The effect of kinesio taping with exercise compared with exercise alone on pain, range of motion, and disability of the shoulder in postmastectomy females: a randomized control trial
Identifieur interne : 004126 ( Pmc/Corpus ); précédent : 004125; suivant : 004127The effect of kinesio taping with exercise compared with exercise alone on pain, range of motion, and disability of the shoulder in postmastectomy females: a randomized control trial
Auteurs : Sayed A. Tantawy ; Dalia M. KamelSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2016.
Abstract
[Purpose] The aim of the study was to investigate the effect of kinesio tape on pain, range of motion, and disability of the shoulder. [Subjects and Methods] Seventy-four female patients who underwent modified radical mastectomy participated in this study. They were randomly divided into two groups, an experimental group that received kinesio tape for the shoulder joint in addition to a conventional physiotherapy program and a control group that received the physiotherapy program only. Outcome measures included the Visual Analogue Scale, shoulder range of motion, and Shoulder Pain and Disability Index. [Results] The experimental group showed significant differences in all outcome measures both within and between groups. The control group only showed a significant within group difference in shoulder flexion. [Conclusion] Clinicians should be able to recognize the benefits achieved through the use of adjunct treatment options such as kinesio tape in comparison with benefits that can be obtained through the use of individual modalities in physical therapy. Kinesio tape can be suggested and recommended for postmastectomy patients, especially for shoulder pain, range of motion, and disability.
Url:
DOI: 10.1589/jpts.28.3300
PubMed: 28174439
PubMed Central: 5276748
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PMC:5276748Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The effect of kinesio taping with exercise compared with exercise alone on
pain, range of motion, and disability of the shoulder in postmastectomy females: a
randomized control trial</title><author><name sortKey="Tantawy, Sayed A" sort="Tantawy, Sayed A" uniqKey="Tantawy S" first="Sayed A" last="Tantawy">Sayed A. Tantawy</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kamel, Dalia M" sort="Kamel, Dalia M" uniqKey="Kamel D" first="Dalia M" last="Kamel">Dalia M. Kamel</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28174439</idno><idno type="pmc">5276748</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5276748</idno><idno type="RBID">PMC:5276748</idno><idno type="doi">10.1589/jpts.28.3300</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">004126</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004126</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The effect of kinesio taping with exercise compared with exercise alone on
pain, range of motion, and disability of the shoulder in postmastectomy females: a
randomized control trial</title><author><name sortKey="Tantawy, Sayed A" sort="Tantawy, Sayed A" uniqKey="Tantawy S" first="Sayed A" last="Tantawy">Sayed A. Tantawy</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kamel, Dalia M" sort="Kamel, Dalia M" uniqKey="Kamel D" first="Dalia M" last="Kamel">Dalia M. Kamel</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>[Purpose] The aim of the study was to investigate the effect of kinesio tape on pain,
range of motion, and disability of the shoulder. [Subjects and Methods] Seventy-four
female patients who underwent modified radical mastectomy participated in this study. They
were randomly divided into two groups, an experimental group that received kinesio tape
for the shoulder joint in addition to a conventional physiotherapy program and a control
group that received the physiotherapy program only. Outcome measures included the Visual
Analogue Scale, shoulder range of motion, and Shoulder Pain and Disability Index.
[Results] The experimental group showed significant differences in all outcome measures
both within and between groups. The control group only showed a significant within group
difference in shoulder flexion. [Conclusion] Clinicians should be able to recognize the
benefits achieved through the use of adjunct treatment options such as kinesio tape in
comparison with benefits that can be obtained through the use of individual modalities in
physical therapy. Kinesio tape can be suggested and recommended for postmastectomy
patients, especially for shoulder pain, range of motion, and disability.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ferlay, J" uniqKey="Ferlay J">J Ferlay</name></author><author><name sortKey="Soerjomataram, I" uniqKey="Soerjomataram I">I Soerjomataram</name></author><author><name sortKey="Ervik, M" uniqKey="Ervik M">M Ervik</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ibrahim, As" uniqKey="Ibrahim A">AS Ibrahim</name></author><author><name sortKey="Khaled, Hm" uniqKey="Khaled H">HM Khaled</name></author><author><name sortKey="Mikhail, Nn" uniqKey="Mikhail N">NN Mikhail</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Stevens, Pe" uniqKey="Stevens P">PE Stevens</name></author><author><name sortKey="Dibble, Sl" uniqKey="Dibble S">SL Dibble</name></author><author><name sortKey="Miaskowski, C" uniqKey="Miaskowski C">C 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28174439</article-id><article-id pub-id-type="pmc">5276748</article-id><article-id pub-id-type="publisher-id">jpts-2016-620</article-id><article-id pub-id-type="doi">10.1589/jpts.28.3300</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>The effect of kinesio taping with exercise compared with exercise alone on
pain, range of motion, and disability of the shoulder in postmastectomy females: a
randomized control trial</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tantawy</surname><given-names>Sayed A</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kamel</surname><given-names>Dalia M</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><aff id="aff1"><label>1)</label> Department of Physiotherapy, Center of Radiation, Oncology and Nuclear Medicine, Cairo University Hospitals, Cairo University, Egypt</aff><aff id="aff2"><label>2)</label> Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Kingdom of Bahrain</aff><aff id="aff3"><label>3)</label> Department of Physical Therapy for Obstetrics and Gynecology, Faculty of Physical Therapy, Cairo University, Egypt</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Sayed A Tantawy, Department of Physiotherapy, Center of Radiation, Oncology
and Nuclear Medicine, Cairo University Hospitals, Cairo University: Cairo, Al Maniyal,
Egypt (E-mail: <email xlink:href="tantawyss@yahoo.com">tantawyss@yahoo.com</email>; <email xlink:href="smosa@ahlia.edu.bh">smosa@ahlia.edu.bh</email>)</corresp></author-notes><pub-date pub-type="epub"><day>27</day><month>12</month><year>2016</year></pub-date><pub-date pub-type="ppub"><month>12</month><year>2016</year></pub-date><volume>28</volume><issue>12</issue><fpage>3300</fpage><lpage>3305</lpage><history><date date-type="received"><day>09</day><month>6</month><year>2016</year></date><date date-type="accepted"><day>02</day><month>8</month><year>2016</year></date></history><permissions><copyright-statement>2016©by the Society of Physical Therapy Science. Published by IPEC
Inc.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p>[Purpose] The aim of the study was to investigate the effect of kinesio tape on pain,
range of motion, and disability of the shoulder. [Subjects and Methods] Seventy-four
female patients who underwent modified radical mastectomy participated in this study. They
were randomly divided into two groups, an experimental group that received kinesio tape
for the shoulder joint in addition to a conventional physiotherapy program and a control
group that received the physiotherapy program only. Outcome measures included the Visual
Analogue Scale, shoulder range of motion, and Shoulder Pain and Disability Index.
[Results] The experimental group showed significant differences in all outcome measures
both within and between groups. The control group only showed a significant within group
difference in shoulder flexion. [Conclusion] Clinicians should be able to recognize the
benefits achieved through the use of adjunct treatment options such as kinesio tape in
comparison with benefits that can be obtained through the use of individual modalities in
physical therapy. Kinesio tape can be suggested and recommended for postmastectomy
patients, especially for shoulder pain, range of motion, and disability.</p></abstract><kwd-group><kwd>Mastectomy</kwd><kwd>Shoulder pain</kwd><kwd>Kinesio tape</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>INTRODUCTION</title><p>According to the latest report of the International Agency for Research on Cancer (GLOBOCAN
2012), breast cancer (BC) is by far the world’s most common cancer among women and the most
likely cause that a woman will die from cancer worldwide<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>. In Egypt, the highest incidence rates for cancer among men were in
the liver (33.6%) and bladder (10.7%), while in females they were in the breast (32.0%) and
liver (13.5%). It has been estimated that by 2050, the incidence of cancer will be 3-fold
that in 2013<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>.</p><p>The American Society of Clinical Oncology (ASCO) revealed that the majority of women who
had undergone BC surgery complained of postsurgical shoulder pain with limited upper arm
range of motion (ROM) extending until 1.5 years after surgery<xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>. Likewise, the prevalence of chronic shoulder pain in patients
following mastectomy due to BC has previously been reported to be 20% to 68%<xref rid="r4" ref-type="bibr">4</xref>,<xref rid="r5" ref-type="bibr">5</xref>,<xref rid="r6" ref-type="bibr">6</xref>,<xref rid="r7" ref-type="bibr">7</xref>,<xref rid="r8" ref-type="bibr">8</xref>,<xref rid="r9" ref-type="bibr">9</xref>,<xref rid="r10" ref-type="bibr">10</xref><sup>)</sup>. This adversely affects activities of
daily living (ADL)<xref rid="r11" ref-type="bibr">11</xref><sup>)</sup>. Co-existing
lymphedema often accounts for chronic postsurgical shoulder pain, limited ROM, and decreased
muscle strength<xref rid="r12" ref-type="bibr">12</xref><sup>)</sup>. Postmastectomy
shoulder limitation is greater in patients treated with radiotherapy<xref rid="r13" ref-type="bibr">13</xref><sup>)</sup>. In addition, it has been reported that women who
underwent breast-conserving surgery were less likely to demonstrate shoulder restriction
impairment compared with those who had undergone mastectomy<xref rid="r14" ref-type="bibr">14</xref><sup>)</sup>.</p><p>Early physiotherapy intervention for treatment is perceived to improve treatment outcomes.
Accordingly, upper ROM exercises lasting 6–12 months after mastectomy have been shown to
improve shoulder mobility and reduce pain<xref rid="r15" ref-type="bibr">15</xref>, <xref rid="r16" ref-type="bibr">16</xref><sup>)</sup>.</p><p>One of the current techniques being utilized is kinesio taping (KT), which was developed by
Dr. Kenzo Kase in 1973. Kinesio tape is thinner and more elastic than conventional tape<xref rid="r17" ref-type="bibr">17</xref><sup>)</sup> and can be stretched by approximately
40–60% of its resting length<xref rid="r18" ref-type="bibr">18</xref>, <xref rid="r19" ref-type="bibr">19</xref><sup>)</sup>. The recommended duration for wearing the tape is
approximately 3–5 days<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup>. The concept
that underlies KT for pain reduction is reduction of the pressure on pain receptors,
muscles, and tendons, and this facilitates recovery without limitation of ROM<xref rid="r21" ref-type="bibr">21</xref><sup>)</sup>. Additionally, KT provides sensory
stimulation, decreases formation of adhesions and contractures, increases skin softening,
improves skin pliability, and reduces scar formation<xref rid="r22" ref-type="bibr">22</xref><sup>)</sup>.</p><p>Though some research and studies have demonstrated the effect of KT in the management of
different cases<xref rid="r17" ref-type="bibr">17</xref>, <xref rid="r20" ref-type="bibr">20</xref>, <xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r24" ref-type="bibr">24</xref><sup>)</sup>, evidence is lacking
regarding the effect of KT on postmastectomy shoulder problems. Thus, this study was
implemented to determine the effects of KT on pain, ROM, and disability of the shoulder in
postmastectomy patients. This may provide valuable evidence supporting the importance of KT
in the management of shoulder complaints in such cases.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><p>The study employed randomization and selected 74 postmastectomy female patients with
postoperative shoulder pain and dysfunction admitted to the National Cancer Institute. The
inclusion criteria were as follows: modified radical mastectomy at least 2 weeks previously
and currently undergoing chemotherapy and radiation therapy for stage I or II breast cancer,
presence of shoulder pain with associated limitation of motion of the shoulder, and good
compliance and willingness to participate in KT sessions with written consent. Subjects were
excluded from the study due to the following reasons: diagnosed with active BCA at the time
of the study; presence of skin hypersensitivity to Kinesio tape material; presence of
treatment contraindications including the presence of a pacemaker, heart disease, pregnancy,
infectious disease, epilepsy thrombophlebitis, arterial hypertension, or metastatic cancer;
and presence of mental disturbances of the sensorium or language problems that could make
communication and cooperation problematic.</p><p>The Research Ethics Committee (P.T. REC/012/001249) of the Faculty of Physical Therapy,
Cairo University, approved this study, which was registered with ClinicalTrials.gov under
identifier number NCT02749539, and patients were assessed for eligibility. If a patient met
the inclusion criteria, she was provided with a consent form to sign to declare acceptance
and was randomly allocated to either the control or experimental group through random
assignment. This was done by having a physical therapist randomly pick names from a registry
of qualified patients written on paper. Selection of names was conducted in the presence of
another physical therapist, and each selected name was assigned to a group by alternating
between the two groups. Names of patients assigned to each group were collected and coded
using Microsoft Excel 2010 for windows (Microsoft Corp., Redmond, WA, USA). A patient flow
diagram is presented in <xref ref-type="fig" rid="fig_001">Fig. 1</xref><fig orientation="portrait" fig-type="figure" id="fig_001" position="float"><label>Fig. 1.</label><caption><p>Flow diagram of the Study</p></caption><graphic xlink:href="jpts-28-3300-g001"></graphic></fig>.</p><p>Subjects in both groups received routine physical therapy treatment, which consisted of
active-assistive range of motion exercises (AAROME), active stretching, and strengthening
exercises for the shoulder joint. Likewise, patients also received postural correction
exercises. Initially, the patients were given general exercise instructions regarding
wearing loose and comfortable clothing. They were also informed that all exercises should be
performed slowly and gently within the pain-free range. Furthermore, they were told that
they should breathe regularly during the exercises.</p><p>Exercises were performed at home as well as in a clinic under a physiotherapist’s
supervision. Two sets of 15 repetitions of each exercise were performed for AAROME and
strengthening exercises. Two sets of 10 repetitions with 15- sec hold and relax times were
performed for active stretching exercises. Finally, 3 sets of postural correction were
performed with 3–5 repetitions per set.</p><p>In the first week, Codman’s exercises, finger ladder, overhead pulleys, self-stretching,
and postural correction (from crook and supine lying positions) exercises were
performed.</p><p>In the second week, the same exercises as in the first week were repeated in-addition to
self-stretching by pushing against a wall, hand behind the back towel stretching, static
strengthening against a wall, and postural correction (from sitting and standing positions)
exercises.</p><p>The control and experimental groups performed physical therapy exercises 3 times a week
during the two-week intervention period. The experimental group additionally received KT as
an adjunct treatment, which was reapplied every 3 days interval within the 2 weeks of the
intervention by a certified kinesio taping practitioner.</p><p>Standard 2-inche Kinesio Tex<sup>R</sup> tape was used for taping in the experimental
group. General application guidelines consistent with the procedures described by Kase et
al.<xref rid="r18" ref-type="bibr">18</xref><sup>)</sup> were followed. KT was applied
using 4 strips of Kinesio tape, with the first 3 strips comprising the first KT application,
which was performed with the inhibition technique with 15–25% tension.</p><p>First strip was an I strip applied over the supraspinatus. The anchor was applied just
below the greater tuberosity of the humerus without tension. Then, the patient was
instructed to adduct, extend, and internally rotate the shoulder in conjunction with
contralateral neck flexion. The rest of the tape strip was applied along the spinous process
of the scapula and ended with no tension.</p><p>Second strip was a Y-strip for the deltoid. The anchor was applied on the deltoid’s
insertion with the first tail applied to the anterior deltoid as the arm was externally
rotated and horizontally abducted. The second tail was applied on the posterior deltoid with
the arm in horizontal adduction and internal rotation. Both tails ended with no tension.</p><p>Third strip was an I-strip KT applied to the teres minor muscle. The anchor was placed over
the lower facet of the greater tuberosity with no tension. The patient’s arm was in shoulder
flexion with horizontal abduction and internal rotation. The end of the tape was applied
with no stretch at the inferior angle of the scapula.</p><p>The fourth strip, comprising the second KT application, was applied with the mechanical
correction technique with 50% to 75% tension. It was I-strip (cut down in middle) and was
applied from the coracoid process anteriorly to the posterior deltoid with downward pressure
by the tape at the region of perceived tenderness for the shoulder joint.</p><p>The outcome measures were shoulder pain intensity measured with the Visual Analogue Scale
(VAS); active ROM of shoulder flexion, abduction, and external rotation; and the Shoulder
Pain and Disability Index (SPADI). For the VAS, patients were asked to place a perpendicular
line on the scale that corresponded to their perceived pain intensity. VAS scores describe
the postoperative pain intensity as none, mild, moderate, or severe. The following cutoff
were used for the VAS pain scale: 0–4 mm, no pain; 5–44 mm, mild pain; 45–74 mm, moderate
pain; and 75–100 mm, severe pain<xref rid="r25" ref-type="bibr">25</xref><sup>)</sup>.</p><p>Using a universal goniometer, shoulder ROM of flexion, abduction, and external rotation of
the affected side were measured. Shoulder flexion and external rotation were assessed with
the patient in a supine lying position, while abduction was investigated in an upright
position. In this study, an experienced physiotherapist assessed shoulder ROM before and
after intervention. The KT was applied after the initial evaluation and was removed before
the final assessment, so the tester was blind with respect to the group assignments.</p><p>The SPADI was developed to evaluate the shoulder pain and disability. It consists of 13
items that assess two domains: a 5-item subscale that measures pain and an 8-item subscale
that measures disability. The total score is calculated by averaging the pain and disability
subscale scores<xref rid="r26" ref-type="bibr">26</xref><sup>)</sup>. The SPADI has
reliability coefficients of ICC≥0.89 in a variety of patient populations<xref rid="r27" ref-type="bibr">27</xref><sup>)</sup>. Its internal consistency is high, with
Cronbach’s α typically exceeding 0.90<xref rid="r27" ref-type="bibr">27</xref>, <xref rid="r28" ref-type="bibr">28</xref><sup>)</sup>. The SPADI demonstrates good construct
validity, correlating well with other region-specific shoulder questionnaires<xref rid="r27" ref-type="bibr">27</xref>, <xref rid="r29" ref-type="bibr">29</xref>, <xref rid="r30" ref-type="bibr">30</xref><sup>)</sup>. The translated version of the SPADI in
the Arabic language showed excellent internal consistency, with a Cronbach’s α values of
0.98, and test-retest reliability<xref rid="r31" ref-type="bibr">31</xref><sup>)</sup>.</p><p>All the collected data were tabulated in the PASW Statistics Version18 to apply both
descriptive and inferential statistics. Both the paired and unpaired t-test were used to
indicate inter- and intragroup differences. The p-value was set at 5%.</p></sec><sec sec-type="results" id="s3"><title>RESULTS</title><p>Seventy-four patients underwent modified radical mastectomy. However, only sixty-three
completed the study. Demographic characteristics of the subjects are provided in <xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title>Demographic data of the subjects (mean ± SD)</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" valign="middle" rowspan="1" colspan="1">Experimental<break></break>group (n=33)</th><th align="center" valign="middle" rowspan="1" colspan="1">Control<break></break>group(n=30)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (years)</td><td align="center" rowspan="1" colspan="1">43.33 ± 3.78</td><td align="center" rowspan="1" colspan="1">42.80 ± 3.88</td></tr><tr><td align="left" rowspan="1" colspan="1">Marital status</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" style="padding-left:10pt" rowspan="1" colspan="1">Married</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">19</td></tr><tr><td align="left" style="padding-left:10pt" rowspan="1" colspan="1">Divorced</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">4</td></tr><tr><td align="left" style="padding-left:10pt" rowspan="1" colspan="1">Widow</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">7</td></tr><tr><td align="left" rowspan="1" colspan="1">Affected side</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" style="padding-left:10pt" rowspan="1" colspan="1">Dominant</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">18</td></tr><tr><td align="left" style="padding-left:10pt" rowspan="1" colspan="1">Nondominant</td><td align="center" rowspan="1" colspan="1">13</td><td align="center" rowspan="1" colspan="1">12</td></tr><tr><td align="left" rowspan="1" colspan="1">Pre-existing shoulder problem</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1">Postsurgical complications</td><td align="center" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td></tr><tr><td align="left" style="padding-left:10pt" rowspan="1" colspan="1">None</td><td align="center" rowspan="1" colspan="1">30</td><td align="center" rowspan="1" colspan="1">29</td></tr><tr><td align="left" style="padding-left:10pt" rowspan="1" colspan="1">Infection</td><td align="center" rowspan="1" colspan="1">2</td><td align="center" rowspan="1" colspan="1">1</td></tr><tr><td align="left" style="padding-left:10pt" rowspan="1" colspan="1">Bleeding</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">0</td></tr></tbody></table></table-wrap>.</p><p>Baseline characteristics and pre- and posttreatment scores for outcome measures are
presented for both the experimental and control groups. No meaningful difference existed
between the groups when matched. A summary of the mean scores for each of the outcomes
measured, pain, shoulder ROM (shoulder abduction), and SPADI, are presented in <xref rid="tbl_002" ref-type="table">Table 2</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2.</label><caption><title>Pre- and posttreatment measurement scores in the experimental and control
groups</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" rowspan="3" colspan="1">Outcomes</th><th colspan="2" valign="middle" align="center" rowspan="1">Experimental group n=33</th><th colspan="2" valign="middle" align="center" rowspan="1">Control group n=30</th></tr><tr><th colspan="2" rowspan="1"><hr></hr></th><th colspan="2" rowspan="1"><hr></hr></th></tr><tr><th align="center" valign="middle" rowspan="1" colspan="1">Pre</th><th align="center" valign="middle" rowspan="1" colspan="1">Post</th><th align="center" valign="middle" rowspan="1" colspan="1">Pre</th><th align="center" valign="middle" rowspan="1" colspan="1">Post</th></tr></thead><tbody><tr><td align="left" valign="middle" rowspan="1" colspan="1">VAS</td><td align="center" valign="middle" rowspan="1" colspan="1">4.9 ± 1.8</td><td align="center" valign="middle" rowspan="1" colspan="1">3.3 ± 1.4*</td><td align="center" valign="middle" rowspan="1" colspan="1">4.8 ± 1.6</td><td align="center" valign="middle" rowspan="1" colspan="1">4.1 ± 1.5</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Flexion (degrees)</td><td align="center" valign="middle" rowspan="1" colspan="1">94.1 ± 8.7</td><td align="center" valign="middle" rowspan="1" colspan="1">130.6 ± 8.7*</td><td align="center" valign="middle" rowspan="1" colspan="1">93.2 ± 8.0</td><td align="center" valign="middle" rowspan="1" colspan="1">104.3 ± 7.4*</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">Abduction (degrees)</td><td align="center" valign="middle" rowspan="1" colspan="1">74.5 ± 8.7</td><td align="center" valign="middle" rowspan="1" colspan="1">103.3 ± 12.3*</td><td align="center" valign="middle" rowspan="1" colspan="1">73.3 ± 8.7</td><td align="center" valign="middle" rowspan="1" colspan="1">76.6 ± 8.1</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">External rotation (degrees)</td><td align="center" valign="middle" rowspan="1" colspan="1">64.4 ± 14.6</td><td align="center" valign="middle" rowspan="1" colspan="1">79.9 ± 8.0*</td><td align="center" valign="middle" rowspan="1" colspan="1">64.1 ± 12.8</td><td align="center" valign="middle" rowspan="1" colspan="1">68.2 ± 12.0</td></tr><tr><td align="left" valign="middle" rowspan="1" colspan="1">SPADI</td><td align="center" valign="middle" rowspan="1" colspan="1">102.4 ± 3.7</td><td align="center" valign="middle" rowspan="1" colspan="1">93.6 ± 4.9*</td><td align="center" valign="middle" rowspan="1" colspan="1">101.0 ± 5.2</td><td align="center" valign="middle" rowspan="1" colspan="1">99.00 ± 4.5</td></tr></tbody></table><table-wrap-foot><p>*Indicates significance change</p></table-wrap-foot></table-wrap>. The decreases in scores recorded for the VAS and SPADI are indicative of
improvement. The increases in scores for shoulder ROM indicate improvement.</p><p>The control group showed no change in the VAS score (p=0.071), indicating that there was no
significant difference in pain intensity compared with the pretreatment score. The
experimental group showed a mean difference of 1.63 points in VAS score in comparison with
the mean difference of 0.72 points in the control group. The experimental group showed
significant improvement both within and between groups (p=0.0001 and p=0.025, respectively).
Both groups showed significant within-group improvement (p=0.0001) in shoulder flexion ROM
after two weeks of treatment. The experimental group improved by 36.50°, while the control
group improved by 11.2°.</p><p>For the experimental group, a significant difference was noted between groups (p=0.0001) in
respect to shoulder flexion. Measurement of both shoulder abduction and external rotation in
the experimental group showed significant improvement both within and between groups
(p=0.0001, p=0.001), shoulder abduction and external rotation improving by 28.70° and 15.4°
respectively. There was no significant difference (p=0.123, p=0.195) in the control group,
with shoulder abduction and external rotation only improving by 3.3° and 4.06°,
respectively.</p><p>In terms of the SPADI, the experimental group showed significant improvement within and
between groups (p=0.001), the SPADI score decreasing by 8.8 points between before and after
treatment. There was no meaningful difference noted within the control group (p=0.103),
which showed a decrease of 2 points.</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>Few studies have been performed to evaluate the clinical effects of shoulder KT with
physical therapy in patients suffering from shoulder-related problems following mastectomy,
but several authors have reported pain reduction following KT application<xref rid="r17" ref-type="bibr">17</xref>, <xref rid="r20" ref-type="bibr">20</xref>, <xref rid="r23" ref-type="bibr">23</xref>, <xref rid="r32" ref-type="bibr">32</xref><sup>)</sup>. Regarding pain intensity, the current study found a greater decrease
in the experimental group after KT application compared with the control group. This is
consistent with findings that showed a greater pain reduction after applying KT compared
with application of physical therapy alone<xref rid="r33" ref-type="bibr">33</xref><sup>)</sup>. Noticeable clinical improvements were evident by the second week
of treatment and similar to statistically significant findings reported for the reduction in
pain between before and after treatment with KT<xref rid="r17" ref-type="bibr">17</xref>,
<xref rid="r33" ref-type="bibr">33</xref>, <xref rid="r34" ref-type="bibr">34</xref><sup>)</sup>. In contrast, Akbas et al.<xref rid="r35" ref-type="bibr">35</xref><sup>)</sup> did not report significant pain reduction despite the addition of
physical therapy treatment and concluded that KT was not even superior to sham
taping/placebo taping.</p><p>Generally, the results related to shoulder ROM after KT were significant both within and
between groups in the experimental group when baseline and posttreatment values were
analyzed. Several authors have previously reported improvement of shoulder ROM accompanied
by reduction of pain intensity with KT application<xref rid="r24" ref-type="bibr">24</xref>,
<xref rid="r36" ref-type="bibr">36</xref>,<xref rid="r37" ref-type="bibr">37</xref>,<xref rid="r38" ref-type="bibr">38</xref><sup>)</sup>. In the present study, the improvement in
shoulder ROM after KT application in addition to physical therapy was similar to
findings<xref rid="r20" ref-type="bibr">20</xref>, <xref rid="r39" ref-type="bibr">39</xref><sup>)</sup> of earlier studies. Concomitantly, pain reduction resulted in
improvement in shoulder abduction, flexion, and external rotation ROM. In contrast, there
was only significant improvement in shoulder flexion when both pre- and posttreatment values
were compared in the control group.</p><p>In contrast, the shoulder flexion results of our control group, a previous study reported
that shoulder abduction primarily showed a significant difference after physical therapy and
was the only outcome to improve<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup>.</p><p>Several reasons may account for pain reduction through the use of KT application. One of
these possible reasons is the Gate Control Theory. The tape used for KT is presumed to
stimulate the neuromuscular pathway through an increase in afferent feedback<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup>. Under the Gate Control Theory, an
increase in the afferent stimulus to large-diameter nerve fibers can lessen the input
received by small-diameter nerve fibers conducting pain sensation<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup>. Another possible mechanism is activation of circulatory
and neurological systems with movement<xref rid="r37" ref-type="bibr">37</xref><sup>)</sup>.
The tape can be used to support muscles, fasciae and joints in addition to allowing
unrestricted ROM. Depending on the amount of applied stretch, potential benefits of the
application involve the provision of a stimulus through the skin based on the position of
the taping, the facilitation of fascial tissues alignment, and the creation of additional
space through the lifting of fasciae and soft tissue above the area affected. This lifting
effect increases the amount of the space and reduces localized pressure, which eventually
improves circulation and lymphatic drainage<xref rid="r40" ref-type="bibr">40</xref><sup>)</sup>. This mechanism is perceived to be the underlying rationale for
reduction of swelling and muscle spasm<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup>.
In terms of shoulder movement facilitation through its entire ROM, the stretching of the
skin over the region caused by KT, guides the shoulder through the arc. An improvement in
glenohumeral motion will facilitate the effects of KT. This will decrease the mechanical
irritation present in the soft tissues surrounding the shoulder joint<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup>.</p><p>The current study showed that KT had a significant effect in terms of improvements in pain
intensity, disability scores, and shoulder ROM. Therefore, KT can be used in combination
with physical therapy interventions. Furthermore, clinicians should be able to recognize the
benefits achieved through the use of adjunct treatment options such as KT in comparison to
benefits that can be obtained through the use of individual modalities in physical therapy.
KT can be suggested and recommended for postmastectomy patients, especially for pain, ROM,
and disability of the shoulder.</p><p>The limitations of this study were the short duration of KT application and the small
sample size. Therefore, clinical trials should be conducted with a larger sample size for an
extended period of time. Further research may produce additional information on the
potential benefits of KT as an adjunct treatment with physical therapy in postmastectomy
patients. Clinical messages are:</p><p>• The use of KT with physical therapy modalities decreases shoulder-related signs and
symptoms after mastectomy.</p><p>• KT application reduces shoulder pain and its resultant effects on disability with
improvement of shoulder range of motion.</p><p>• The use of KT in combination with physical therapy can be recommended for pain relief in
patients with shoulder limitation of motion.</p><sec><title>Conflict of interest</title><p>Sayed A. Tantawy and Dalia M. Kamel declare that they have no competing interests.</p></sec></sec></body><back><ack><p>The research did not secure any specific grant or source of funding from any specific
organization in either the private or public sector.</p><p>The authors would like to thank Dr. Pocholo B. Trinidad for his assistance in editing of
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