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PRISMA flow diagram of studies.
Introduction
Carpal Tunnel Syndrome (CTS) is one of the most widely-known
and most common UE diagnosis that is caused by compression to
the median nerve. This disease has a significant impact on the work
force as it heavily affects those who perform repetitive wrist motion
within their line of work (e.g. hairdresser). In recent years, the
common approach in treating CTS involved splinting, injections,
and/or other various conservative therapy treatments. Over the past
few years there has been an apparent increase in the use of
Kinesiotaping, and few RCT’s have been conducted to investigate
Kinesiotape’s effects towards treating CTS. While some research
has been conducted, there is no evidence of a SR. Therefore, the
purpose of this review is to determine Kinesio tape’s effect on
improving CTS pain levels, symptom severity, and patient function
measured by the Visual Analog Scale (VAS) and the Boston Carpal
Tunnel Questionnaire’s (BCTQ) symptom severity and function subsections.
VAS Effect Size (ES) of Both Groups; Pre-Post Intervention Difference
VAS (MCID=1.64)
Study
Inclusion and Exclusion criteria KT systematic review
Exclusion Criteria
Non-RCT
Non-CTS related
Unable to access
On-going trial
Foreign
date: > 10 years
Reason
PEDro score of 4
N=4
Foreign
Non-RCT
Systematic Review
Qualitative Study
Unable to access
N = 15
Table 2.
Methodological rating of the RCT’s were completed using the
PEDro criterion score. At least 2 raters read each of the 5
articles and were blinded to individual PEDro scores. No
disagreements between raters were evident. Articles meeting
the cutoff PEDro criterion score (>7) were then identified with
the weighted average standardized effect size (SES)
calculated for control and intervention groups. Sensitivity
analysis was completed by removing the study with the
largest sample size and re-calculating weighted average
SES.
Külcü et. Al.
20
2.5 cm
20
1.9 cm
Krause et al.
25
5.4 (mm*)
22
17.5 (mm*)
Rania et. Al.
30
5.2 cm
30
0.26 cm
Study
1.23
Favors Control
KT Group (N)
KT Effect Size
Control Group (N)
CG Effect Size
Akturk et. Al.
28
9.06
30
0.5
Külcü et. Al.
20
6.9
20
3.5
Krause et al.
25
0.2
22
0.3
Yildirim et. Al.
19
7.31
19
6.14
BCTQ-Symptom Severity Effect Size (ES) of Both Groups; Pre-Post Intervention Difference
Table 3.
Methodological rating of RCT’s based on the PEDRO scores
Quality Assessment
PEDro Score
Study
1
2
3
4
5
6
7
8
9
10
Y
N
Y
Y
Y
N
Y
Y
Y
Y
Akturk et. Al.
Külcü et. Al.
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Kruase et al.
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Rania et. Al.
Y
N
Y
Y
N
N
Y
Y
Y
Y
Yildirim et. Al.
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
BCTQ-Symptom Severity (MCID=1.55)
Study
Total
8
9
8
7
9
Table 4. Disagreement between raters indicated by *. Percent agreement between raters was 100% (50/50).
Description of included articles.
Akturk
et al.
Sample
Size
(KT/CG)
58
(28/30)
Külcü
et al.
40
(20/20)
Krause
et al.
47
(25/22)
Study
Rania
et al.
60
(30/30)
Participant
Description
Tx Description
KT
Group (N)
KT Effect Size
Control
Group (N)
CG Effect Size
Akturk et. Al.
28
10.4
30
0.3
Külcü et. Al.
20
12.0
20
8.6
Krause et al.
Yildirim et. Al.
25
19
0.2
11.1
22
19
0.4
12.54
Table 8. (Leite JC et al., 2006).
Kinesiotape’s Effect on CTS Symptom Severity Forest Plot
Result
-Mild to moderate CTS
diagnosed via ENMG
over 3 mo. Pain a/o
numbness spreading to
palmar face of hand. 1+
positive finding between
Tinel, Phalen, or carpal
compression test
KT group vs standard
treatment group who
received splinting. Both
groups received the same
exercise.
Significant improvements
found in both groups but
significant differences
favoring KT group found in
BCTQ-S and BCTQ-F.
-18+ yo w/ mildmoderate CTS
symptoms <1 year.
Pain in median nn
distribution during
activity or numbness in
the median nn
distribution.
-18+ yo in Southern
California area. English
speaking. Positive
findings in ether the
Tinel or Phalen’s test
CTS signs
KT group vs Placebo KT
group and an OD group.
Placebo KT group receive
improper tape application
and all 3 groups received
the same exercises.
All 3 groups showed pain
relief and decreases in
symptom severity. Significant
improvement only found in
KT group for functional
status.
KT group vs Placebo KT
group vs a standard CTS
protocol group. All three
groups received the same
exercises. The placebo
KT group had tape
applied with 0% stretch
but had the same wear
pattern. The standard
protocol group received a
1-size-fits-all cock-up
orthosis.
KT group vs Control
group. Both groups
received the same
exercises.
Significant improvement in
VAS scores only in the KT
group. The KT group and
placebo KT group showed
significant improvement in
function but not with the
Orthotic group.
-Recruited from local
OP clinic of neurology
department. Symptoms
> 3 mo. Positive Tinel’s
& Phalen’s tests.
Positive
electrodiagnostic
findings for CTS
Yildirim 38(19/19) -Ages 18-60 w/ mildet al.
moderate CTS.
Symptoms >3 mo.
Table 5.
.
CG Effect Size
BCTQ-Function (MCID=2.05)
Excluded article description and reason for exclusion
Güner et al.
Mindy L, Pou Y.
J. Öncü et al.
Chang HY et al.
D'Angelo et al.
Krause et al.
Kaplan et al.
Soheir et al.
Control Group (N)
BCTQ-Function Effect Size (ES) of Both Groups; Pre-Post Intervention Difference
Table 1.
Study
KT Effect Size
Table 7. (Leite JC et al., 2006).
Databases searched:
•Cochrane (Database of SR & Central Register of Controlled Trials),
CINAHL, MEDLINE, PEDRO, PubMed, and TRIP
•Keywords: 1. Kinesiotape or KT or Kinesio Tape. 2. CTS or carpal
tunnel syndrome. 3. Treatment or intervention or evaluation.
•Dates searched: 2010 to 2020
RCT
N = ≥ 30
CTS related
date: ≤ 10 years
English
KT Group (N)
Table 6. (Krause et al. 2020) [* = Researcher assumed the VAS used mm for measurement.]
Methods
Inclusion Criteria
Kinesiotape’s Effect on CTS Pain Levels Forest Plot
Results
Favors Control
KT tape vs control group.
Both groups received the
same exercises
Favors Treatment
BCTQ-S Improvement
Figure 1.
Kinesiotape’s Effect on CTS Function Forest Plot
Significant difference in pain
levels in favor of the KT
group.
2.59
Favors Treatment
Figure 3.
●As noted by the forest plots, the combined weighted SES for KT groups
were all considered large, as all 3 groups exceeded the ‘large SES’ cutoff score of 0.8. The combined weighted SES for control groups for CTS
symptom severity and function fell below this same SES cut-off but
showed a large SES for pain levels.
●Individual t-tests were conducted, and no significant differences
between groups were found in any of the 3 outcome measures (⍺=0.05;
CI=95%: Symptom Severity: p = 0.5590, Function: p = 0.7327,
Pain : p = 0.3591).
●Findings show a more favorable improvement towards the KT groups
noted by the MCID scores (Tables 6, 7, & 8) for BCTQ-F, BCTQ-S, and
VAS.
Discussion
●All KT groups demonstrated large effect sizes (>0.8). The researchers
recognize that even small effect sizes may still provide clinical
meaningfulness to a clinician. Although exercise alone groups showed
moderate effects sizes, the data presented in this SR suggests that KT
was favorable to exercise alone. Individual t-tests were conducted and
indicated no statistically significant difference between the groups, but
that is not to say that the KT treatment was not more favorable.
●Limitations:. KT, being a broad term that encompasses many different
names, can be used for various treatment strategies which may have
caused the search keywords to be too specific or too broad. Limited to an
initial small amount of total articles to review resulting in a lower than
desired amount of studies for each data set.
●Clinical implications: KT may assist relief in pain, symptom severity,
and/or improve function. This study recognizes that some clinicians may
only be interested in 1 of the 3 dependent variables presented in our
research, and the data does allow the use of KT in conjunction with
empirical evidence from the clinician/researcher. Both groups in each
study received the same exercises, but as the control groups showed
improvement noted by MCID scores, the data suggest greater favorability
towards the KT groups noted by SES.
●Future research: Specifically compare other interventions to KT such
as: splinting, physical agent modalities, casting, and/or surgery. This
study primarily focused on KT groups being compared to placebo-KT
groups that received only exercise.
Conclusion
Significant findings within
each group but not between
groups.
Favors Control
Favors Treatment
BCTQ-S Improvement
KT may be an effective intervention to improve CTS pain, symptom
severity, and function, but may not be more superior than other
conservative interventions as there were no significant differences
between groups for all 3 outcome measures conducted in the SR.
Figure 2.
References: Aktürk S, Büyükavcı R, Aslan Ö, Ersoy Y. Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study. Clin Rheumatol. 2018;37(9):2465-2469. doi:10.1007/s10067-018-4176-1. Geler Külcü D, Bursali C, Aktaş İ, Bozkurt Alp S, Ünlü Özkan F, Akpinar P. Kinesiotaping as an alternative treatment method for carpal tunnel syndrome. Turk J Med Sci. 2016;46(4):1042-1049. Published 2016 Jun 23. doi:10.3906/sag-1503-4. Krause D, Roll SC, Javaherian-Dysinger H, Daher N. Comparative efficacy of the dorsal application of Kinesio tape and splinting for
carpal tunnel syndrome: A randomized controlled trial. Journal of Hand Therapy. March 2020. doi:10.1016/j.jht.2020.03.010. Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord. 2006;7:78. Published 2006 Oct 20. Doi:10.1186/1471-2474-7-78. Rania AR, Battecha KH, Mansour WT. Influence of Kinesio Tape in Treating Carpal Tunnel Syndrome. Journal of Medical Science and Clinical Research. 2013;1(1):1-9. Yıldırım P, Dilek B, Şahin E, Gülbahar S, Kızıl R. Ultrasonographic and clinical evaluation of additional
contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of carpal tunnel syndrome. Turk J Med Sci. 2018;48(5):925-932. Published 2018 Oct 31. doi:10.3906/sag-1709-72.
Introduction
Carpal Tunnel Syndrome (CTS) is one of the most widely-known
and most common UE diagnosis that is caused by compression to
the median nerve. This disease has a significant impact on the work
force as it heavily affects those who perform repetitive wrist motion
within their line of work (e.g. hairdresser). In recent years, the
common approach in treating CTS involved splinting, injections,
and/or other various conservative therapy treatments. Over the past
few years there has been an apparent increase in the use of
Kinesiotaping, and few RCT’s have been conducted to investigate
Kinesiotape’s effects towards treating CTS. While some research
has been conducted, there is no evidence of a SR. Therefore, the
purpose of this review is to determine Kinesio tape’s effect on
improving CTS pain levels, symptom severity, and patient function
measured by the Visual Analog Scale (VAS) and the Boston Carpal
Tunnel Questionnaire’s (BCTQ) symptom severity and function subsections.
VAS Effect Size (ES) of Both Groups; Pre-Post Intervention Difference
VAS (MCID=1.64)
Study
Inclusion and Exclusion criteria KT systematic review
Exclusion Criteria
Non-RCT
Non-CTS related
Unable to access
On-going trial
Foreign
date: > 10 years
Reason
PEDro score of 4
N=4
Foreign
Non-RCT
Systematic Review
Qualitative Study
Unable to access
N = 15
Table 2.
Methodological rating of the RCT’s were completed using the
PEDro criterion score. At least 2 raters read each of the 5
articles and were blinded to individual PEDro scores. No
disagreements between raters were evident. Articles meeting
the cutoff PEDro criterion score (>7) were then identified with
the weighted average standardized effect size (SES)
calculated for control and intervention groups. Sensitivity
analysis was completed by removing the study with the
largest sample size and re-calculating weighted average
SES.
Külcü et. Al.
20
2.5 cm
20
1.9 cm
Krause et al.
25
5.4 (mm*)
22
17.5 (mm*)
Rania et. Al.
30
5.2 cm
30
0.26 cm
Study
1.23
Favors Control
KT Group (N)
KT Effect Size
Control Group (N)
CG Effect Size
Akturk et. Al.
28
9.06
30
0.5
Külcü et. Al.
20
6.9
20
3.5
Krause et al.
25
0.2
22
0.3
Yildirim et. Al.
19
7.31
19
6.14
BCTQ-Symptom Severity Effect Size (ES) of Both Groups; Pre-Post Intervention Difference
Table 3.
Methodological rating of RCT’s based on the PEDRO scores
Quality Assessment
PEDro Score
Study
1
2
3
4
5
6
7
8
9
10
Y
N
Y
Y
Y
N
Y
Y
Y
Y
Akturk et. Al.
Külcü et. Al.
Y
Y
Y
Y
Y
N
Y
Y
Y
Y
Kruase et al.
Y
Y
Y
Y
N
N
Y
Y
Y
Y
Rania et. Al.
Y
N
Y
Y
N
N
Y
Y
Y
Y
Yildirim et. Al.
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
BCTQ-Symptom Severity (MCID=1.55)
Study
Total
8
9
8
7
9
Table 4. Disagreement between raters indicated by *. Percent agreement between raters was 100% (50/50).
Description of included articles.
Akturk
et al.
Sample
Size
(KT/CG)
58
(28/30)
Külcü
et al.
40
(20/20)
Krause
et al.
47
(25/22)
Study
Rania
et al.
60
(30/30)
Participant
Description
Tx Description
KT
Group (N)
KT Effect Size
Control
Group (N)
CG Effect Size
Akturk et. Al.
28
10.4
30
0.3
Külcü et. Al.
20
12.0
20
8.6
Krause et al.
Yildirim et. Al.
25
19
0.2
11.1
22
19
0.4
12.54
Table 8. (Leite JC et al., 2006).
Kinesiotape’s Effect on CTS Symptom Severity Forest Plot
Result
-Mild to moderate CTS
diagnosed via ENMG
over 3 mo. Pain a/o
numbness spreading to
palmar face of hand. 1+
positive finding between
Tinel, Phalen, or carpal
compression test
KT group vs standard
treatment group who
received splinting. Both
groups received the same
exercise.
Significant improvements
found in both groups but
significant differences
favoring KT group found in
BCTQ-S and BCTQ-F.
-18+ yo w/ mildmoderate CTS
symptoms <1 year.
Pain in median nn
distribution during
activity or numbness in
the median nn
distribution.
-18+ yo in Southern
California area. English
speaking. Positive
findings in ether the
Tinel or Phalen’s test
CTS signs
KT group vs Placebo KT
group and an OD group.
Placebo KT group receive
improper tape application
and all 3 groups received
the same exercises.
All 3 groups showed pain
relief and decreases in
symptom severity. Significant
improvement only found in
KT group for functional
status.
KT group vs Placebo KT
group vs a standard CTS
protocol group. All three
groups received the same
exercises. The placebo
KT group had tape
applied with 0% stretch
but had the same wear
pattern. The standard
protocol group received a
1-size-fits-all cock-up
orthosis.
KT group vs Control
group. Both groups
received the same
exercises.
Significant improvement in
VAS scores only in the KT
group. The KT group and
placebo KT group showed
significant improvement in
function but not with the
Orthotic group.
-Recruited from local
OP clinic of neurology
department. Symptoms
> 3 mo. Positive Tinel’s
& Phalen’s tests.
Positive
electrodiagnostic
findings for CTS
Yildirim 38(19/19) -Ages 18-60 w/ mildet al.
moderate CTS.
Symptoms >3 mo.
Table 5.
.
CG Effect Size
BCTQ-Function (MCID=2.05)
Excluded article description and reason for exclusion
Güner et al.
Mindy L, Pou Y.
J. Öncü et al.
Chang HY et al.
D'Angelo et al.
Krause et al.
Kaplan et al.
Soheir et al.
Control Group (N)
BCTQ-Function Effect Size (ES) of Both Groups; Pre-Post Intervention Difference
Table 1.
Study
KT Effect Size
Table 7. (Leite JC et al., 2006).
Databases searched:
•Cochrane (Database of SR & Central Register of Controlled Trials),
CINAHL, MEDLINE, PEDRO, PubMed, and TRIP
•Keywords: 1. Kinesiotape or KT or Kinesio Tape. 2. CTS or carpal
tunnel syndrome. 3. Treatment or intervention or evaluation.
•Dates searched: 2010 to 2020
RCT
N = ≥ 30
CTS related
date: ≤ 10 years
English
KT Group (N)
Table 6. (Krause et al. 2020) [* = Researcher assumed the VAS used mm for measurement.]
Methods
Inclusion Criteria
Kinesiotape’s Effect on CTS Pain Levels Forest Plot
Results
Favors Control
KT tape vs control group.
Both groups received the
same exercises
Favors Treatment
BCTQ-S Improvement
Figure 1.
Kinesiotape’s Effect on CTS Function Forest Plot
Significant difference in pain
levels in favor of the KT
group.
2.59
Favors Treatment
Figure 3.
●As noted by the forest plots, the combined weighted SES for KT groups
were all considered large, as all 3 groups exceeded the ‘large SES’ cutoff score of 0.8. The combined weighted SES for control groups for CTS
symptom severity and function fell below this same SES cut-off but
showed a large SES for pain levels.
●Individual t-tests were conducted, and no significant differences
between groups were found in any of the 3 outcome measures (⍺=0.05;
CI=95%: Symptom Severity: p = 0.5590, Function: p = 0.7327,
Pain : p = 0.3591).
●Findings show a more favorable improvement towards the KT groups
noted by the MCID scores (Tables 6, 7, & 8) for BCTQ-F, BCTQ-S, and
VAS.
Discussion
●All KT groups demonstrated large effect sizes (>0.8). The researchers
recognize that even small effect sizes may still provide clinical
meaningfulness to a clinician. Although exercise alone groups showed
moderate effects sizes, the data presented in this SR suggests that KT
was favorable to exercise alone. Individual t-tests were conducted and
indicated no statistically significant difference between the groups, but
that is not to say that the KT treatment was not more favorable.
●Limitations:. KT, being a broad term that encompasses many different
names, can be used for various treatment strategies which may have
caused the search keywords to be too specific or too broad. Limited to an
initial small amount of total articles to review resulting in a lower than
desired amount of studies for each data set.
●Clinical implications: KT may assist relief in pain, symptom severity,
and/or improve function. This study recognizes that some clinicians may
only be interested in 1 of the 3 dependent variables presented in our
research, and the data does allow the use of KT in conjunction with
empirical evidence from the clinician/researcher. Both groups in each
study received the same exercises, but as the control groups showed
improvement noted by MCID scores, the data suggest greater favorability
towards the KT groups noted by SES.
●Future research: Specifically compare other interventions to KT such
as: splinting, physical agent modalities, casting, and/or surgery. This
study primarily focused on KT groups being compared to placebo-KT
groups that received only exercise.
Conclusion
Significant findings within
each group but not between
groups.
Favors Control
Favors Treatment
BCTQ-S Improvement
KT may be an effective intervention to improve CTS pain, symptom
severity, and function, but may not be more superior than other
conservative interventions as there were no significant differences
between groups for all 3 outcome measures conducted in the SR.
Figure 2.
References: Aktürk S, Büyükavcı R, Aslan Ö, Ersoy Y. Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study. Clin Rheumatol. 2018;37(9):2465-2469. doi:10.1007/s10067-018-4176-1. Geler Külcü D, Bursali C, Aktaş İ, Bozkurt Alp S, Ünlü Özkan F, Akpinar P. Kinesiotaping as an alternative treatment method for carpal tunnel syndrome. Turk J Med Sci. 2016;46(4):1042-1049. Published 2016 Jun 23. doi:10.3906/sag-1503-4. Krause D, Roll SC, Javaherian-Dysinger H, Daher N. Comparative efficacy of the dorsal application of Kinesio tape and splinting for
carpal tunnel syndrome: A randomized controlled trial. Journal of Hand Therapy. March 2020. doi:10.1016/j.jht.2020.03.010. Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord. 2006;7:78. Published 2006 Oct 20. Doi:10.1186/1471-2474-7-78. Rania AR, Battecha KH, Mansour WT. Influence of Kinesio Tape in Treating Carpal Tunnel Syndrome. Journal of Medical Science and Clinical Research. 2013;1(1):1-9. Yıldırım P, Dilek B, Şahin E, Gülbahar S, Kızıl R. Ultrasonographic and clinical evaluation of additional
contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of carpal tunnel syndrome. Turk J Med Sci. 2018;48(5):925-932. Published 2018 Oct 31. doi:10.3906/sag-1709-72.