Effects of the Kinesio® Taping on the gait of stroke subjects: a systematic review with meta-analysis

Magalhães, Henrique Couto da Gama; Menezes, Kênia Kiefer Parreiras de; Avelino, Patrick Roberto

doi:10.1590/1809-2950/17387024022017

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 24 (2) • June 2017 • https://doi.org/10.1590/1809-2950/17387024022017 copy

Effects of the Kinesio® Taping on the gait of stroke subjects: a systematic review with meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Kinesio Taping (KT) has been used in the rehabilitation of post CVA patients and several recent studies have investigated its effects on the gait of these subjects, reporting promising results. We investigated the effects of the use of KT in the gait of stroke subjects through a systematic review of the literature. Searches were conducted on databases Medline, CINAHL, SPORTDiscus, Web of Science, LILACS and PEDro, without restrictions of date or language of publication. The articles were screened independently by two evaluators and disagreements were resolved by a third party. Methodological quality was assessed according to PEDro scale. When possible, outcome measures were analyzed using the program Comprehensive Meta-Analysis, version 3.0. We included 15 studies of low to moderate methodological quality (mean 4.7). For gait speed, we included 7 studies of low to moderate methodological quality in the meta-analysis that, under the model of fixed effects, found that the KT significantly increased the gait speed of post-stroke subjects in 0.05 m/s (95%CI 0.002 to 0.100; I²=0%; p<0.05). However, for the step length, functional mobility and balance no significant difference was found (p>0.05). This systematic literature review showed there are still no evidence about the use of KT in rehabilitation of post-stroke patients in order to improve the gait. Although gait speed, according to the meta-analysis, have shown a statistically significant gain, its value cannot be considered clinically relevant to patients.

Keywords:
Compression Bandages; Stroke; Gait; Rehabilitation; Review

Study / Score in the PEDro scale	Sample	Objective	Intervention	Instruments/tests	Results
Boeskov et al.⁽¹⁴14 Boeskov B, Carver LT, Essen-Leise A, Henriksen M. Kinesthetic taping improves walking function in patients with stroke: a pilot cohort study. Top Stroke Rehabil. 2014;21(6):495-501. doi: 10.1310/tsr2106-495. https://doi.org/10.1310/tsr2106-495... ^)/(²2 Olney SJ, Richards CL. Hemiparetic gait following stroke. Part I: characteristics. Gait Posture. 1996;4(2):136-48. doi: 10.1016/0966-6362(96)01063-6. https://doi.org/10.1016/0966-6362(96)010... ⁾	32 acute stroke patients (9 women and 23 men), with an average age of 60 years old. No control group:	To investigate the KT effect in the anterior thigh and knee region on the maximum gait speed.	During 3 cycles, patients were told to walk 12 meters and measurements were made before and after the use of KT. Elastic KT was used applied to the anterior part of the thigh and knee.	10-Meter Walk Test	Use of KT has significantly improved the gait speed. Similarly, the number of steps taken during the 10MWT decreased significantly.
Carda et al.⁽²⁰20 Carda S, Invernizzi M, Baricich A, Cisari C. Casting, taping or stretching after botulinum toxin type. A for spastic equinus foot: a single-blind randomized trial on adult stroke patients. Clin Rehabil. 2011;25(12):1119-27. doi: 10.1177/0269215511405080. https://doi.org/10.1177/0269215511405080... ^)/(⁷7 Paoloni M, Bernetti A, Fratocchi G, Mangone M, Parrinelo L, Del Pilar Cooper M, et al. Kinesio Taping applied to lumber muscles influences clinical and electromyographic characteristics in chronic low back pain patients. Eur J Phys Rehabil Med. 2011;47(2):237-44.⁾	69 stroke patients (35 women and 34 men), with an average age of 62 years old, divided into 3 groups:	To investigate the effect of different adjuvant treatments after botulinum toxin type a.	After the use of botulinum toxin in the Plantar flexors, the patients were randomly divided into 3 groups, accompanied by gait training for 30 minutes and plantar flexor stretching for 20 minutes 1 time per day for a week. Evaluations were made before the injections, 30 days and 90 days later.	6-minute walk test, 10-meter walk test and Functional Ambulation Categories.	Patients treated with KT for the first week had statistically significantly better and longer-lasting than those treated only with stretching.
	Group 1 - KT
	Group 2 - Serial Splint
	Group 3 - Stretching
Choi et al.⁽²³23 Choi YK, Nam CW, Lee JH, Park YH. The effects of taping prior to PNF treatment on lower extremity proprioception of hemiplegic patients. J Phys Ther Sci. 2013;25(9):1119-22. doi: 10.1589/jpts.25.1119. https://doi.org/10.1589/jpts.25.1119... ^)/(⁵5 Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A follow-up one and four years post stroke. Clin Rehabil. 2003;17(7):731-4. doi: 10.1191/0269215503cr670oa. https://doi.org/10.1191/0269215503cr670o... ⁾	30 patients (15 women and 15 men), with an average age of 54 years old, divided into 2 groups:	To compare the effects of KT on the joint angle of the knee joint and on the functioning of patients with hemiplegia resulting from stroke.	The experimental group received the proprioceptive neuromuscular facilitation 30 minutes during 4 weeks and KT. Elastic KT was applied to the patella for lower slide.	Berg Balance Scale and 10-Meter Walk Test.	The analysis demonstrated statistically significant improvement in balance and speed for the experimental group. There was also significant improvement among the groups on balance and gait speed compared to the control group.
	Control: Neuromusucular Proprioceptive Facilitation
	Experimental: Neuromusucular Proprioceptive facilitation with KT application.
Ekiz et al.⁽²¹21 Ekiz T, Aslan MD, Özgirgin N. Effects of Kinesio Tape application to quadriceps muscles on isokinetic muscle strength, gait, and functional parameters in patients with stroke. J Rehabil Res Dev. 2015;52(3):323-31. doi: 10.1682/JRRD.2014.10.0243. https://doi.org/10.1682/JRRD.2014.10.024... ^)/(⁵5 Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A follow-up one and four years post stroke. Clin Rehabil. 2003;17(7):731-4. doi: 10.1191/0269215503cr670oa. https://doi.org/10.1191/0269215503cr670o... ⁾	24 patients (12 men and 12 women) with an average age of 51 years old, divided into 2 groups:	To evaluate the effects of KT application on isokinetic muscular strength of the quadriceps, gait and functional parameters of stroke patients.	Both groups performed a conventional rehabilitation program 5 times a week for 4 weeks. Elastic KT was used on the vastus medialis, vastus lateralis and bilateral rectus femoris muscle.	6-minute walk test, 10-meter walk test, Berg Balance Scale, Timed Up and Go Test and Rivermead Mobility Index.	Compared to baseline levels, there has been significant improvement in gait, balance and gait speed of the KT group. However, there was no statistically significant difference between the groups.
	Control: without application of KT.
	Experimental: with application of KT.
Hillier et al.⁽²⁶26 Hillier SL, Masters R. Does taping control the foot during walking for people who have had a stroke? Intl J Ther Rehabil. 2005;12(2):72-7. doi: 10.12968/ijtr.2005.12.2.17458. https://doi.org/10.12968/ijtr.2005.12.2.... ^)/(⁶6 Kase K, Wallis J, Kase T. Clinical therapeutic applications of the Kinesio Taping method. Texas: Kinesio USA LLC, 2013.⁾	5 patients (2 women and 3 men), aged between 49 and 78 years old.	To investigate the potential effect of KT on ankle inversion control.	Patients were instructed to walk on a force platform during 6 gait cycles. Measurements were made before and after the use of elastic KT on the ankle during 2 days.	Force platform	There was improvement in the heel contact and ankle inversion control after using the KT.
Hwang et al.⁽²⁷27 Hwang YI, An DH. Immediate effects of an elastic arm sling on walking patterns of chronic stroke patients. J Phys Ther Sci. 2015;27(1):35-7. doi: 10.1589/jpts.27.35. https://doi.org/10.1589/jpts.27.35... ^)/(⁵5 Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A follow-up one and four years post stroke. Clin Rehabil. 2003;17(7):731-4. doi: 10.1191/0269215503cr670oa. https://doi.org/10.1191/0269215503cr670o... ⁾	13 patients (9 men and 4 women) with an average age between 48 and 81 years old, exposed to 2 situations: with and without the KT.	To investigate the immediate effects of elastic sling made of KT on the standards of gait of stroke patients.	Patients were instructed to walk on a treadmill twice in each condition, with a 5-minute break between cycles.	Cadence, 10-Meter Walk Test, step length and stride length.	The condition that used the elastic sling had a statistically significant increase in the step length and speed gait compared to baseline values.
Hyun et al.⁽²⁸28 Hyun KH, Cho HY, Lim CG. The effect of knee joint Mulligan taping on balance and gait in subacute stroke patients. J Phys Ther Sci. 2015;27(11):3545-7. doi: 10.1589/jpts.27.3545. https://doi.org/10.1589/jpts.27.3545... ^)/(⁵5 Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A follow-up one and four years post stroke. Clin Rehabil. 2003;17(7):731-4. doi: 10.1191/0269215503cr670oa. https://doi.org/10.1191/0269215503cr670o... ⁾	30 patients (13 men and 17 women), with an average age of 53 years old, divided into 2 groups:	To determine the effects of KT Mulligan in balance and gait in acute stroke patients.	Measurements were made before and after the intervention with a 30-minute interval. The KT was applied on the knee joint of the experimental group and placebo KT in the knee joint of the control group.	Cadence, 10-Meter Walk Test, step length and stride length.	The balance in the dynamic position of the experimental group significantly improved after the KT application. The gait cadence, speed and length of the step also improved significantly. However, no significant differences were observed in the standing balance or gait balance for the control group compared to the group that used KT.
	Control: application of placebo KT.
	Experimental: with application of KT.
Karadag-Saygi et al.⁽²⁹29 Karadag-Saygi E, Cubukcu-Aydoseli K, Kablan N, Ofluoglu D. The role of kinesiotaping combined with botulinum toxin to reduce plantar flexors spasticity after stroke. Top Stroke Rehabil. 201017(4):318-22. doi: 10.1310/tsr1704-318. https://doi.org/10.1310/tsr1704-318... ^)/(⁷7 Paoloni M, Bernetti A, Fratocchi G, Mangone M, Parrinelo L, Del Pilar Cooper M, et al. Kinesio Taping applied to lumber muscles influences clinical and electromyographic characteristics in chronic low back pain patients. Eur J Phys Rehabil Med. 2011;47(2):237-44.⁾	20 stroke patients (12 women and 8 men), with an average age of 60 years old, divided into 2 groups:	To evaluate the effect of KT as an adjuvant therapy to botulinum toxin on spasticity.	The KT was applied by a physical therapist after application of botulinum toxin. Home exercises were made twice a day for 20 minutes, for 4 weeks. The clinical evaluation was made before and after 2 weeks and 1, 3 and 6 months. KT was used applied on elastic ankle, tibialis anterior and gastrocnemius.	Step length and 10-meter walk test.	The KT group showed increase in the step length in the first month and increased gait speed after the first and the third month. However, there was no significant difference between the groups.
	Group A - botulinum toxin and KT Group B - botulinum toxin and placebo KT			Step length and 10-meter walk test.
Kilbreath et al.⁽³⁰30 Kilbreath SL, Perkins S, Crosbie J, McConnell J. Gluteal taping improves hip extension during stance phase of walking following stroke. Aust J Physiother. 2006;52(1):53-6. doi: 10.1016/S0004-9514(06)70062-9. https://doi.org/10.1016/S0004-9514(06)70... ^)/(⁴4 Chiou IL, Burnett CN. Values of activities of daily living: a survey of stroke patients and their home therapists. Phys Ther. 1985;65(6):901-6. doi: 10.1093/ptj/65.6.901. https://doi.org/10.1093/ptj/65.6.901... ⁾	15 acute stroke patients (10 men and 5 women) with an average age of 62 years old, exposed to 3 situations: without KT, with KT in the gluteus, and placebo KT.	To determine whether the KT in the glutei causes improvement of hip extension of the affected side during the phase of support for stroke people.	For each of the 3 conditions (without KT, elastic KT application on the gluteus, and application of placebo KT) subjects walked for 10 meters in a self-selected speed and as fast as possible, for 5 cycles, eliminating 2 cycles to avoid learning effect.	2D motion analysis, step length and 10-meter walk test.	KT in the gluteus caused a statistically significant improvement in hip extension with an increase in the step length in the affected side immediately after its application. In contrast, the placebo KT did not improve.
Kim et. al.⁽²²22 Kim WI, Choi YK, Lee JH, Park YH. The effect of muscle facilitation using Kinesio Taping on walking and balance of stroke patients. J Phys Ther Sci. 2014;26(11):1831-4. doi: 10.1589/jpts.26.1831. https://doi.org/10.1589/jpts.26.1831... ^)/(⁵5 Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A follow-up one and four years post stroke. Clin Rehabil. 2003;17(7):731-4. doi: 10.1191/0269215503cr670oa. https://doi.org/10.1191/0269215503cr670o... ⁾	30 stroke patients divided into 2 groups:	To evaluate changes in function and balance after application of KT in stroke patients.	KT was applied on the affected side in the quadriceps, tibialis anterior, biceps brachii and cuff rotators muscles. KT was used for 6 weeks and the gait evaluation and balance was made before and after.	Straight Line Walking Test, Berg Balance Scale and 10-Meter Walk Test.	There was no statistically significant difference in the straight line walking test and 10-meter test for the experimental group. There was also a statistically significant difference in the Berg Balance Scale and 10-meter walk test between the 2 groups. The experimental group showed a significant improvement in the Straight Line Walking Test and the 10-meter walk test compared to the control group.
	Control: without application of KT.
	Experimental: with application of KT.
Maguire et al.⁽²⁵25 Maguire C, Sieben JM, Frank M, Romkes J. Hip abductor control in walking following stroke - the immediate effect of canes, taping and TheraTogs on gait. Clin Rehabil. 2010;24(1):37-45. doi: 10.1177/0269215509342335. https://doi.org/10.1177/0269215509342335... ^)/(³3 Skilbeck CE, Wade DT, Hewer RL, Wood VA. Recovery after stroke. J Neurol Neurosurg Psychiatry. 1983;46(1):5-8. doi: 10.1136/jnnp.46.1.5. https://doi.org/10.1136/jnnp.46.1.5... ⁾	13 stroke patients (5 women and 25 men) with an average age of 64 years old, exposed to 4 situations: walking with nothing, with KT on hip abductors, using a cane and with the use of TheraTogs.	To investigate the effects of each condition in temporospatial parameters of gait.	During 6 gait cycles, the subjects walked with self-selected speed over a line. The electrodes were placed on the gluteus medius and the tensor fasciae latae.	Electromyography, 10-meter walk test and step length.	The combined use of KT in hip abductors and TheraTogs increased in a statistically significant way the muscle activity of the hemiplegic hip abductors and speed gait compared to baseline values.
Nam et al.⁽¹⁹19 Nam CW, Lee JH, Cho SH. The effect of non-elastic taping on balance and gait function in patients with stroke. J Phys Ther Sci. 2015;27(9):2857-60. doi: 10.1589/jpts.27.2857. https://doi.org/10.1589/jpts.27.2857... ^)/(⁵5 Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A follow-up one and four years post stroke. Clin Rehabil. 2003;17(7):731-4. doi: 10.1191/0269215503cr670oa. https://doi.org/10.1191/0269215503cr670o... ⁾	30 stroke patients (16 women and 14 men), with an average age of 64 years old, divided into 2 groups:	To investigate the influence of exercise on the ability of balance and gait function in stroke patients after application of KT.	Exercises 3 times a week for 6 weeks with elastic KT, applied to the ends of the affected lower side. In the experimental group, KT was applied before the therapeutic exercises. In the control group, only the therapeutic exercises were performed.	Berg Balance Scale, Timed Up and Go Test and motion analysis system.	The intervention significantly improved Berg Balance scale scores and the Timed Up and Go test, as well as the duration of support phase during the gait in the experimental group compared to the control group.
	Control: without application of KT.
	Experimental: with application of KT.
Pratim⁽²⁴24 Pratim DB. A study of effects of gluteal taping on TD-parameters following chronic stroke patients. In J Phys Occup Ther. 2011;5(1):36-9.^)/(¹1 World Health Organization. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders. Stroke. 1989;20(10):1407-31. doi: 10.1161/01.STR.20.10.1407. https://doi.org/10.1161/01.STR.20.10.140... ⁾	30 chronic stroke patients (19 men and 11 women), aged between 40 to 60 years old, divided into 2 groups:	To evaluate the use of KT in the glutei of chronic stroke patients.	The control group performed a conventional program of treatment as strengthening, stretching, ground exercises and passive motion. The experimental group received the conventional treatment program associated with the use of KT on the affected gluteal side. All patients attended the sessions of physical therapy every day for 3 months. During the treatment, no medicine was used.	10-Meter Walk Test, step length, stride length, step width and cadence.	No significant difference was found between the groups. However, the intervention in the control group gained better results. There was significant improvement in the gait time and distance in both groups.
	Control: Conventional physical therapy
	Experimental: Conventional physical therapy with application of KT.
Reiter et al.⁽³¹31 Reiter F, Danni M, Lagalla G, Ceravolo G, Provinciali L. Low-dose botulinum toxin with ankle taping for the treatment of spastic equinovarus foot after stroke. Arch Phys Med Rehabil. 1998;79(5):532-5. doi: 10.1016/S0003-9993(98)90068-5. https://doi.org/10.1016/S0003-9993(98)90... ^)/(⁵5 Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A follow-up one and four years post stroke. Clin Rehabil. 2003;17(7):731-4. doi: 10.1191/0269215503cr670oa. https://doi.org/10.1191/0269215503cr670o... ⁾	18 stroke patients (7 women and 11 men) with age range from 28 to 70 years old, divided into 2 groups:	To evaluate the effectiveness of combined treatment for spastic foot using selective injections of botulinum toxin.	Group A - 190 to 320U injection of botulinum toxin in several calf muscles. Group B - 100U injection of botulinum toxin in the posterior tibial muscle, followed by elastic KT applied on the ankle and thigh.	10-Meter Walk Test and step length	The combination of small doses of botulinum toxin with KT use led to a reduction of heel inversion improving in a statistically significant manner the gait parameters.
	Group A - Botulinum toxin
	Group B - Botulinum toxin and KT.
Rojhani-Shirazi et al.⁽¹⁵15 Rojhani-Shirazi Z, Amirian S, Meftahi N. Effects of ankle kinesio taping on postural control in stroke patients. J Stroke Cerebrovasc Dis. 2015;24(11):2565-71. doi: 10.1016/j.jstrokecerebrovasdis.2015.07.008. https://doi.org/10.1016/j.jstrokecerebro... ^)/(⁶6 Kase K, Wallis J, Kase T. Clinical therapeutic applications of the Kinesio Taping method. Texas: Kinesio USA LLC, 2013.⁾	40 patients (26 men and 14 women), with an average age of 49 years old, divided into 2 groups:	To investigate the effect of KT on postural control in stroke patients.	All variableswere measured on the first day immediately after using the KT and 24 hours later in the experimental group, and on the first day and 24 hours later in the control group.	Berg Balance Scale, Timed Up and Go Test and force platform.	There was a statistically significant increase in the balance between the first day and 24 hours later in the KT group compared to the control group. The medial-lateral displacement of COP differed significantly after using KT in the experimental group compared to the control group.
	Control: without application of KT.
	Experimental: with application of KT.

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[1] Corresponding address: Kênia Kiefer Parreiras de Menezes - Avenida Presidente Antônio Carlos, 6627, Department of Physical Therapy of Universidade Federal de Minas Gerais, Campus Pampulha - Belo Horizonte (MG), Brazil - Zip Code: 31270-901 - Email: keniakiefer@yahoo.com.br