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Effects of Kinesio Taping On Breast Cancer-Related Lymphedema: A Meta-Analysis in Clinical Trials
Effects of Kinesio Taping On Breast Cancer-Related Lymphedema: A Meta-Analysis in Clinical Trials
Effects of Kinesio Taping On Breast Cancer-Related Lymphedema: A Meta-Analysis in Clinical Trials
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All content following this page was uploaded by Karina Tamy Kasawara on 08 January 2018.
To cite this article: Karina Tamy Kasawara, Jéssica Monique Rossetti Mapa, Vilma Ferreira,
Marco Aurélio Nemitalla Added, Silvia Regina Shiwa, Nelson Carvas Jr & Patricia Andrade Batista
(2018): Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis in clinical
trials, Physiotherapy Theory and Practice
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PHYSIOTHERAPY THEORY AND PRACTICE
https://doi.org/10.1080/09593985.2017.1419522
REVIEW
Background: Lymphedema is known as a secondary complication of breast cancer treatment, Received 16 August 2016
caused by reduction on lymphatic flow and lymph accumulation on interstitial space. The Kinesio Accepted 23 February 2017
Taping (KT) has become an alternative treatment for lymphedema volume reduction. The objec- Revised 27 January 2017
tive of the study was to evaluate the literature through a systematic review on KT effects on KEYWORDS
lymphedema related to breast cancer. Kinesio Taping; Neoplasm;
Methods: Search strategies were performed by the following keywords: “Kinesio Taping,” “Athletic Lymphedema; Mastectomy
Tape,” “Cancer,” “Neoplasm,” “Lymphedema,” and “Mastectomy” with derivations and different
combinations. The following databases were accessed: SCIELO, LILACS, MEDLINE via PubMed, and
PEDro, between 2009 and 2016. Studies published in English, Portuguese, and Spanish were
considered for inclusion. The studies’ methodological quality was assessed by the PEDro scale.
Results: Seven studies were identified by the search strategy and eligibility. All of them showed
positive effect in reducing lymphedema (perimeter or volume) before versus after treatment.
However, with no effects comparing the KT versus control group or others treatments (standar-
dized mean difference = 0.04, confidence interval 95%: −0.24; 0.33), the average score of the
PEDro scale was 4.71 points.
Conclusions: KT was effective on postmastectomy lymphedema related to breast cancer; how-
ever, it is not more efficient than other treatments.
CONTACT Karina Tamy Kasawara, PT, PhD karina.tamy@gmail.com Department of Obstetrics and Gynecology, University of Campinas, Campinas,
Brazil.
© 2018 Taylor & Francis
2 K. T. KASAWARA ET AL.
mechanical stimuli; its active elastic acts upon the lym- In the first stage of the study selection, two authors
phatic system and reduces the congestion of lymphatic independently performed the search in the databases
flow in the area where it is applied, which decreases the (KTK and JMRM) and reviewed the titles and summa-
circumference of the affected limb (Pinheiro, Godoy, ries of articles identified by the search strategies. The
and Sunemi, 2015). Therefore, the objective of this complete article was assessed for abstracts that did not
study was to systematically review the literature and provide sufficient information about the proposed
evaluate the effects of KT on breast cancer-related theme. During the second phase, the same reviewers
lymphedema. independently assessed the full articles and made their
selections according to the eligibility criteria.
Methods The same reviewers worked independently and per-
formed a duplicate extraction of the data regarding the
This was a systematic review with a meta-analysis characteristics of the methodological studies, interven-
regarding the effect of KT on lymphedema secondary tions, and outcomes using standard forms; disagree-
to mastectomy related to breast cancer. This systematic ments were resolved by a third reviewer (VF). The
review was registered at PROSPERO (http://www.crd. outcome of using KT to reduce postmastectomy lym-
york.ac.uk/prospero/): (CRD42015027023). All the phedema resulting from breast cancer was analyzed.
PRISMA standards (www.equator-network.org)
(Padula et al., 2012) and recommendations for systema-
tic review development were followed. Quality assessment methodology
The included studies considered both randomized con-
Eligibility criteria trolled trials and non-randomized trials. These publica-
Clinical studies of women diagnosed with lymphedema
following a mastectomy for breast cancer who also under- Table 1. Search strategies combination for screening studies
went KT therapy were considered for inclusion. Exclusion published on scientific database.
#1 “Mastectomy” OR “Lymphedema” OR “Neoplasm” OR “Early
criteria were disregarded case reports and case series, Detection of Cancer” AND “Kinesio Taping”
duplicate studies that were indexed in more than one of #2 “Lymphedema” AND “Kinesio”
#3 “Lymphedema” AND “Athletictape”
the health science databases, and studies that used KT for #4 ”Lymphedema” AND “Athletic” AND “Tape”
congenital or primary lymphedema related to types of #5 “Mastectomy” AND “Kinesiotaping”
#6 “Mastectomy” AND “Kinesio”
cancer other than breast cancer or lymphedema in the #7 “Mastectomy” AND “Kinesio” AND “Taping”
lower limbs. Therefore, studies that were not related to the #8 “Mastectomy” AND “Athletictape”
#9 “Mastectomy” AND “Athletic” AND “Tape”
proposed theme and did not present a comparison group #10 “Neoplasm” AND “Kinesiotaping”
(i.e., control group or other treatment) were excluded. #11 “Neoplasm” AND “Kinesio”
#12 “Neoplasm” AND “Kinesio” AND “Taping”
#13 “Neoplasm” AND “Athletictape”
#14 “Neoplasm” AND “Athletic” AND “Tape”
Search strategy #15 “Cancer” AND “Kinesiotaping”
#16 “Cancer” AND “Kinesio”
To fulfill the purpose of this study, a search of scientific #17 “Cancer” AND “Athletictape”
#18 “Cancer” AND “Athletic” AND “Tape”
articles in the following electronic databases was
PHYSIOTHERAPY THEORY AND PRACTICE 3
tions were evaluated methodologically following the analysis of random effects was carried out and calculated
criteria of the PEDro Scale (Shiwa et al., 2011). using the R statistical analysis software (version 3.3.2).
The PEDro Scale is composed of 11 criteria based on
the Delphi Scale except 2 criteria (8 and 10). The
methodological quality was assessed as follows: (1) the
Results
source of the subjects and requirements for the study
were specified; (2) the choice of study subjects was Study description
random; (3) the person who determined the random-
Sixteen studies were located using the search strategy.
ness of a subject was unaware of the group to which he
Of these, only seven studies (Malicka, Rosseger,
would belong; (4) at the beginning, the study groups
Hanuszkiewicz, and Woźniewski, 2014; Melgaard,
should have had similar prognoses; (5) the subjects
2016; Pekyavas et al., 2014; Pop et al., 2014; Smykla
participated in a “blind” form; (6) the therapists applied
et al., 2013; Taradaj et al., 2016, 2014; Tsai et al., 2009)
the study of the “blind” form; (7) the evaluators mea-
met all the established inclusion criteria and were ana-
sured the key result of the “blind’ form; (8) the key
lyzed in this systematic review (Figure 1).
result was assigned to 85% of the subjects after they
The total number of women included for analysis in
Downloaded by [University of Toronto Libraries] at 08:22 08 January 2018
Studies duplicate
Total of studies included by search
removed (n = 6)
strategy (n=21)
Studies excluded by
Studies selected
title and abstract
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(n =15)
(n = 8)
(n = 7)
Figure 1. Flowchart of the study selection process for inclusion in this systematic review with meta-analysis.
limb circumference in four levels out of seven with KT therapy techniques to reduce lymphedema following
treatment. mastectomy for breast cancer.
Considering patients comfort and experience with
KT, only three studies (Melgaard, 2016; Pekyavas
et al., 2014; Tsai et al., 2009) have evaluated their Meta-analysis
quality of life and satisfaction with KT as a treatment Pop et al. (2014) study did not provide sufficient data to
for lymphedema following a mastectomy. perform a meta-analysis, authors were contacted by
e-mail; however, we did not receive data information in
order to proceed with the statistical analysis. Thus, six
Methodology quality description studies (Malicka, Rosseger, Hanuszkiewicz, and
Woźniewski, 2014; Melgaard, 2016; Pekyavas et al.,
The average score of the seven clinical trials evalu- 2014; Smykla et al., 2013; Taradaj et al., 2016; Tsai et al.,
ated was 4.71 (SD 1.8) in a total of 10 possible 2009) were considered for the meta-analysis (Figure 2).
points (Table 3). Melgaard (2016) had the highest Figure 2A is a comparison of the treatment group
score (7 points), even though it was a pilot study and the control group. In the Smykla et al. (2013),
with a small sample size (n = 10). Moreover, this study analysis was performed considering the KT
study (Melgaard, 2016) showed a favorable treat- group as the treatment group and the quasi-KT group
ment that used KT along with other physical as a control group. Likewise, in the study, Pekyavas
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Table 2. (Continued).
Study (year) Study design Population description Measurements Treatment protocol Outcome
Pop et al. (2014) Clinical 44 Participants with lymphedema Perimetry evaluated in sitting position by
Treatment was performed 3 times/The mean reduction on lymphedema was
study, non- postmastectomy, stages 1 and 2. Divided in measurement apparatus developed by the week during 21 days 55% on SG and 27% on CG (p < 0.001)
randomized two groups: SG (n = 22): KT and exercise. CG authors. The upper limb was bent at 90° SG: 20 min of upper limb elevation
The elevation of upper limb and KT
(n = 22): KT applied in opposite direction with extension of the elbow joint, and the
before KT application, which wasapplication was effective on SG comparing
(proximal to distal) and conventional clinical lymphedema was measured every 4 cm applied in spiral and directional
to CG. Moreover, SG presented better ROM
control (10% of stretch) and grip strength
K. T. KASAWARA ET AL.
Figure 2. Standardized mean difference on lymphedema reduction comparing Kinesio Taping treatment versus control treatment.
et al. (2014) G3 (CDT + KT) was considered the treat- the treatment group, while G2 (CDT + bandage + KT)
ment group and G1 the control group. In Taradaj et al. was the control group. In Taradaj et al. (2016), G1
(2016), G1 (KT) was considered treatment group and (KT) was considered treatment group and G3 (ban-
G2 (quasi-KT) as control group. The heterogeneity of dage) was considered control. The heterogeneity (I2)
these studies was not statistically significant (p = 0.78), of the studies was 3.15%, Tau2 = 0.004 with a
I2 = 0% and Tau2 = 0. As a result of the analysis, there p = 0.39. Similarly, to the other comparison of treat-
was no significant difference (standardized mean dif- ment versus control analysis, there was no statistically
ference = 0.04, 95% CI: −0.24; 0.33) between partici- significant difference (standardized mean differ-
pants who completed their KT treatment and those ence = 0:12, 95% CI: −0.16; 0.41).
who underwent a comparison group on reduction of
their lymphedema volume associated with breast cancer
treatment. Discussion
As shown in Figure 2B, in the study of Smykla KT had a positive effect reducing upper limb lymphe-
et al. (2013), the KT group was considered as the dema volume in patients postmastectomy comparing
treatment group, while the multilayered compression before and after treatment. However, when comparing
therapy group was the control group. According to to control group or others treatments, KT has no sig-
Pekyavas et al. (2014), the G3 (CDT + KT) group was nificant effect on lymphedema volume reduction. The
8 K. T. KASAWARA ET AL.
methodological quality assessed by the PEDro Scale possibility of proper hygiene in the upper limbs for these
classifies studies in the intermediate category (4.7 patients (Finnerty, Thomason, and Woods, 2010).
points). Regarding the patient’s quality of life before and/
The use of KT has been questioned in several clinical or after treatment, Tsai et al. (2009) applied two
conditions, such as in patients with musculoskeletal questionnaires: (1) European Organization for
pain (Added et al., 2016; Castro-Sánchez et al., 2012; Research and Treatment of Cancer Quality of Life
Luz Júnior et al., 2015; Parreira et al., 2014) as this (EORTC QLQ-30) and (2) European Organization
method does not always significantly reduce pain. for Research and Treatment of Cancer Quality of
However, in other esthetic and clinical conditions, Life (EORTC QLQ-BR23). These questionnaires
such as cellulitis, a randomized clinical trial showed were administered at the beginning and also at the
positive results with the prerogative that KT generates end of the treatment; their comparison revealed a
a different traction stimulus on the top of the skin significant change in regard to the patients’ quality
(Silva et al., 2014). Nevertheless, other studies have of life, mostly in an improved emotional state.
shown the same positive effect on reducing the lym- Pekyavas et al. (2014) used the Short Form 36, a
phedema volume in the lower limbs, increasing lymph general questionnaire, to assess quality of life, and
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flow using KT in experimental animal models (Shim, the results of the questionnaires comparing the appli-
Lee, Lee, 2003) and in clinical study in humans (De cation at the beginning and end of the treatment did
Godoy, Braile, and Godoy, 2003). not achieve significant results. However, the partici-
In this investigation, five studies (Melgaard, 2016; pants were accepting of the use of KT according to
Pekyavas et al., 2014; Pop et al., 2014; Smykla et al., the questionnaire.
2013; Tsai et al., 2009) analyzed any associated proces- The Visual Analogue Scale was used by Tsai et al. (2009)
sing techniques, which made it difficult to assess the and Pekyavas et al. (2014) to assess the quality of life of
isolate effect of KT by itself as a standalone therapy patients treated with KT; both studies presented a positive
strategy. Furthermore, the KT protocol changed from 3 result at the end of treatment. Moreover, all studies
times a week for 3 weeks (9 sessions) (Pop et al., 2014) (Pekyavas et al., 2014; Pop et al., 2014; Smykla et al., 2013;
up to 5 times a week for 4 weeks (20 sessions) (Tsai Tsai et al., 2009) suggested that the comfort and conveni-
et al., 2009). The length of time that KT was worn each ence of the intervention were better with KT than with a
day included “as long as possible” (Tsai et al., 2009), compression bandage, especially in cases in which a ban-
which translated to an average of 22 h daily (Pekyavas dage is contraindicated.
et al., 2014) for three applications a week, which was Among the limitations of this systematic review is the
approximately 56 h (Pop et al., 2014) for up to three lack of standard nomenclature for the term “Kinesio
consecutive days (72 h) (Smykla et al., 2013). All trials Taping” which does not constitute a MeSH Term and
followed the application recommendation for KT, therefore hindered the search for articles related to this
which must be maintained for no longer than theme. In addition, the low methodological quality of the
3–5 days due to the reduction of the effect of the elastic studies included in this systematic review does not allow a
polymer (Castro-Sánchez et al., 2012; Wallis, Kase, and final conclusion on the indication of KT’s use as a techni-
Kase, 2003). Likewise, the orientation used to keep KT que for reducing lymphedema in patients postmastectomy
fixed on the skin also varied. for breast cancer.
Several authors have suggested that the use of KT in In this systematic review, it was possible to evaluate
lymphedema cases has a positive effect due to the surface the performance of KT in the treatment of postmas-
tension in the skin and also because of the application tectomy lymphedema in breast cancer patients by
technique in a centripetal direction, which respects the examining studies that had applied KT in different
anatomy of the lymphatic system and can encourage the forms. The use of KT was considered effective, but an
flow of lymph (Martins et al., 2016; Shim, Lee, and Lee, evaluation of these studies using the PEDro Scale does
2003; Silva et al., 2014). In addition to the reduction of not make them highly reliable for recommending the
lymphedema volume, other studies have evaluated the use of KT as an alternative for the treatment of
improvement in ROM (Pop et al., 2014; Taradaj et al., lymphedema.
2016); it is understood that these factors are associated In conclusion, KT was effective on reducing postmas-
with patients’ quality of life. Lymphedema implies an tectomy lymphedema related to breast cancer; however, it
impairment of the activities of daily living and also has is not more efficient than others treatments. Despite these
social and emotional impacts (Pekyavas et al., 2014; Tsai promising results, more studies with a high methodological
et al., 2009). In such cases, treatment of the lymphedema quality are needed to determine the best use of KT in
using KT offers comfort and convenience as well as the reducing postmastectomy lymphedema due to breast
PHYSIOTHERAPY THEORY AND PRACTICE 9
cancer; so, it may be incorporated routinely in the clinical Nascimento SL, De Oliveira RR, De Oliveira MM, Amaral
treatment of lymphedema. MT 2012 Complications and physical therapeutic treat-
ment after breast cancer surgery: A retrospective study.
Fisioterapia E Pesquisa 19: 248–255.
Declaration of Interest Padula RS, Pires RS, Alouche SR, Chiavegato LD, Lopes AD,
Costa LO 2012 Analysis of reporting of systematic reviews
The authors declare no conflict of interest. in physical therapy published in Portuguese. Brazilian
Journal of Physical Therapy 16: 381–388.
Parreira P, Costa L, Hespanhol LC, Lopes AD, Costa LO 2014
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