International Journal of Surgery 59 (2018) 27–35

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International Journal of Surgery

journal homepage: www.elsevier.com/locate/ijsu

Review

Kinesio taping improves pain and function in patients with knee T

osteoarthritis: A meta-analysis of randomized controlled trials
Zhijun Lu, Xiaoming Li∗, Rongchun Chen, Chaoyang Guo
Department of Spinal Surgery, Ganzhou People's Hospital, Jiang Xi, China

ARTICLE INFO ABSTRACT

Keywords: Objective: To perform a meta-analysis from randomized controlled trials (RCTs) to evaluate the efficacy of
Kinesio taping Kinesio Taping in reducing pain and increasing knee function in patients with knee osteoarthritis (OA).
VAS Methods: The electronic databases include PubMed, Embase, web of science and the Cochrane Library up to
WOMAC August 2018. Studies searched were considered eligible if they met the criteria as follows: Population: patients
Knee osteoarthritis
with knee OA; Intervention: intervention groups received Kinesio Taping for the treatment of knee OA;
Meta-analysis
Comparisons: Control group received sham taping; 3) Outcomes: visual analog scale (VAS), McMaster
Universities Arthritis Index (WOMAC) scale, range of motion and muscle strength; Study design: RCTs. The
Cochrane Collaboration's tool was used to assess risk of bias. We assessed statistical heterogeneity for each RCT
with the use of a standard Chi2 test and the I2 statistic. STATA statistical software 15.0 was used for meta-
analysis.
Results: Five RCTs involving 308 patients were included. The present meta-analysis demonstrated that there
were significant differences between Kinesio Taping groups and control groups in terms of visual analog scale
(VAS), WOMAC scale and flexion range of motion. No significant difference was found regarding quadriceps
femoris muscle between groups.
Conclusion: Kinesio Taping is effective in improving for pain and joint function in patients with knee OA. Due to
the limited quality of the evidence currently available, the results of our meta-analysis should be treated with
caution.

1. Introduction an elastic woven-cotton strip with heat-sensitive acrylic adhesive which

Knee osteoarthritis (OA) is the most prevalent chronic joint disease.
Cartilage is the central tissue affected by OA and causes subsequent
symptoms, including joint pain, stiffness and joint swelling, which di-
minishes the range of motion [1,2]. It is one of the major causes of
deformity, resulting in huge medical expense and poor quality of life. It
affects nearly 34% of those ages 65 and older [3]. The number of pa-
tients with knee OA has increased in tandem with population aging and
it remains a huge healthcare challenge. Currently, no reliable treatment
has been confirmed to prevent progression of knee OA. The aim of
treatment was to relieve pain and increase functional outcomes.
Numerous conservative methods for pain management, including
modification of daily activities and peri-articular infiltration analgesia
have been tested [4,5], and the optimal method is currently still under
debate. Among the different strategies used in physiotherapy, the ap-
plication of taping has showed improved outcomes to treat knee OA
[6,7]. Kinesio Taping was first introduced in 1979 in Japan (Fig. 1). It is
can increase muscle flexibility and strength [8,9]. It is widely used in
musculoskeletal disorder, such as shoulder impingement and sport in-
juries and it has become one of the rehabilitation modalities [10,11]. In
2011, guidelines from the American College of Rheumatology has re-
commended taping in patients with knee OA.
Although previous studies have demonstrated Kinesio Taping was
effective in knee disease, there was still a lack of reliable evidence and
the effect of Kinesio Taping in knee OA was still controversial.
Therefore, we performed a meta-analysis of randomized controlled
trials (RCTs) to evaluate the efficacy of Kinesio Taping in reducing pain
and increasing knee function in patients with knee OA.
2. Methods
This study was reported according with the guideline of PRISMA
statement and AMSTAR (Assessing the methodological quality of sys-
tematic reviews) Guidelines. Ethical approval or patient consent was

∗
Corresponding author.
E-mail address: lixiaoming3353@126.com (X. Li).

https://doi.org/10.1016/j.ijsu.2018.09.015
Received 2 August 2018; Received in revised form 5 September 2018; Accepted 21 September 2018
Available online 28 September 2018
1743-9191/ © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Z. Lu et al. International Journal of Surgery 59 (2018) 27–35

not required since the present study was a review of previous published
literature.

2.1. Search strategy

Two reviewers performed an electronic literature search for RCTs

assessing the outcome of treatment of knee OA with Kinesio Taping.
The electronic databases include PubMed, Embase, web of science and
the Cochrane Library up to August 2018. No language or date restric-
tions was applied. The following terms were used as key words:
“Kinesio Taping”, “knee osteoarthritis” and “randomized controlled
trial”. In addition, further articles that may have been missed in the
electronic databases were manually searched from selected articles. The
detail retrieval process is shown in Fig. 2.

2.2. Inclusion criteria

Studies searched were considered eligible if they met the PICOS

Fig. 1. The Kinesio taping method a -Y shaped quadriceps technique.
criteria as follows: Population: patients with knee OA; Intervention:
intervention groups received Kinesio Taping for the treatment of knee
OA; Comparisons: Control group received sham taping; 3) Outcomes:
visual analog scale (VAS), McMaster Universities Arthritis Index
(WOMAC) scale, range of motion and muscle strength; Study design:
RCTs were considered as potential included studies. Studies excluded
from the present meta-analysis were comprised of incomplete data, case
reports, conference abstracts, or review articles.

Fig. 2. PRISMA flow diagram for search strategy and study selection.

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 Z. Lu et al.

Table 1
Characteristics of the included studies.
Author Year Design Number of Mean age Female patient BMI Intervention Outcomes Follow up (M)
participants

(KT/Control) (KT/Control) (KT/Control) (KT/Control)

Cho 2016 RCT 23/23 58/58 17/16 25/22 Intervention:an I-shaped KT starting at the origin of the rectus femoris and a Y-shaped KT proximal to VAS scale 2
the superior patellar boarder WOMAC scale
Control:sham tape Range of motion
Wageck 2017 RCT 38/38 70/69 35/31 30/31 Intervention:three KT elements applied simultaneously VAS scale 6
Control:sham tape WOMAC scale
Range of motion
Muscle strength

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Mutlu 2017 RCT 20/19 54/57 16/17 31/31 Intervention:KT on their quadriceps femoris and hamstring muscle 10-m Walk Test 1
Control:sham tape VAS scale
WOMAC scale
Range of motion
Muscle strength
10-m Walk Test
Aydogdu 2017 RCT 28/26 53/51 24/22 31/32 Intervention:KT on quadriceps and hamstring muscles was performed with Y-shaped technique VAS scale 1.5
Control:sham tape WOMAC scale
Range of motion
Muscle strength
Rahlf 2018 RCT 47/47 65/65 24/26 29/28 Intervention:KT on their quadriceps femoris and hamstring muscle VAS scale 2
Control:sham tape WOMAC scale
10-m Walk Test

KT: kinesio taping, RCT: randomized controlled trial.

International Journal of Surgery 59 (2018) 27–35
Z. Lu et al. International Journal of Surgery 59 (2018) 27–35

Table 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Study Random Sequence Allocation Blinding of participates and Blinding of outcome Incomplete Outcome Selective Other bias
Generation Concealment personal assessment Data Reporting

Cho low risk low risk high risk unclear risk low risk low risk low risk
Wageck low risk low risk unclear risk low risk low risk low risk low risk
Mutlu low risk low risk unclear risk low risk low risk low risk low risk
Aydogdu low risk low risk high risk low risk low risk low risk low risk
Rahlf low risk low risk unclear risk high risk low risk low risk low risk

Table 3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Fig. 3. Forest plot of comparison: VAS score at rest.

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Z. Lu et al.
Fig. 4. Forest plot of comparison: VAS score during walk.
2.3. Data extraction
Two reviewers retrieved the relevant data from articles using a
standard data extraction form independently. The extracted data in-
cluded publication date, authors, study design, inclusion and exclusion
criteria, number and demographics of participants, intervention of each
group, duration of follow-up, and outcomes. For missing data, such as
standard deviations, we tried to get it by contacting with the original
author first. Two reviewers extracted the data independently, and any
disagreement was discussed until a consensus was reached.
2.4. Risk of bias and quality assessment
The methodological bias and quality of included RCTs were assessed
by The Cochrane Collaboration's tool for assessing risk of bias according
to the Cochrane Handbook for Systematic Reviews of Interventions. It is
a two-part tool with seven specific domains: sequence generation, al-
location concealment, blinding of participants and personnel, blinding
of outcome assessment, incomplete outcome data, selective outcome
reporting and other sources of bias. Disagreements were by consensus
after discussion, and if necessary, the third reviewer was consulted.
2.5. Statistical analysis
STATA statistical software 15.0 was used for meta-analysis. The
continuous variables would be conducted by weighted mean difference
(WMD) and 95% confidence interval (CI). For the dichotomous out-
come, we calculated the odds ratios (ORs) and 95% CIs. The chi-
squared statistic and the I2 statistic were used for the test of hetero-
geneity. A P < 0.05, I2 > 50% was considered a significant
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International Journal of Surgery 59 (2018) 27–35
heterogeneity, and a random-effect model was applied. Otherwise, a
fixed-effect model was used if there was no significant heterogeneity
(P ≥ 0.05, I2 ≤ 50%). Publication bias was showed by the funnel plot.
3. Result
3.1. Study selection
The flow path of how to search, exclude, and include papers in this
meta-analysis were displayed in Fig. 2. In the primary search, a total of
214 studies (PubMed: 66, EMBASE: 57, Cochrane Library: 36 and Web
of Science: 55) were identified. Full texts of reference list were also
manually searched from selected articles. Finally, five full-text RCTs
[12–16] associated with Kinesio Taping and control in patients with
knee OA were finally included in the meta-analysis. No more studies
were retrieved through review articles and references of included stu-
dies.
3.2. Study and patient characteristics
Detailed characteristics of five eligible studies are represented in
Table 1. The meta-analysis involved 156 participants who received
Kinesio Taping and 152 who received a control intervention. The pa-
pers had similar distributions of sex, age, BMI, intervention and all of
them were published between 2016 and 2018. The sample size ranged
from 39 to 94, and the mean age of patients ranged from 51 to 70 years.
The follow up duration ranged from 1 to 6 weeks.
Z. Lu et al.
Fig. 5. Forest plot of comparison: WOMAC scale.
3.3. Quality assessment
Seven aspects of the RCTs related to the risk of bias were assessed,
following the instructions in the Cochrane Handbook for Systematic
Reviews of Interventions [17] (Tables 2 and 3). All studies were ran-
domized and mentioned that the lists of random numbers were gener-
ated through computers. All RCTs used sealed envelopes for allocation
concealment. None article reported double blinding to the surgeons and
participants and three RCTs [13–15] reported blinding to assessors.
Low risk of bias due to incomplete outcome data and selective outcome
reporting was detected.
3.4. Outcome of meta-analysis
3.4.1. VAS at rest
Five [12–16] studies reported VAS at rest. No significant hetero-
geneity was found in the pooled outcomes, so a fixed-effect model was
utilized in our study (χ2 = 2.57, df = 4, I2 = 0%, P = 0.631). As
shown in Fig. 3, the pooled results showed significant difference be-
tween the two groups (WMD = −0.394; 95% CI = −0.759 to −0.029;
P = 0.034).
3.4.2. VAS during walking
All included [12–16] studies showed VAS during walking. A low
heterogeneity among studies was found (χ2 = 5.11, df = 4,
I2 = 21.8%, P = 0.276), so we used a fixed-effect model. The overall
estimate indicated that the difference was statistically significant, and
VAS during walking was higher in control group (WMD = −0.429,
95% CI: −0.752 to −0.105, P = 0.009; Fig. 4).
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International Journal of Surgery 59 (2018) 27–35
3.4.3. WOMAC scale
All RCTs [12–16] provided data on WOMAC scale. There was no
significant heterogeneity (χ2 = 4.89, df = 4, I2 = 18.2%, P = 0.299);
therefore, a fixed-effect model was used. The overall pooled results
indicated that Kinesio Taping was associated with an improved
WOMAC scale compared with control groups (WMD = −5.026, 95%
CI: −7.649 to −2.403, P < 0.001; Fig. 5).
3.4.4. Flexion range of motion
Four studies [12–15] reported flexion range of motion. Hetero-
geneity existed between the included studies (χ2 = 10.46, df = 3,
I2 = 71.3%, P = 0.015). Thus, a random-effect model was performed.
The present meta-analysis revealed that the application of Kinesio
Taping could significantly improve knee flexion range of motion
(WMD = 6.193, 95% CI: 2.678 to 9.709, P = 0.001; Fig. 6).
3.4.5. Muscle strength
Quadriceps femoris muscle strength was reported in three RCTs
[13–15]. There was no significant heterogeneity, and a fixed-effect
model was adopted (χ2 = 1.07, df = 2, I2 = 0%, P = 0.584). The pre-
sent meta-analysis indicated that there was no significant difference in
quadriceps femoris muscle in patients with knee OA (WMD = 3.205,
95% CI: −3.141 to 9.550, P = 0.322; Fig. 7).
3.4.6. Evidence level
The overall evidence is low, which indicates that further research is
likely to significantly alter confidence in the effect estimate and to
change the estimate (Table 4). This finding may lower the confidence in
any recommendations.
Z. Lu et al.
Fig. 6. Forest plot of comparison: flexion range of motion.
4. Discussion
Up to now, the systematic review and meta-analysis of comparative
studies about Kinesio Taping in patients with knee OA have not yet
been performed. Thus, we performed this meta-analysis from recent
published RCTs and found that Kinesio Taping was associated with a
significantly improved in VAS, WOMAC scale and knee range of mo-
tion. No significant difference was found between groups in quadriceps
femoris muscle strength.
Osteoarthritis is the most common form of arthritis. It is a slowly
progressive, which may cause pain, stiffness and disability, decreasing
quality of life. With the aging population, the incidence of OA has in-
creased year by year. It is reported that nearly 35% of those ages 65 and
older suffered OA and it has been a severe social problem all around the
world [18]. Recent study indicated that OA also affected young people.
The weight-bearing joints are most frequently affected, such as knees
and hips. Nonpharmacological includes exercise, weight control and
physical therapy. Degeneration of arthrodial cartilage and chronic in-
flammation of the synovium may lead to pain. The goal of treatment is
to improve joint function, prevent progression and reduce pain. Kinesio
Taping was developed by Kase et al. and it is an elastic cotton strip with
an acrylic adhesive that is used with the intent of treating pain and
disability from athletic injuries and a variety of other physical dis-
orders. Huang et al. [19] reported that Kinesio Taping could improve
pain during functional activities as well as the performance. Ana-
ndkumar et al. [20] investigated the effects of Kinesio Taping on people
with knee OA. They compared an intervention group who received
Kinesio Taping to a placebo group received sham Taping. VAS scale was
adopted to measure pain and it was considered a subjective method.
They showed that there was a decreased pain in Kinesio Taping groups
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International Journal of Surgery 59 (2018) 27–35
while climbing stairs. The present meta-analysis indicated that Kinesio
Taping was associated with a significantly reduction in VAS scale at
rest, as well as at movement in patients with knee OA. This pain re-
duction can be attributed to neurological suppression, due to stimula-
tion of cutaneous mechanoreceptors. However, the VAS scale among
included studies were recorded at different time points, so this may
cause significant heterogeneity, which should be taken into considera-
tion when analyzing the results.
Articular cartilage can be damaged by normal wear and abnormal
mechanical loading which may cause abnormal cellular activities in
cartilage and synovium, resulting in stiffness, loss of range of motion
[21]. Joint function is an important parameter to evaluate the effec-
tiveness of treatment in knee OA, and the WOMAC is one of the most
commonly used functional and disability scores. Kinesio Taping can be
a cheap and convenient option that aims to reduce symptoms and im-
prove function. Intra-articular aseprtic inflammation can be reduce by
the use of Kinesio Taping. Our study demonstrated that Kinesio Taping
was associated with an improved WOMAC compared with sham
Taping. Lysholm knee scoring scale is also a well validated functional
score designed for knee disorders. However, only Wageck et al. [13]
showed the outcome of Lysholm scale, thus we failed to perform a meta-
analysis, and further study was required.
Quadriceps femoris muscle weakness is a common symptoms in
knee OA and this may affect joint function and accelerate progress of
degeneration [22,23]. It is well recognized that it was crucial to en-
hance the quadriceps femoris muscle strength in knee OA. Kinesio
Taping has become an effective rehabilitation modality used in mus-
culoskeletal system [24]. Currently, there remains controversial on
improving quadriceps strength in knee OA, although lots of articles has
been published. Aydogdu et al. [15] concluded that Kinesio Taping was
Z. Lu et al. International Journal of Surgery 59 (2018) 27–35

Fig. 7. Forest plot of comparison: quadriceps femoris muscle strength.

Table 4
Evidence level.
Quality assessment Sample size Outcome measures Quality Importance

Number of Limitations Inconsistency Indirectness Imprecision KT Control

RCT

VAS at rest
4 serious serious no serious no serious 156 152 WMD = −0.394; 95% Low critical
limitations inconsistency indirectness imprecision CI = −0.759 to −0.029
VAS during walking
4 serious serious no serious no serious 156 152 WMD = −0.429, 95% CI: −0.752 Low critical
limitations inconsistency indirectness imprecision to −0.105
WOMAC scale
4 serious serious no serious no serious 156 152 WMD = −5.026, 95% CI: −7.649 Low critical
limitations inconsistency indirectness imprecision to −2.403
Flexion range of motion
4 serious serious no serious no serious 109 105 WMD = 6.193, 95% CI: 2.678 to Low critical
limitations inconsistency indirectness imprecision 9.709
Muscle strength
3 serious serious no serious no serious 86 83 WMD = 3.205, 95% CI: −3.141 to Low critical
limitations inconsistency indirectness imprecision 9.550

associated with a statistically significant improvements in quadriceps
muscle strength in knee OA. However, Lemosa et al. [25] reported that
the use of Kinesio Taping did not change muscle strength. Therefore, we
performed the present meta-analysis and showed that there was no
significant difference in quadriceps femoris muscle in patients with
knee OA. Published articles have hypothesized that placebo effect could
be a major attributing factor. Although efforts has been made in as-
sessing the contribution of placebo to the effect of Kinesio Taping,
evidence investigating the quantity of placebo effects is still very lim-
ited. This should be considered when analyzing the results.
The limitations of this study were as follows: (1) our study included
five RCTs with a sample size ranging from 39 to 94, so the outcome
should be treated cautiously; (2) the analysis of some outcome mea-
sures, such as flexion range of motion was based on a relatively small
sample size with high heterogeneity, so firm conclusion cannot be de-
rived; (3) the comparison of Kinesio Taping and traditional drug was
still unclear, further study was necessary; (4) short-term follow-up
caused the underestimation of complications; (5) Although there was
no obvious publication bias among studies, it was still unavoidable.

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