Kinesiology taping is an increasingly popular technique used as an adjunct to physiotherapy intervention for children with cerebral palsy (CP), but as yet we do not have a review of the available evidence as to its efficacy.
To critically appraise and establish best available evidence for the efficacy of truncal application of kinesiology taping combined with physiotherapy, versus physiotherapy alone, on gross motor function (GMF) in children with CP.
Seven databases were searched using the terms CP, kinesio taping and/or kinesiology tape and/or taping, physiotherapy and/or physical therapy and GMF. Only randomised controlled trials (RCTs) were included and appraised using the PEDro scale. Revman© Review Manager was used to combine effects for GMF in sitting, standing and activities of daily living.
Five level IIB RCTs that scored 3–6/8 on the PEDro scale were included. Meta-analysis showed that taping was effective for improving GMF in sitting and standing as measured by the Gross Motor Function Measure (B) (
There is moderate evidence to support kinesiology taping applied to the trunk as an effective intervention when used as an adjunct to physiotherapy to improve GMF in children with CP, especially those with GMF Classification Scale levels I and II, and particularly for improving sitting control.
Kinesiology taping is a useful adjunct to physiotherapy intervention in higher functioning children with CP. Current evidence however is weak and further research into methods of truncal application is recommended.
Children with cerebral palsy (CP) typically present with motor impairments including tone abnormalities, muscle weakness and increased reflexes (Bax et al.
One intervention not included in Novak et al.’s (
Considering that sensory and proprioceptive feedback are prerequisites for proper motor development (Hadders-Algra
Because of its proposed effects, relatively inexpensive cost and easy application, KT may be an effective complementary adjunct to current physiotherapy interventions for improving GMF in children with CP. However, the quality of the available evidence supporting KT in this context has not yet been well established. Contradictory findings warrant further investigation and a more thorough review. The purpose of this SR was thus to critically appraise and collate the best available evidence for the effectiveness of KT (as opposed to rigid taping) applied to the trunk as an adjunct to physiotherapy, versus physiotherapy alone, for improving GMF in children with CP. This SR could possibly enhance evidence-based practice in the field of CP, to enable physiotherapists to make more informed decisions regarding optimal treatment with KT in this population.
Seven electronic databases, accessed through the Stellenbosch University library services, were searched from inception to May 2018 (Cochrane Library, EBSCO Host [CINAHL, Pre-CINAHL], Google Scholar, PEDro, PubMed, Science Direct and Scopus). Individual search strategies were developed for each database according to its function. Key search terms included CP, physiotherapy, physical therapy, kinesiology taping, KT taping, kinesio tape, taping and GMF. Each database was searched independently by two authors. Retrieved titles, abstracts and full texts were scrutinised independently by each member of the group of authors based on the eligibility criteria set at the onset of the review. Through discussion within the group, the final articles for full review were selected.
Studies were assessed according to the following eligibility criteria:
Type of studies: Only randomised controlled trials (RCTs) published in English and scoring three or more on the PEDro scale (De Morton
Participants: Studies were included if they recruited male and/or female children (< 18 years old), diagnosed with CP but otherwise healthy. Studies were excluded if they involved participants who previously participated in trials using KT, had undergone any orthopaedic surgery or had received botulinum toxin injection in the 6 months prior to the assessment date, had structural scoliosis or demonstrated an allergic reaction to any materials used in the study.
Interventions: Kinesiology taping applied to the trunk as an adjunct to conventional physiotherapy (including, but not confined to, neurodevelopmental treatment [NDT], constraint-induced manual therapy [CIMT], stretching, muscle strengthening, tone modulation exercises, gait re-education and balance re-education exercises). Studies using rigid taping or any other forms of taping not conforming to the specific properties of KT were excluded.
Comparisons: Conventional physiotherapy without any KT application.
Outcomes: Studies were included if they used outcome measures assessing GMF – including, but not limited to, motion analysis, the Gross Motor Function Measure (GMFM), Paediatric Balance Scale (PBS), Timed-Up-And-Go (TUG), Bruininks–Oseretsky Test of Motor Proficiency (BOTMP) and Sitting Assessment Scale (SAS).
The National Health and Medical Research Council (NHMRC) Hierarchy of Evidence (Merlin, Weston & Tooher
The adapted Joanna Briggs Institute data extraction form was used to extract and capture the relevant data from the included articles. Data were obtained concerning the following categories: citation, study type, participants, interventions, comparisons, outcome measures, results, post-intervention clinical status and implications. Two articles were allocated to each author to perform data extraction, ensuring that information could be cross-checked and unanimity reached among the authors with subsequent recompilation of the data.
Data pertaining to GMF in sitting and in standing were synthesised in the form of meta-analyses using the Revman© Review Manager Software (2008) using a fixed-effects approach to illustrate combined effects in the form of forest plots. Weighted mean differences (WMDs) were used to express outcomes for continuous data (mean and standard deviation [SD]) and the
Ethical approval for this study was not required as all data used were publicly available. However, all studies included in this review had ethical clearance.
The results of the search strategy are summarised in
Article identification search strategy.
Databases or other sources | Initial hits | Accepted titles | Accepted abstracts |
---|---|---|---|
Cochrane | 285 | 4 | 4 |
Ebsco Host-CINAHL | 863 | 5 | 4 |
PEDro | 7 | 1 | 2 |
PubMed | 473 | 5 | 3 |
Science Direct | 142 | 17 | 0 |
Google Scholar | 125 | 19 | 4 |
Scopus | 56 | 8 | 5 |
Note: Duplicates between the databases = 17
All the included articles (Badawy et al.
Description of the included studies’ sample demographics.
Variable | Type | Kaya Kara et al. ( |
Şimşek et al. ( |
Ibrahim ( |
Karabay et al. (2015) | Badawy et al. (2016) |
---|---|---|---|---|---|---|
Sample size | Kinesio taping | 15 | 15 | 15 | 15 | 19 |
No taping | 15 | 15 | 15 | 15 | 19 | |
Gender of participants | Kinesio taping | 8 males |
8 males |
Not specified | Not specified | 10 males |
No taping | 7 males |
10 males |
11 males |
|||
Age of participants (years) | Kinesio taping | Mean (SD): 9 year (2 year 3 month) | Mean (SD): 8 year 3 month (3 year 4 month) | Mean (SD): 8 year 4 month (1 year 9 month) | Mean (SD): 12.7 month (1.46 month) | Mean (SD): 78.05 month (28.75 month) |
No taping | Mean (SD): 9 year 7 month (3 year 4 month) | Mean (SD): 6 year 9 month (2 year 10 month) | Mean (SD): 12.6 month (1.3 month) | Mean (SD): 68.4 month (28.8 month) |
Badawy et al. (
All the studies made use of 5 cm Kinesio® tape (
Description of intervention (kinesiology tape and physiotherapy).
Type | Kaya Kara et al. ( |
Şimşek et al. ( |
Ibrahim ( |
Badawy et al. (2016) | Karabay et al. (2015) |
---|---|---|---|---|---|
Kinesio® tape (KT) | Kinesio® tape (KT) | Kinesio® tape (KT) | Kinesio® tape (KT) | Kinesio® tape (KT) | |
Intervention application | ‘I’ taping for scapula stabilisation and postural control, using 5 cm tape (KT was also applied to lower and upper limbs) | KT was applied longitudinally between C7 and S1 along the paraspinal musculature. |
Two strips were placed immediately lateral to the vertebral spinous processes in a caudal-cephalo direction from the levels of L3/L4-T1. The other two strips were placed along the lower trapezius muscle from the acromion process to T12 in an oblique manner | KT tape was cut into ‘I’ strips and secured onto the acromioclavicular joint without stretch. Tape was then applied in an oblique manner to T12 with stretch, and secured at the last 5 cm without stretch | |
Physiotherapy management | Neurodevelopmental treatment (NDT) which consisted of stretching, weight-bearing, functional reaching and walking | Exercises focusing on tone regulation, activities of upper extremity like grabbing-releasing and activities of sitting and balance reactions related to sitting | Exercises to improve the sitting and standing position, to increase sitting and standing balance, and activities to improve the upper extremity function including reaching, grasping and release | NDT which included facilitation of rolling, sitting positions, active trunk control exercises, improving sitting balance, righting and equilibrium reactions, weight bearing exercises, hand function exercises and proprioceptive training | NDT (non-specified) |
Duration | KT was applied for 12 weeks in all studies. |
KT was applied bilaterally for 4 weeks and was changed every 3–4 days | |||
Physiotherapy management | NDT which consisted of stretching, weight-bearing, functional reaching and walking | Exercises focusing on tone regulation, activities of upper extremity like grabbing-releasing and activities of sitting and balance reactions related to sitting | Exercises to improve the sitting and standing position, to increase sitting and standing balance, and activities to improve the upper extremity function including reaching, grasping and release | NDT which included facilitation of rolling, sitting positions, active trunk control exercises, improving sitting balance, righting and equilibrium reactions, weight bearing exercises, hand function exercises and proprioceptive training | NDT (non-specified) |
Duration | Two sessions a week for 12 weeks | 1-hour sessions, three times a week for 12 weeks | 1.5-hour sessions, three times a week for 12 weeks | Four to five sessions per day for 4 weeks |
Note: Dosage and duration of physiotherapy management in the KT group were the same as for the control group.
C1, first cervical vertebra; cm, centimetres; S1, first sacral vertebra; T12, 12th thoracic vertebra; L3, third lumbar vertebra; L4, fourth lumbar vertebra; L5, fifth lumbar vertebra.
Different outcome measures were utilised to assess GMF across the studies (
Timeline and outcome measures used by included studies.
Outcome measures | Kaya Kara et al. ( |
Şimşek et al. ( |
Ibrahim ( |
Badawy et al. (2016) | Karabay et al. (2015) | Testing period |
---|---|---|---|---|---|---|
Gross Motor Function Measure (GMFM) | → | → | → | → | → | Baseline |
- | - | - | - | → | 4 weeks | |
→ | → | → | → | - | 12 weeks | |
Sitting Assessment Scale (SAS) | - | → | - | - | - | Baseline |
- | → | - | - | - | 12 weeks | |
Bruinisks–Oseretsky Test of Motor Proficiency (BOTMP) | → | - | - | - | - | Baseline |
→ | - | - | - | - | 12 weeks |
The GMFM is an observational assessment tool incorporating 88 items, scored on a four-point ordinal scale (ranging from 0 to 3) (Russell et al.
The SAS, as utilised by Şimşek et al. (
The BOTMP is a standardised norm-referenced measure used to assess GMF (Bruininks & Bruininks
The effect of KT as an adjunct to physiotherapy on GMF in children with CP is summarised in the tables and/or forest plots.
Ibrahim (
Effect of kinesiology taping on gross motor function as determined by the Gross Motor Function Measure (B).
Reference | Outcome measure | No taping | KT | |
---|---|---|---|---|
Ibrahim ( |
GMFM (B) – baseline | 34.84 (8.40) | 35.85 (7.25) | 0.005 |
GMFM (B) – 12 weeks | 42.48 (9.21) | 49.90 (2.11) | ||
0.020 |
< 0.001 |
- | ||
Şimşek et al. ( |
GMFM (B) – baseline | 57.97 (24.60) | 57.10 (24.30) | 0.127 |
GMFM (B) – 12 weeks | 61.66 (22.56) | 75.66 (25.12) | ||
0.011 |
0.001 |
|||
Badawy et al. (2016) | GMFM (B) – baseline | 29.85 (3.5) | 29.76 (3.4) | < 0.050 |
GMFM (B) – 12 weeks | 45.37 (3.2) | 69.86 (4.1) | ||
< 0.050 |
< 0.050 |
- | ||
Karabay et al. (2015) | GMFM (B) – baseline | 39.30 (14.4) | 34.20 (16.5) | < 0.010 |
GMFM (B) – 4 weeks | 43.70 (14.5) | 41.00 (15.5) | ||
0.000 |
0.000 |
- |
GMFM (B), the (B) describes the sitting domain evaluated in GMFM; GMFM, Gross Motor Function Measure; KT, kinesiology taping.
, Values that indicate statistically significant results.
A meta-analysis illustrates KT to be favoured for GMFM (B) (
Kinesiology taping versus no taping as measured by Gross Motor Function Measure (B) sitting function at the end of the intervention period.
Şimşek et al. (
Effect of kinesiology taping on sitting function as determined by Gross Motor Function Measure (B) and Sitting Assessment Scale.
Reference | Outcome measure | No taping mean (SD) | Kinesiology taping mean (SD) | |
---|---|---|---|---|
Şimşek et al. ( |
GMFM (B) – baseline | 57.97 (24.60) | 57.10 (24.30) | 0.925 |
GMFM (B) – 12 weeks | 61.66 (22.56) | 75.66 (25.12) | 0.127 | |
0.011 |
0.001 |
- | ||
Şimşek et al. ( |
SAS – baseline | 12.47 (3.64) | 13.53 (3.48) | 0.419 |
SAS – 12 weeks | 13.20 (3.32) | 16.47 (1.96) | 0.003 |
|
0.028 |
0.000 |
- |
GMFM (B), the (B) describes the sitting domain evaluated in GMFM; GMFM, Gross Motor Function Measure; SAS, Sitting Assessment Scale; SD, standard deviation.
, Values that indicate statistically significant results.
Both Ibrahim (
Effect of kinesiology taping on standing function as determined by Gross Motor Function Measure (D).
Reference | Outcome measure | No taping mean (SD) | KT mean (SD) | |
---|---|---|---|---|
Ibrahim ( |
GMFM (D) – baseline | 28.73 (5.76) | 27.11 (1.45) | - |
GMFM (D) – 12 weeks | 33.23 (4.83) | 37.85 (2.82) | 0.003 |
|
0.020 |
0.0001 |
- | ||
Kaya Kara et al. ( |
GMFM (D) – baseline | - | - | - |
GMFM (D) – 12 weeks | 1.37 (3.47) | 3.23 (4.88) | 0.239 | |
0.684 | 0.028 |
- |
GMFM (D), the (D) describes the standing domain evaluated in GMFM.
GMFM, Gross Motor Function Measure; KT, kinesiology taping; SD, standard deviation.
, Values that indicate statistically significant results.
In Kaya Kara et al.’s (
Effect of kinesiology taping on standing as determined by Gross Motor Function Measure (E).
Reference | Outcome measure | No taping mean (SD) | KT mean (SD) | |
---|---|---|---|---|
Kaya Kara et al. ( |
GMFM (E) – baseline | - | - | 0.818 |
GMFM (E) – 12 weeks | 0.94 (1.81) | 2 (2.12) | 0.227 | |
0.036 |
0.005 |
- |
GMFM (E), the (E) describes the walking, running and jumping domain evaluated in GMFM; GMFM, Gross Motor Function Measure; KT, kinesiology taping; SD, standard deviation.
, Values that indicate statistically significant results.
Kinesiology taping is a treatment technique increasingly being used in numerous fields of physiotherapy to improve posture and function (Jaraczewska & Long
Sitting function as determined by GMFM (B) in three out of the four studies reported a significant overall effect in favour of the KT group (Badawy et al.
Despite the lack of significant change on the GMFM (B), Şimşek et al. (
Measurement of the kyphotic angle was an additional outcome measured by Badawy et al. (
Although pooling of data via meta-analysis favoured the KT group, the effect on standing posture and function was, however, contradictory. One study found that KT improved standing function (Karabay et al.
One study included additional measures for GMF and also reported on BOTMP and GMFM (E) scores (Kaya Kara et al.
This review limited its investigation of taping to KT. Other forms, such as rigid and therapeutic taping as described by Footer (
Despite only RCTs being included in this review, the methodological quality of these studies was low to moderate, with PEDro scores ranging from 3 to 6 out of 9. Scores were lost regarding the issue of blinding. The nature of the intervention, however, does not allow for blinding of neither the participant nor the therapists administering the intervention. However, therapists may have altered their physiotherapy intervention knowing which children were receiving the investigational intervention. Sham taping could possibly have reduced treatment bias. In addition, the assessor was blinded in only one study (Kaya Kara et al.
One of the main strengths of this SR was that the full spectrum of children as classified by the GMFCS was included. Although our findings suggest that there is moderate evidence that taping is more effective in higher functioning children, this is based on the outcome of only four studies, and in one (Karabay et al.
All studies only reported on the effect of KT after 4 or 12 weeks of intervention. There was no description of immediate or long-term effects of KT in this population. The current evidence suggests that the lasting effect beyond physiotherapy intervention is limited to as long as the KT is applied (Thelen et al.
It is recommended that the type of application of KT be considered when using this as an adjunct to physiotherapy treatment, as described by the studies. Although KT is relatively inexpensive, the tape needs to be replaced every 3 days which, in a poorly resourced setting, can become quite costly. However, it can be applied by any trained therapist and is usually readily accessible, which makes KT a favourable intervention to use.
It is also recommended that further studies investigate the long-term effects of KT, both regarding how well and how long application can be tolerated by the skin and whether the functional gains achieved during the exposure period are maintained in the long term. Blinding assessors (and where possible blinding the therapist) is also recommended to avoid treatment and measurement bias. We also propose
Kinesiology taping applied to children with spastic diplegia and/or functioning at GMFCS levels I and II has moderate evidence (level II) for effectiveness in improving GMF when used as an adjunct to physiotherapy. Clinicians will find it most beneficial on children who require improved sitting postural control to perform functional tasks. Further research is required to better understand the short- and long-term effects of KT. It is also recommended that the type of application of KT be considered when using this as an adjunct to physiotherapy treatment.
The authors wish to thank Ms M. Burger for her guidance in the research process and Ms K. Berner for editorial support.
The authors report no conflict of interest and declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
M.U. was responsible for the conceptualisation of the study, revisions of the manuscript and final approval of the manuscript. J.P.C., N.F., R.P., S.P., A.C.R. and K.S. were responsible for the conceptualisation of the study, study design, data searching, extraction and capturing and approval of the final manuscript. J.P.C. was involved in revisions of the manuscript and approval of the final manuscript.