Clinical Notes 9 March 2018 Research informed

Clinical Notes 9

March 2018

Esther de Ru

GoPhysio Netherlands

Research informed practice: using ET-Taping as Pain Management option for children. Using ET tape as pain reduction for children with chronic pain and/or in palliative care. A gentle and cost effective alternative to pharmaceutical treatment. What does research say and what are the clinical possibilities? Elastic therapeutic taping (Kinesio/Kinesiology Taping) has become a well-known and welcome modality in our ‘box of tools’ to address pain. Many studies have already been undertaken on this subject. Our role as caretakers can be significant, our positive attitude should help make children suffering from extreme pain or chronic pain a little more bearable. The possible ‘perceived‘ placebo effect can be used to our advantage. Could ET-tape be an option to help relieve pain in children? RESEARCH CONDUCTED INTO THE EFFECTS OF ET-TAPING ON PAIN When using pain AND Kinesio/Kinesiology/Medical/Physio/Kineo/etc etc AND Taping as search terms more than 300 documents were found. Of these 300 documents: 46 were related to back pain 11 were related to knee pain 8 were related to shoulder pain 14 were related to cervical spine pain 14 were related to epicondylitis 3 were related to muscle pain and spasm 13 were related to myofascial pain 2 were related to CRPS one mention of using ETT for CRPS presentation Dr. Chopra1 3 were related to hypermobility 4 were related to fractures 14 were related to dolor & dor (pain) In the many other documents and studies pain was mentioned as ‘one of the treatment goals’ and these documents were therefor not included in the above list. A number of Systematic Reviews looking into the effects of ET- tape on pain have been conducted. Highlighted are the most relevant conclusions of each study. Artioli DP & Bertolini GRF (2013) Kinesio taping: application and results on pain; systematic review. Doi 10.1590/1809-2950/553210114 pg 94-99 The PubMed, SciELO, Lilacs, Scirus and Academic Google databases were consulted, using the keywords: Kinesio Taping and Kinesio Tape, either associated or not to pain. Ten clinical trials related to pain and Kinesio taping were selected, assessed by using the PEDro scale, and its results were analyzed. Kinesio taping provided higher, similar or lower pain reduction than in other groups (control, placebo or technique). Results: The application continues to use the principles of Kenzo Kase, the gate control theory being the most described so far to justify the hypoalgesic effect; and the effects were only found in short-term (24 hours to 1 week). Pain relief provided by Kinesio taping was similar or slightly superior to other interventions, not representing a reason for it to be the main treatment of choice. However, it can be considered an adjunct or complementary technique. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-29502014000100094 Montalvo A.M. et al (2014) Effect of kinesiology taping on pain in individuals with musculoskeletal injuries; systematic review and meta-analysis. Phys.Sportsmed 2014.may42(2):48-57 English-language publications from 2003 to 2013 were surveyed by searching SPORTDiscus, Scopus, ScienceDirect, CINAHL, Cochrane Library, PubMed, and PEDro databases using the terms kinesio tap*, kinesiology tap*, kinesiotap*, and pain. Thirteen articles investigating the effects of kinesiology tape application on pain with at least level II evidence were selected. The combined results of this meta-analysis indicate that kinesiology tape may have limited potential to reduce pain in individuals with musculoskeletal injury; however, depending on the conditions, the reduction in pain may not be clinically meaningful. Kinesiology tape application did not reduce specific pain measures related to musculoskeletal injury above and beyond other modalities compared in the context of included articles. We suggest that kinesiology 1

http://www.ehlers-danlos-initiative.de/fileadmin/user_upload/EDS/aktuelles/Complex_pain_in_adults_and_children_Original.pdf

tape may be used in conjunction with or in place of more traditional therapies, and further research that employs controlled measures compared with kinesiology tape is needed to evaluate efficacy. https://www.ncbi.nlm.nih.gov/pubmed/24875972 Nelson NL (2016) Kinesio taping for chronic low back pain; a systematic review. J Bodyw Mov Ther. 2016 Jul;20(3):672-81. doi: 10.1016/j.jbmt.2016.04.018 This is the first systematic review to explicitly report the effects of KT on CLBP. Objective: The aim of this review was to summarize the results of randomized controlled trials (RCTs) investigating the effects of KT on CLBP. Searches were performed on PubMed, MEDLINE, SPORT Discus and Science Direct, up to June 17, 2015, using keywords: Kinesiology taping, kinesio taping, chronic low back pain. Results: Five studies involving 306 subjects met the inclusion criteria and corresponded to the aim of this review. The methodological quality of the included RCTs was good, with a mean score of 6.6 on the 10-point PEDro Scale. Moderate evidence suggests KT, as a sole treatment or in conjunction with another treatment, is no more effective than conventional physical therapy and exercise with respect to improving pain and disability outcomes. There is insufficient evidence suggesting that KT is superior to sham taping in improving pain and disability. Conclusion: Kinesio taping is not a substitute for traditional physical therapy or exercise. Rather, KT may be most effective when used as an adjunctive therapy, perhaps by improving ROM, muscular endurance and motor control. https://www.ncbi.nlm.nih.gov/pubmed/27634093 Trobec K & Persolja M (2017) Efficacy of kinesiotaping in reducing low back pain; a comprehensive review. JHSci 2017.410 1-8 Cochrane Library, CINAHL, COBIB.SI, PubMed and Science Direct were searched using Boolean operators search strings of different keywords such as adult, low back pain, Kinesio tape, Kinesio Taping, KinesioTaping, effects. The search was limited to full-text articles published from 2011 to 2016. (9 articles were reviewed) Results: The effect of Kinesio Taping in reducing low back pain is positive but was not statistically significant in analysed studies. Taping therapy may therefore be used as a supplementary method to conventional physical therapy procedures and may be important for patients because of its easy accessibility and safety. https://www.academia.edu/34541118/Efficacy_of_Kinesio_Taping_in_reducing_low_back_pain_A_comprehensive_ review Vanti C et al (2015) Effects of Taping on Spinal Pain and disability: systematic review and meta-analysis of randomized Trails. Physical Therapy vol 95nr4-pg493-506 (both rigid and elastic tape were reviewed) 8 RCTs were included Result for single trials indicated that both elastic and nonelastoc taping are not better that placebo or no treatment on spinal disability. Positive results were found only for elastic taping and only for short-term pain reduction in WAD or specific neck pain Results; although different types of taping were investigated, the results of this systematic review did not show any firm support for their effectiveness. https://academic.oup.com/ptj/article/95/4/493/2686337 To my knowledge not a single study has been conducted with pain as main tape treatment goal in children. The few found mentioning pain as one of the aspects looked into are named here below: Baha Naci et al (2016) Effect of kinesiotaping method on kinesiophobia, balance and pain in a patient with Duchenne MD; a case report. Pediatrics Cognent Medicine (2016), 3:1265203 Bakhtiary AH et al (2015) Effect of kinesio taping on pain and functional disability in young female with menstrual low back pain Koomesh Spring 2015, 16(30: 404-412 abstract Camerota P et al (2015) The effects of neuromuscular taping on gait walking strategies in a patient with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type. TjAdvMusc.Dis 2015, vol7(1)3-10 Deniz Tuncer, Hülya Nilgün Gürses, Kamer Unal Eren, Busra Kepenek Varol 2017 Effect of Kinesio® Taping Application on Chest Expansion in a Child with Joint Hypermobility Syndrome Pediatrics, Cogent Medicine (2017), 4: 1408251 Haltia M. (2010) Kinesiotaping and hamstring strain of children with Juv.Idiopathic arthritis Helsinki Uni thesis PT Ba web I have read all documents and am not judging the ‘levels’ of this evidence. I am very happy to read and learn from the expert opinions, case descriptions and every ‘high quality’ paper. I want to know as much as I can, be as informed as possible to be able to make the very ‘best’ treatment choices.

WHAT DO THESE OUTCOMES SAY AND HOW CAN I USE IN THE CLINIC? Below a few examples of the ‘strange’ results of the SR’s named above.  we have found an effect but this is no more effective than conventional physiotherapy  the effect was not above and beyond other modalities compared in the context  Pain relief was similar or slightly superior to other interventions, not representing a reason for it to be the main treatment of choice This type of conclusion makes me question the ability of researchers. Are they objective? Why are they adding their own opinion? Do they want to tell us what to do? When I read results like the above I tend to go into ‘fight-mode’ and chose to take notice of the positive possibilities discussed between lines. So what do these outcomes mean to me? How can I use the knowledge obtained from reading all these articles to the best advance of children under my care? WHEN USED WISELY I SEE ET-TAPE AS A VERY GENTLE OPTION TO HELP CHILDREN DEAL WITH THEIR PAIN. PERSONALLY I MUCH PREFER A PIECE OF TAPE TO ANY MEDICATION, PILL, COLD METAL ‘FASCIA TOOL’ OR ELECTRO-EQUIPMENT. WHY NOT LET CHILDREN HAVE ACCESS TO THIS POSSIBILITY AS WELL? Like adults children have gut feelings of what is right and wrong. They are sensitive beings and will recognize when therapists are truly engaged. Recent research on the intentions of the therapist using tape and what was communicated to the patient has shown its importance. If therapist and child both have positive expectations, chances are that positive results will be the case. A child will know if you mean what you say. This will influence the outcomes of what we do. Elastic Therapeutic Tape can be used in a number of ways in the clinic:  Locally, to address the pain by mimicking the instinctive touch of a parent or own hand.  In dermatomes or reflex skin areas paravertebrally when local treatment is not possible.  To address swelling when this is making moving difficult or causing pain.  To address organ dysfunction and cramp and spasm causing pain.  If electrotherapy has proven effective, changes are that tape will work equally efficiently as a number of studies (adults & children) comparing both have already shown.2 Applying tape will emphasize that the child is being taken seriously. That we appreciate that they are in pain. Just like the positive effects of a band aide, tape can make the difference. AND it is a nice ‘placebo’.  If I can improve the child’s quality of life by means of some very colourful tapes (normally not my first choice) I will certainly not refrain from doing so. CONCLUSION: Research shows that Elastic Therapeutic Tape has a positive effect on pain just like a number of other modalities. Children with chronic pain and those in palliative care have the right to ask the very best options of us. So let’s use Elastic Therapeutic Tape as a treatment option against pain more than we are doing now. Let us test patch a number of brands to find which is best for each specific child and in every case. Let us take 100% care of the skin before and during the whole application time. Let us make a difference. KEYPOINTS are: absolute 100% SKIN CARE and using MAX 0 -10% STRETCH OF THE TAPE.

2

Azatcam Godmen et al (2016) Comparison of effectiveness of transcutaneous electrical nerve stimulation and kinesio taping added to exercises in patients with myofascial syndrome. Doi10.3233/BMR150503 Baigiamasis Darbas (2013) effects of kinesio taping en electrostimulation for patellar positiona and pain in patients with patella chondromalacia. Ba thesis Lithouwen Elbasan B (2015) The effects of neuromuscular electrical stimulation and kinesio taping on sitting balance in children with cerebral palsy. AACPDM conf 2015 Goldaraz Gomez I & Goldaraz Gomez E (2012) Dolor lumbar crónico inespecífico, comparación de la efectividad de un protocolo de tratamiento basado en la electroterapia convencional vs. un protocolo de tratamiento basado en la electroterapia convencional y vendaje neuromuscular-kinesiotape http://www.efisioterapia.net/articulos/dolor-lumbar-cronico Karabay I, Dogan A, Timus E, Koseoglu BF, Ersoz M (2016) Training postural control and sitting in children with cerebral palsy; kinesio taping versus neuromuscular electrical stimulation. CTinCP 24(2016)67-72 Kuru T, Yalıman A, Dereli EE. (2012) Comparison of efficiency of Kinesio taping and electrical stimulation in patients with patellofemoral pain syndrome. ActaOrthoTraumaTurc 2012;46(5):385-92 http://www.aott.org.tr/article/view/2423/2871 N.A. Nieves Estrada, A.C. Echevarría González (2013) Effect of neuromuscular electrical stimulation and kinesio taping in sialorrhea in patients with mild cerebral palsy and moderate. Fisioterapia Volume 35, Issue 6, November–December 2013, Pages 272–276 Urte Virbalaite (2013) Effect of kinesio taping and electrostimulation for patellar position and pain in patients with patellar chondromalacie. Ba thesis