Kinesio Tape Bandage

Kinesio Tape Bandage

PEP Topic 
Lymphedema
Description 

Kinesio tape is a type of bandage for taping that allows longitudinal stretch, so is somewhat elastic, and is composed of cotton fibers and acrylic heat sensitive glue. Kinesio tape is waterproof and is worn for 1-3 days without removal. Kinesio tape has been used for sports application and was evaluated as an alternative to standard compression bandaging for lymphedema in patients with cancer.

Benefits Balanced With Harm

Research Evidence Summaries

Pekyavas, N.O., Tunay, V.B., Akbayrak, T., Kaya, S., & Karatas, M. (2014). Complex decongestive therapy and taping for patients with postmastectomy lymphedema: A randomized controlled study. European Journal of Oncology Nursing, 18, 585–590. 

doi: 10.1016/j.ejon.2014.06.010
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Study Purpose:

To evaluate the effects of Kinesio® taping with decongestive therapy in women with breast cancer-related upper extremity lymphedema

Intervention Characteristics/Basic Study Process:

Patients with grade 2 or 3 lymphedema were randomly assigned to one of three groups, (1) complete decongestive therapy (CDT) and bandaging, (2) CDT, bandaging, and Kinesio taping, or (3) CDT and Kinesio taping. The study continued for 10 treatment sessions. After completion, all patients were provided with compression garments. Patients were instructed to continue exercises at home. Treatments were done by a lymphedema therapist, and patient assessments were done by a physiotherapist who was blinded to treatment allocation. Patients were assessed at baseline, after 10 days of treatment, and one month after the completion of treatment. Each group received five sessions per week for two weeks.

Sample Characteristics:

  • N = 41  
  • MEAN AGE = 49.6 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: The average time since surgery was 7.37 years.  
  • OTHER KEY SAMPLE CHARACTERISTICS: The majority of participants had modified radical mastectomies, and all but two patients had axillary dissections.

Setting:

  • LOCATION: Turkey

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Late effects and survivorship

Study Design:

Single, blinded, randomized, three-group design

Measurement Instruments/Methods:

  • Visual Analog Scale (VAS) for intensity of lymphedema symptoms such as pain and heaviness
  • Circumferential arm measurements at 5 cm intervals from wrist to axilla
  • Short Form 36 (SF-36)

Results:

All groups experienced a significant reduction in arm volume during the treatment period. Those groups whose treatment included Kinesio taping had the greatest volume of reduction during the treatment period and from baseline to one month after treatment (p < 0.05). All groups experienced a reduction in associated symptoms, and there were no differences in symptoms between groups.

Conclusions:

The addition of Kinesio taping to CDT in women with breast cancer-related lymphedema was associated with significant improvements in arm volume as measured in this study.

Limitations:

  • Small sample (< 100)
  • Baseline sample/group differences of import
  • Unintended interventions or applicable interventions not described that would influence results
  • Other limitations/explanation: There were significant group differences in the types of surgery that were done and the prevalence of radiation and chemotherapy treatment. There was no information on the amount or type of exercise that participants used during the study although they were encouraged to maintain usual practices.

Nursing Implications:

Kinesio taping in addition to CDT with and without bandaging may improve the effectiveness of lymphedema management. Additional larger studies are warranted for the evaluation of the role of Kinesio taping in lymphedema management. Lymphedema can be a distressing symptom, and the combined therapy tested here may be beneficial for patients. Long-term impact and associated costs need to be explored, and effectiveness in patients with varying lymphedema stages needs to be evaluated.

Smykla, A., Walewicz, K., Trybulski, R., Halski, T., Kucharzewski, M., Kucio, C., . . . Taradaj, J. (2013). Effect of kinesiology taping on breast cancer-related lymphedema: A randomized single-blind controlled pilot study. BioMed Research International, 2013, 767106. 

doi: 10.1155/2013/767106
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Study Purpose:

To assess the efficacy of kinesiology taping (KT) for treating breast cancer-related lymphedema

Intervention Characteristics/Basic Study Process:

Participants were randomly assigned to the KT group (K-tapes), quasi-KT group (bandages), or multilayered compression therapy (MCT) group. Subjects from all groups received a routine treatment, including skin care, 45-minute pneumatic compression therapy with a DL1200 device (at a pressure of 90 mmHg, 12 chambers arm overlapping cuff, hold time three seconds with no interval), one hour of manual lymphatic drainage, and the application of multilayered short-stretch bandages (50–60 mmHg).

Each of the groups were treated three times weekly (bandages or K-tapes were applied and changed on Mondays, Wednesdays, and Fridays) in the four-week intervention period.

Limb volume measurements (both affected and healthy upper limbs) were taken for all three groups before and after therapy.

Sample Characteristics:

  • N = 65  
  • AGE RANGE = 39–81 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Unilateral breast cancer-related lymphedema for at least one year; moderate to severe lymphedema (stages 2 and 3 of upper limb edema with the volume difference between the affected and healthy extremities greater than 20%); no chemotherapy or radiation therapy for at least six months; and good compliance and willingness to sign the written consent form 

Setting:

  • SITE: Single site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Poland

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Late effects and survivorship
  • APPLICATIONS: Pediatrics

Study Design:

Randomized, single-blinded, controlled trial

Measurement Instruments/Methods:

  • Limb volume was measured by an optoelectronic Perometer 40 T cooperating with a personal computer.

Results:

All three groups experienced a reduction in volume, KT (p = 0.002), quasi-KT (p = 0.002), and MCT (p = 0.000001). There were no significant differences in changes in arm volume between the KT group and the quasi-KT group. The edema reduction of MCT was much better than in the taping groups.

Conclusions:

This single-blinded, controlled pilot study did show that K-tape is effective in releiving secondary lymphedema after breast cancer treatment.

Limitations:

  • Small sample (< 100)
  • Subject withdrawals ≥ 10%

Nursing Implications:

The study findings indicated that there is not enough evidence for using K-tape to replace bandages. Well-designed studies with larger sample sizes examining the effectiveness of K-tape for patients with breast cancer and arm lymphedema are needed.

Taradaj, J., Halski, T., Rosinczuk, J., Dymarek, R., Laurowski, A., & Smykla, A. (2015). The influence of kinesiology taping on the volume of lymphoedema and manual dexterity of the upper limb in women after breast cancer treatment. European Journal of Cancer Care. Advance online publication.  

doi: 10.1111/ecc.12331
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Study Purpose:

To evaluate the effects of Kinesiology® taping (KT) on upper extremity lymphedema and manual dexterity

Intervention Characteristics/Basic Study Process:

Patients were randomized to one of three groups, (1) KT, pneumatic compression, and manual lymphatic drainage (MLD), (2) quasi-KT, pneumatic compression, and MLD, or (3) standard pneumatic compression, MLD, and multilayered bandaging. The groups received treatment once per day, three times per week, for four weeks. The same provider administered all sessions of MLD. KT was worn for four days.

Sample Characteristics:

  • N = 82
  • AVERAGE AGE = 61.9 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Unilateral lymphedema of upper limb for at least one year after radical mastectomy surgery and stage 2 or 3 edema
  • OTHER KEY SAMPLE CHARACTERISTICS: Exclusion criteria included patients who received chemotherapy or radiotherapy and hormone therapy within the past six months, hypertension, diabetes, atherosclerosis, scleroderma, psoriasis, collagenosis, rheumatoid arthritis, parasitosis, advanced heart failure, swelling from renal or hepatic disorders, dermatitis, steroid or diuretic use, active venous thrombosis, allergic reactions to compression garments, and primary lymphedema or other cancers.

Setting:

  • SITE: Single site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Rehabilitation Center ProVita in Zory

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Late effects and survivorship

Study Design:

Randomized, placebo-controlled, single-blinded study

Measurement Instruments/Methods:

  • Perometer 400 T
  • Goniometric device from Technomex
  • Hercules dynamometer
  • Nonparametric matched pair Wilcoxon test
  • Spearman correlation analysis

Results:

A statistically significant decrease in limb volume occurred in comparison to initial size in all comparison groups (p < 0.001). However, a significant advantage was seen in group 3 treated with standard pneumatic compression, MLD, and multilayered bandaging. Shoulder range of motion was initially similar and statistically significance in all groups.

Conclusions:

More research on when KT may be effective is needed. KT was not shown to be an effective intervention to reduce limb volume in patients with breast cancer.

Limitations:

  • Small sample (< 100)
  • Other limitations/explanation: Limited follow-up; quality of life evaluation would be helpful

Nursing Implications:

KT is effective in increasing joint mobility, but it should not be used as a replacement for standard multilayered bandaging in the treatment of lymphedema. This study's participants had more extensive surgery than standard of care in the United States. Additional research to identify application with less swelling is needed.

Tsai, H.J., Hung, H.C., Yang, J.L., Huang, C.S., & Tsauo, J.Y. (2009). Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 17(11), 1353–1360.

doi: 10.1007/s00520-009-0592-8
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Study Purpose:

To compare the treatment and retention effects between standard decongestive lymphatic therapy (DLT) combined with pneumatic compression and modified DLT in which the use of a short-stretch bandage is replaced with the use of Kinesio tape (K-tape) combined with penumatic compression

Intervention Characteristics/Basic Study Process:

Patients were randomly grouped into the DLT group or the modified DLT group. During each treatment session, patients had skin care treatment, 30 minutes of manual lymphatic drainage, one hour of pneumatic compression therapy, application of a short-stretch bandage or K-tape, and 20 minutes of physical therapy. Evaluations were executed before and after the control period, after the intervention period, and after the three-month follow-up. A well-trained physical therapist who was blind to the groupings evaluated all patients.

Sample Characteristics:

  • The study sample (N = 41) was comprised of two groups, a DLT group (n = 21) and a modified DLT group (n =20), of female patients with breast cancer.
  • Mean age of patients was 54.6 years with a range of 36–75 years.
  • Patients were included in the study if they had unilateral breast cancer-related lymphedema for more than three months that was moderate to severe (circumference of affected limb greater than that of the unaffected limb by more than 2 cm at one or more sites.

Setting:

The study took place in Taiwan.

Study Design:

The study used a randomized, single-blinded, controlled design.

Measurement Instruments/Methods:

  • Upper-extremity circumference and water displacement volume were measured.
  • Water composition of the upper extremity: An eight-polar tactile-electrode impedance meter was used in the water composition analysis of the upper extremity.
  • Lymphedema-related symptoms were assessed by a visual analog scale from 0–10 (0 = none, 10 = worst possible).
  • Quality of life was assessed using The Taiwan Chinese Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 and QLQ-BR23)
  • Subjects’ response to bandage or K-tape was noted.

Results:

There was no significant difference between groups in all outcome variables (p > 0.05). Excess limb size (circumference and water displacement) and excess water composition were reduced significantly in the bandage group. Excess circumference and excess water composition were reduced significantly in the tape group. The acceptance of K-tape was better than the bandage and benefits included longer wearing time, less difficulty in usage, and increased comfort and convenience (p < 0.05). However, there were more wounds that occurred for those in the K-tape group (p < 0.05).

Conclusions:

The study results suggest that K-tape could be an alternative choice for patients with breast cancer-related lymphedema with poor short-stretch bandage compliance after one month of intervention.

Limitations:

  • The study sample was small with less than 100 patients.
  • There were more wounds caused by the use of K-tape than bandages.
  • The exact reasons why there were a greater number of wounds in the K-tape group needs to be further explored.

Nursing Implications:

The safety of application of K-tape (i.e., wound) needs to be closely monitored. Patients need to be educated regarding how to use K-tape.

Systematic Review/Meta-Analysis

Rodrick, J. R., Poage, E., Wanchai, A., Stewart, B. R., Cormier, J. N., & Armer, J. M. (2013). Complementary, alternative, and other non-complete decongestive therapy (CDT) treatment methods in the management of lymphedema: A systematic search and review. PM&R, 6, 250–274.

doi: 10.1016/j.pmrj.2013.09.008
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Purpose:

STUDY PURPOSE: To provide a critical analysis of the contemporary published research that pertains to complementary, alternative, and other noncomplete decongestive therapies for treatment of lymphedema (LE) and to provide practical applications of that evidence to improve care of patients with or at risk for LE


TYPE OF STUDY: Systematic review

Search Strategy:

DATABASES USED: PubMed, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, PapersFirst, Proceedings-First, Worldcat, PEDro, National Guideline Clearing House, ACP Journal Club, DARE, and the authors' archives


KEYWORDS: Best practice for the management of lymphoedema, plus expanded terms for all literature related to lymphedema (2004–2012)


INCLUSION CRITERIA: No specific inclusion criteria identified


EXCLUSION CRITERIA: No gray literature was included; nonrefereed articles, abstracts, and dissertations were excluded. Exclusion of 574 articles took place due to duplication, inability to obtain the English translation, inadequate sample size, insufficient level of evidence due to study design, and failure to meet inclusion criteria. Another 47 articles were rejected because they fell outside the systematic review inclusion criteria by definition of four categories (i.e.,botanical, pharmaceutical, physical agent modalities, and modalities of contemporary value), by design, or for lack of an English translation. The categories of pharmaceuticals and botanicals were excluded as well.

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: 659 articles were reviewed.

 

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The authors used first screening, second screening, and third screening to determine final body of reviewed articles. The level of evidence for each study assessed by using the research grading system from the Putting Evidence into Practice (PEP) level of evidence guidelines.

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED = 22
  • SAMPLE RANGE ACROSS STUDIES/TOTAL PATIENTS INCLUDED IN REVIEW: Not applicable; included several singles and several review articles
  • KEY SAMPLE CHARACTERISTICS: Human being with lymphedema and animal model with lymphedema (i.e., a rabbit ear model with “created” secondary lymphedema and rat tail model with “created” secondary lymphedema)

Phase of Care and Clinical Applications:

PHASE OF CARE:  Mutliple phases of care

Results:

Limited high-level evidence was available for all categories. Well-constructed randomized, controlled trials related specifically to lymphedema were limited. Objective outcome measures over time were absent from several studies. The rationale for the use and benefits of the specific modality, as related to lymphedema, was often anecdotal. Participant numbers were fewer than 50 for most studies.

Conclusions:

No interventions were ranked as "recommended for practice." Two treatment modalities (low-level laser therapy and Kinesio taping combined with decongestive lymphatic therapy and pneumatic compression, with Kinesio taping compared with compression bandaging) in three studies were ranked as "likely to be effective." The literature review indicated that many of the physical agent modalities demonstrated long-standing support within the literature, with broad parameters for therapeutic application and benefit for secondary conditions associated with lymphedema. However, additional investigation regarding the individual contributory value and the factors that contribute to their efficacy specific to lymphedema is critically needed.

Limitations:

Inclusion criteria were not clearly stated. Sample range across studies and total patients included in review were not specified.

Nursing Implications:

More rigorous human research in complementary and alternative modalities is needed to optimize patient outcomes.

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