommended (Hammer 2006).

The application of KT theoretically determines the physiological benefit and desired outcome. For example if muscle is damaged the skin is stretched manually first and KT is applied unstretched (Kinesio Holding Corporation 2008). This type of application will cause the skin to form convolutions which lifts the skin (Kahanov 2007). Theories suggest that these convolutions encourage regeneration of injured tissues (Zajt-Kwiatkowska et al 2007) by increasing the interstitial space and ultimately alleviating interstitial pressures which may occur from swelling and inflammation following injury (Hammer 2006). It is also theorised that lifting the skin detaches filaments which attach the skin to endothelial cells of the lymphatic and capillary beds. This is hypothesised to create channels which allows for lymph to drain thus reducing swelling (Lipinska et al 2007) and allowing an increase in blood flow to the area (Yasukawa et al 2006). Support for an improvement in blood flow via KT came from an unpublished study conducted by Kase and Hashimoto (1998) who found that following KT application, peripheral blood flow, measured via Doppler ultrasound, increased by 20-60% in patients with chronic disorders and poor circulation.

The assumption has also been made that decreasing the interstitial pressure also decompresses subcutaneous nociceptors leading to decreased pain (Kahanov 2007). Another theory suggests that the tension KT stimulates afferent mechanoreceptor output to the central nervous system which may dampen down nociceptive input (i.e. gate control theory of pain) (Kneeshaw 2002).

Despite these claimed benefits from KT there is no substantial evidence to support them. Furthermore, the theoretical process outlining the mechanism as to how KT achieves these benefits has not been verified. At this time without specific scientific analysis, the perceived physiological benefits of KT are hypothetical (Gonzalez-Iglesias et al 2009, Thelen et al 2008).

As there is a lack of research to validate the underlying physiological effect of KT, so too is there a lack of evidence to substantiate anecdotal support for the therapeutic efficacy of KT. Therefore, the purpose of this systematic review was to identify, evaluate and critique the available randomised controlled trials which have examined the treatment efficacy of KT for use in musculoskeletal conditions.

METHODS

Literature Search Strategy

A search was conducted in September 2009 to identify clinical trials which examined the use and treatment efficacy of KT in musculoskeletal disorders. The electronic databases of Scopus, Cochrane Library, Physiotherapy Evidence Database and EBSCO Health Database were searched to locate the studies that were relevant to this review. Keywords (including truncations of relevant brand names) used to search each of the databases are as follows: kinesio* OR kinaes* OR kines*; athletic; tape OR taping; strap*; acu OR aku; tex*; physiotherap* OR physical therap* OR physio*. The reference lists of the selected articles were also searched to find other relevant articles not found during the original database search. There was no limitation in publishing dates apart from those applied by the individual databases (i.e. date of publication, language etc).

Study Selection

Articles were included if they were randomised controlled trials (RCTs) and quasi-experimental design studies which focused on the use of KT in the treatment of musculoskeletal conditions. Articles were excluded if they used non-clinical populations (i.e. healthy populations), non-English articles, traditional taping alone, university theses or conference proceedings.

Methodological Assessment

Three reviewers assessed the quality of the selected articles independently using the 11-item PEDro scale, which was developed by The Centre of Evidence-Based Physiotherapy (CEPB) (Table 1). The PEDro Scale is a checklist of yes/no questions used to examine particular aspects research methodology, including key aspects of internal validity (Hubbard et al 2004).

Studies have also found the inter-rater reliability of the PEDro Scale to be of an appropriate standard whilst assessing RCTs (Maher et al 2003, Tooth et al 2005) and when compared with the Jadad score, the PEDro Scale is more comprehensive in assessing methodological quality (Bhogal et al 2005). The PEDro Scale scoring system operates by allocating one point for every answer of "yes" and zero points are allocated for "no". The external validity of the articles is represented by criterion one of the PEDro Scale and is not included within the final quality score thus the quality of an article is scored out of ten.

Internal validity is a reflection of a study's methodological quality. Within the PEDro Scale, seven of the eleven items address internal validity. Methodological quality of an RCT is paramount as studies of low quality may exaggerate treatment efficacy of an intervention and therefore produce a biased result (Maher et al 2003). The internal validity of each study is assessed more selectively in this review by using an internal validity score (IVS), as used in other systematic reviews (Ellis and Hing 2008; Reid and Rivett 2005; van Tulder et al 1997). For this study the items 2, 3, 5, 6, 7, 8 and 9 of the PEDro Scale were selected to total the IVS as they are representative of internal validity (Ellis and Hing 2008). A point for each item is allocated, provided the study has fulfilled the criteria and contributes toward the final 7-item IVS (Ellis and Hing 2008; Reid and Rivett 2005). Studies with a final IVS of 6-7 are considered to have high methodological quality, an IVS of 4-5 are considered to have moderate methodological quality and an IVS of 0-3 represents a study of limited methodological quality (Ellis and Hing, 2008).

Any discrepancies in the rating between the three reviewers were resolved with discussion and reassessment of the scale criteria. If left unresolved a fourth reviewer was available, however this was not necessary as agreement was reached.

RESULTS

Selection of studies

A total of 321 articles were found using the outlined databases and search strategy. Of this total only four studies fulfilled the inclusion and exclusion criteria. However one of these studies (Akinbo and Ojetunde 2007) was not accessible through international libraries, inter-loan facilities or online databases. As a result, this study was not included in the literature review leaving only three articles available for critique.

Methodological Quality

The methodological quality for each article is provided in Table 2. The studies conducted by Thelen et al (2008) and Gonzalez-Iglesias et al (2009) were given an IVS of six out of seven indicating high methodological quality. The remaining article conducted by Hsu et al (2008) was allocated an IVS of two out of seven indicating limited methodological quality.

A common feature amongst all three studies was the fulfilment of items 2 and 9 of the PEDro Scale indicating that participants were randomly allocated to their groups and intention-to-treat analysis was performed in at least one outcome measure. All three studies however failed to fulfil item six of the PEDro Scale highlighting that the therapists who administered the taping were not blinded to group allocation. Hsu et al (2008) failed to satisfy any further IVS items which resulted in a final IVS of two out of seven. Studies conducted by Thelen et al (2008) and Gonzalez-Iglesias et al (2009) fulfilled the remainder of the IVS items (3, 5, 7, 8) to obtain a final IVS rating of six out of seven.

Study characteristics

Table 3 provides a summary of the study characteristics for each of the RCT's included in this review. All three studies addressed the short term effects of kinaesthetic taping on a range of outcome measures such as pain relief, muscle strength, muscular activity and range of motion. The focus on the short term effects of KT was a similarity between all three studies critiqued within the literature review. In addition all three studies had similar treatment and control groups consisting of a standardised KT application and a sham tape application.

DISCUSSION

All three of the studies that were examined in this review were heterogeneous, in terms of participant population, outcome variables assessed and methods of KT application. This makes direct quantitative comparison of the therapeutic efficacy of KT difficult. The studies conducted by Hsu et al (2008) and Thelen et al (2008) both focus on the effects of KT on shoulder impingement. Hsu et al (2008) focused on the efficacy of KT on muscle performance and scapular kinematics of the shoulder whereas Thelen et al (2008) focused on the efficacy of KT on the relief of shoulder pain.

Gonzalez-Iglesias et al (2009) and Thelen et al (2008) both measured the effect KT has on pain relief in the neck and the shoulder respectively. Gonzalez-Iglesias et al (2009) also investigated the use of KT in altering cervical range of motion. Although both studies addressed potential pain relief from the use of KT, different anatomical regions were examined and therefore are not comparable.

The findings of these studies support the short term use of KT in assisting with immediate pain relief, which may persist for an estimated 24 hour period post-treatment (p<0.01) (Gonzalez-Iglesias et al 2009). Thelen et al (2008) found a statistically significant difference in pain relief at day one following the removal of KT in participants with shoulder impingement or rotator cuff tendonitis (p=0.05). However by day three the difference no longer existed. This suggests that KT is effective when applied and persists for a short period post-application (Thelen et al 2008). The use of KT also increased cervical range of motion in patients with whip lash disorder (p<0.01) (Gonzalez-Iglesias et al 2009) and improved muscle activity and scapular kinematics in participants with shoulder impingement (p <0.05) (Hsu et al 2008).

Although the results of all three studies were statistically significant, indicating therapeutic benefit, the clinical significance of the intervention was not established. Questions must therefore be raised as to whether the results of these studies, in support of the use of KT, suggests a level of efficacy to change clinical practice for patients presenting with symptoms of pain, decreased ROM, muscle activity and muscular kinematics of the neck and shoulder.

The results of the review found that two of the studies (Gonzalez-Iglesias et al 2009, Thelen et al 2008) were robust demonstrating high methodological quality and one of the studies (Hsu et al 2008) demonstrated limited methodological quality. The studies conducted by Gonzalez-Iglesias et al (2009) and Thelen et al (2008) fulfilled six of the seven items of the IVS. However both studies failed to control for the blinding of therapists who administered the treatment in both the control and intervention groups. A different taping technique was used between groups therefore the practitioner who administered the taping was aware of what group each of the participants belonged to.

The remaining study, conducted by Hsu et al (2008) demonstrated limited methodological quality with an IVS of two out of seven. The study only fulfilled items 2 (random allocation) and 9 (inclusion of 'intention to treat' analysis). The study failed to address the remaining criteria, namely, all forms of blinding (therapist, assessor and subject), obtaining outcome measures from at least 85% of participants and concealment of allocation. As a consequence, the methodological quality of this study was limited and therefore the results must be questioned. The study also failed to include the initial participant numbers. In addition there were drop outs due to unexpected injury. This was not apparent within the results and was only mentioned within the discussion of the study. Failure to be clear on these two details compromises the reliability of the results obtained from the study.

The blinding of therapists who administered the KT application was a key methodological deficit amongst all three studies. Devising a mechanism to blind therapists to participant group allocation is difficult. This is because the nature of KT application is dependant largely on the desired effect. To achieve a specific action, for example muscle force or pain relief, the therapist must know what method of KT application is required to facilitate the effect.

Currently the research surrounding KT is limited. However, the widespread use of KT amongst athletes internationally has contributed to its extensive popularity within the sporting arena. Despite a lack of establishing the clinical significance to support KT, as demonstrated by all three studies, the accumulation of anecdotal evidence has prevailed over a lack of substantial scientific evidence.

Areas for future research can be identified through the gaps found in the current research. All three articles failed to produce adequate power within their studies as a result of small sample sizes. Recruitment of sufficient participant numbers is paramount to rule out the null hypothesis or reveal the effect of an independent variable, particularly when intending to highlight clinical and statistical significance. Another commonality of all three studies was the focus on short term effects of KT only. Further research to determine the long term effects of KT may be worthwhile to assist with rehabilitation of musculoskeletal conditions.

Recruitment of a more generalised population is another recommendation for further research as the studies included within the review used young active participants or samples of convenience. Therefore the results of current research cannot be generalised to other populations who may also benefit from kinaesthetic taping.

The use of KT with active exercise is another area that has not been addressed in the studies as the articles did not consider active intervention with KT application. Kase and Wallis (2002) suggest that KT is more effective when coupled with physical activity therefore the true benefits of KT may be more pronounced with adequate exercise. This is yet to be proven.

The lack of a true control group was another limitation amongst all three studies. Although all studies used a sham tape group it is unclear if the pure application of tape alone caused participants to report a therapeutic effect, especially in regards to a subjective outcome measure such as pain. Incorporating a true control group would be useful to eliminate a placebo effect.

The use of non steroidal anti inflammatory drugs (NSAIDs) may have been a confounding factor for improving pain levels for participants within the two studies of high methodological quality. In the study conducted by Gonzalez-Iglesias et al (2009) participants were instructed to withdraw the use of analgesics 72 hours prior to testing. It is unclear if this time period was sufficient to eliminate the effects of NSAIDs on pain levels (Gonzalez-Iglesias et al 2009). Thelen et al (2008) allowed participants to continue using analgesia throughout the study. Therefore it is unclear if analgesics contributed to the improvement in pain within the two studies. Many common non-steroidal anti-inflammatory drugs are reported to have a maximum half life of 100 hours (Walker and Edwards 2003). Therefore, a wash out phase of 4 to 5 days may be a more acceptable time period to consider in future research.

A total of four RCTs fulfilled the inclusion criteria for this systematic review. Unfortunately one of these RCTs was unable to be included due to its unavailability. Due to the small number of RCTs fulfilling the inclusion criteria, the results of this particular study may have influenced the final results of the review, therefore potentially limiting the scope of this review.

It should be noted that, although 321 studies were found using the search strategy, fifty four of the studies were KT specific. This is because 'tape' and 'taping' were used as keywords and produced a large number of articles unrelated to KT. Of the fifty four articles, ten were conference proceedings indicating that scientific exploration of KT is actively being pursued. However these were excluded from the review in accordance with the exclusion criteria.

Including the studies conducted by Kenzo Kase, the creator of KT, would have been beneficial for the review. However the use of non-English studies was an exclusion criterion. Therefore the pioneering evidence surrounding KT, which was published in Japanese, was not critiqued. To date we are unaware of any publications or systematic reviews, published in English, which have analysed the quality of the Kase articles, or other KT studies, thus the methodological quality of this evidence is uncertain.

CONCLUSION

KT is therapeutic tool used with increasing frequency within musculoskeletal rehabilitation. The anecdotal benefits of KT are based on proposed theories which are yet to be validated with adequate evidence. The current systematic review has identified three accessible RCTs to evaluate and analyse the use and treatment efficacy of KT for musculoskeletal conditions. Despite two of the studies demonstrating high methodological quality, the lack of demonstration of clinical significance of the results highlights the need for more research. At present there is no substantial evidence to support the use and treatment efficacy of KT within a clinical musculoskeletal population.

Future research requires an adequate and generalised sample size and sample population, investigation surrounding the potential long term benefits of KT, control for the use of NSAIDs, incorporation of a true control group and integration of activity with KT application.

This study won the annual ML Roberts prize awarded for the best 4th year undergraduate research project from AUT University in 2009. NZJP publishes the resulting paper without internal peer review.

ADDRESS FOR CORRESPONDENCE

Richard Ellis, School of Rehabilitation and Occupation Studies, AUT University, Private Bag 92006, Auckland 1142, New Zealand, Tel: 09-9219999 x7612. Fax: 09-9219620, email: richard.ellis@aut, ac.nz

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Kelly T Bassett, BHSc (Physiotherapy)

Stacey A Lingman, BHSc (Physiotherapy)

Richard F Ellis, (PostGradDipHSc, BPhty)

Senior Lecturer, School of Rehabilitation and Occupation Studies, AUT Unive rsity
Table 1: PEDro Scale (Modified from
Maher et al 2003)
                                                     Score
Criteria                                           Yes(1) No(0)

1. Eligibility criteria were specified

2. Subjects were randomly allocated to
interventions (in a cross over study, subjects
were randomly allocated an order in which
treatments were received)

3. Allocation was concealed

4. The intervention groups were similar at
baseline regarding the important prognostic
indicators

5 there was blinding of all subjects

6. there was blinding of all therapists who
administered the therapy

7. there was blinding of all assessors who
measured at least one key outcome

8. measures of at least one key outcome
were obtained from more than 85% of the
subjects initially allocated to groups

9. all subjects for whom outcome measures
were available received the treatment of
control condition as allocated or, where
this was not the case, data for at least one
key outcome was analysed by "intention to
treat"

10. the results of between-intervention group
statistical comparisons are reported for at
least one key outcome

11. the study provides both point measures of
variability for at least one key outcome

TOTAL

Table 2: PEDro and IVS Rating for each Study

                 Thelen et      Hsu et     Gonzalez-Iglesias
                 al (2008)    al (2008)      et al (2009)

1 *                  1            1                1
(2)                  1            1                1
(3)                  1            0                1
4                    1            1                1
(5)                  1            0                1
(6)                  0            0                0
(7)                  1            0                1
(8)                  1            0                1
(9)                  1            1                1
10                   1            1                1
11                   1            1                1
PEDro rating        9/10         5/10            9/10
Final               6/7          2/7              6/7
IVS                 High       Limited           High

Notes: (n) criteria used to obtain an IVS, * Criteria excluded from
the PEDro rating

Table 3: Study Characteristics

Author        Purpose of trial             Subject demographics

Thelen et     To compare the short/term    College students with
al (2008)     effects of a therapeutic     rotator cuff tendonitis or
              KT application on reducing   positive impingement tests
              pain and disability in       and c/o difficulty in ADL
              subjects with shoulder       n=42
              pain (rotator cuff           Mean age: 20 years
              tendonitis/impingement)      Mean duration of
              as compared to sham KT       symptoms: 15 days
              application                  Mean pain (VAS scale
                                           100 mm): IG: 44.1
                                           CG: 43.9

Hsu et al     To investigate the effects   N=17
(2008)        of elastic taping on the
              scapular kinematics,         Amateur baseball players
              muscle strength and          with positive shoulder
              electromyographic activity   Impingement signs in two
              in baseball players with     or more tests and one
              shoulder impingement         subacromial impingement
              problems                     test
                                           Mean age: 23+-2.8yrs
                                           Mean duration of
                                           symptoms: 2 months
                                           Mean pain (VAS scale
                                           0-8): 3

Gonzalez-     Determine the short-term     N=41
Iglesias et   effects of KT on neck pain   Patients reporting
al (2009)     and cervical range of        neck pain as a result of
              motion In individuals with   a motor vehicle accident
              acute whiplash-associated    within 40 days of the
              disorders (WADs).            injury
                                           Mean age: 33+-7 yrs
                                           Mean duration of
                                           symptoms: 24+-8 days
                                           Mean pain: 4.3+-0.9

Author        Intervention group (IG)      Control group (CG)

Thelen et     N=21 Standard therapeutic    N=21 Standardized
al (2008)     KT application using KT      neutral KT application
              protocol for rotator cuff
              tendonitis/impingement       -2 strips of tape with
                                           no stretch
              -5 strips of tape with
              50-75% stretch applied       Tape worn for 48-72
                                           hours and subject
              Tape worn for 48-72 hours    returned 12-24 hours
              and subject returned 12-     after removing the
              24 hours after removing      tape
              the tape
                                           3 day follow up for
              3 day follow up for          reassessment and
              reassessment and             reapplication of tape
              reapplication of tape
                                           6 day reassessment of
              6 day reassessment of        outcome measures
              outcome measures

Hsu et al     N=17                         N= 7 subjects asked
(2008)        Subjects asked initially     Initially to flex/
              to flex/elevate into         elevate into scaption
              scaption 3 times @ 8secs     3 times[R] 8secs per
              per movement with 2kg        movement with 2kg
              weight, 3min rest then       weight, 3min rest then
              hold weight at               hold weight at
              125[degrees] for 5 sees 3    125[degrees] for 5 sees 3
              times, then 3 maximal        times, then 3 maximal
              contractions, 3min rest      contractions, 3min rest
              Subjects then taped on       Subjects then taped on
              lower trapezius muscle       lower trapezius muscle
              using KT with minimal        using sham tape with no
              tension                      stretch

Gonzalez-     N=21 Standardized            N=20 Placebo Kinesio
Iglesias et   therapeutic Kinesio Tape     Tape application
al (2009)     application
                                           a) l-strip applied with
              a) Y-strip placed over       no tension
              posterior cervical
              extensor musles applied      b) Applied over the
              from insertion (T1-T2) to    spinous processes
              origin (C1-C2) with off-     of the cervical &
              paper tension on either      thoracic spine
              side of neck
                                           c) Applied in a neutral
              b) Applied in a position     cervical spine position
              of cervical contralateral
              side-bending and rotation    d) Overlying strip
                                           placed over the mid-
              c) Overlying strip placed    cervical region with
              over C3-C6 with the          no tension
              cervical spine in flexion
              to apply tension to the
              posterior neck

Author        Outcome                      Results

Thelen et     Outcomes were                No meaningful differences
al (2008)     measured at baseline,        existed between groups at
              Immediately after            baseline.
              taping, 3 days and 6
              days post-treatment          CG showed no immediate
                                           change in any outcome
              1) Shoulder Pain and         measures
              Disability Index (SPADI)
                                           IG Day 1 pain free ROM
              2) Pain-free active          showed improvement P=.005
              ROM                          Mean difference of
                                           19.1[degrees] (99% CI)
              3) 100mm VAS to              Both IG & CG showed main
              assess pain intensity at     effect for change over
              endpoint of pain-free        time (P [less than or
              active ROM                   equal to] .001) with
                                           significant change in all
                                           measures by day 6

Hsu et al     Outcomes were                No significant difference
(2008)        measured pre- and            at baseline for all
              post-treatment               outcome variables
                                           Significant difference
              1) Muscle strength           between groups found in
              using hand-held              scapular posterior tilt at
              dynamometer                  30[degrees] to 60[degrees]
                                           of humeral elevation/
              2) Serratus anterior,        scaption (p<0.05) CG
              lower and upper              increased upper trapezius
              trapezius, EMG using         muscle activity in
              8-channel FM/FM              90[degrees] to
              Telemetric EMG system        120[degrees] shoulder
                                           elevation (p<0.05) IG
              3) Scapular                  increased lower trapezius
              displacement, scapular       activity when lowering
              orientation & humeral        during 60[degrees] to
              elevation angle using        30[degrees] (p<0.05)
              3D kinematic data with       Strength of lower
              Liberty electromagnetic      trapezius Increased after
              tracking system              KT application (P=0.05)

Gonzalez-     Outcomes were                Statistical significance
Iglesias et   measured at baseline,        in group by time in KT
al (2009)     Immediately following        reducing neck pain
              taping and 24 hours          immediately post
              post-treatment               application & 24 hrs
                                           post (p<.001)
              1) Level of neck pain
              using the Numerical Pain     Statistical significance
              Rating Scale (NPRS)          for all directions of
                                           cervical ROM in KT group
              2) Cervical range of         (p<.001)
              motion
              using CROM device            Experimental group
                                           improved cervical ROM vs.
                                           control group (p<.001)

                                           Minimal clinical
                                           difference not reached

Note: KT = Kinesiotape; N = Number; EMG = Electromyography; c/o =
complaining of; kg = kilogram; VAS = Visual Analogue Scale; ADL =
Activities of daily living; CG = Control group; IG = Intervention
group
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