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KSR Number: KSRA96973

Evidence for kinesio taping in management of myofascial pain syndrome: a systematic review and meta-analysis

Risk of Bias Assessment

Overall summary: High risk of bias in the review

Bottom Line

Current evidence suggests that kinesio taping may reduce pain intensity and improve range of motion immediately following taping compared to other treatments (especially other non-invasive treatments) for patients with myofascial pain syndrome; however, the impact of kinesio taping over longer periods of time remains unclear. These conclusions should be interpreted with caution since methodological weaknesses mean relevant studies may have been missed and study heterogeneity was not fully addressed for all outcomes. Further large, high-quality trials are needed to provide additional evidence to support the use of kinesio taping over other interventions in patients with myofascial pain syndrome.

Risk of Bias Assessment

Overall summary High risk of bias in the review

High

Studies were restricted based on publication format, meaning relevant studies may have been missed. Heterogeneity was assessed and found to be moderate or high for several outcomes; the source of this heterogeneity was not fully explained for all outcomes.

A. Did the interpretation of findings address all of the concerns identified in Domains 1 to 4? Probably no
B. Was the relevance of identified studies to the review's research question appropriately considered? Probably yes
C. Did the reviewers avoid emphasizing results on the basis of their statistical significance? Probably yes
Risk of bias in the review High

Details of Review

Number of studies 20
Number of participants 959
Last search date November 2018
Review type Intervention
Objective To evaluate the effectiveness of kinesio taping for the management of myofascial pain syndrome in terms of pain intensity, pressure pain threshold, range of motion, muscle strength and disability.
Population Patients diagnosed with myofascial pain syndrome or myofascial trigger points.
Interventions Kinesio taping as the main intervention
Comparator Not pre-specified.
Outcome Primary outcomes: pain intensity, pressure pain threshold and range of motion.

Secondary outcomes: muscle strength and disability.
Study design Randomised controlled trials.

Results

In terms of pain intensity, pooled analysis reported that kinesio taping reduced pain intensity compared to any control treatment in patients with myofascial pain syndrome at post-intervention (mean difference [MD] -1.06 cm, 95% confidence interval [CI] -1.66 to -0.46 cm; 15 RCTs, n=734 patients); however, no difference was reported at later follow-up (MD -0.48 cm, 95% CI -1.06 to 0.10 cm; 7 RCTs, n=346 patients). Subgroup analysis also reported a reduction in pain intensity for kinesio taping compared to other non-invasive techniques both at post-intervention (MD -1.14cm, 95% CI -1.76 to -0.52 cm) and at later follow-up (MD -0.68cm, 95% CI -1.22 to -0.13cm); but no difference for kinesio taping compared to invasive techniques both at post-intervention (MD 0.04cm, 95% CI -0.99 to 1.07cm) and at later follow-up (MD 0.40cm, 95% CI -0.24 to 1.04cm).

In terms of pressure pain threshold, pooled analysis reported no difference in pressure pain threshold for kinesio taping compared to any control treatment at post-intervention (standardised mean difference [SMD] 0.03, 95% CI -0.50 to 0.57; 9 studies, n=406 patients) or at later follow-up (SMD 0.08, 95% CI -0.43 to 0.58; 5 studies, n=197 patients).

In terms of range of motion, pooled analysis reported an improvement in range of motion following kinesio taping compared to any control treatment at post-intervention (SMD 0.26, 95% CI: 0.09 to 0.43; 11 RCTs, n=600 patients); however, no difference was reported at later follow-up (SMD 0.26, 95% CI -0.04 to 0.56; 2 RCTs, n=193 patients). Subgroup analysis also reported an improvement in range of motion for kinesio taping compared to other non-invasive techniques (SMD 0.30, 95% CI 0.12 to 0.48); but no difference for kinesio taping compared to invasive techniques (SMD -0.32, 95% CI -1.01 to 0.37).

In terms of muscle strength, pooled analysis reported no difference in muscle strength for kinesio taping compared to any control treatment at post-intervention (SMD -0.52, 95% CI -1.28 to 0.24; 2 RCTs, n=95 patients) or at later follow-up (SMD 0.44, 95% CI -0.53 to 1.41; 2 RCTs, n=67 patients).

In terms of disability, pooled analysis reported no difference in disability for kinesio taping compared to any control treatment at post-intervention (SMD-0.18, 95% CI -0.56 to 0.21; 5 RCTs, n=259 patients) or at later follow-up (SMD -0.24, 95% CI -1.32 to 0.83; 3 RCTs, n=154 patients).

Full Risk of Bias Assessment

The research objective was clearly stated. Eligibility criteria were well described and appeared appropriate to address the present review question. Studies were restricted based on publication format (protocols and abstracts were excluded).

1.1 Did the review adhere to pre-defined objectives and eligibility criteria? Probably yes
1.2 Were the eligibility criteria appropriate for the review question? Probably yes
1.3 Were eligibility criteria unambiguous? Probably yes
1.4 Were all restrictions in eligibility criteria based on study characteristics appropriate (e.g. date, sample size, study quality, outcomes measured)? Probably yes
1.5 Were any restrictions in eligibility criteria based on sources of information appropriate (e.g. publication status or format, language, availability of data)? Probably no
Concerns regarding specification of study eligibility criteria High

PubMed, SPORTDiscus, LISA, Medline & Medline Complete (EBSCO), American Doctoral Dissertations, Rehabilitation & Sports Medicine Source, Science Direct, Web of Science Core Collection, KCI-Korean Journal Database, Russian Citation Index, SciELO, Physiotherapy Evidence Database and the Cochrane Library were searched for relevant studies. The reference lists of retrieved articles were handsearched for additional relevant studies. The search strategy was reported in full and appeared adequate. Searches were not restricted to date, publication format or language. Two reviewers were independently involved in the study selection process.

2.1 Did the search include an appropriate range of databases/electronic sources for published and unpublished reports? Yes
2.2 Were methods additional to database searching used to identify relevant reports? Yes
2.3 Were the terms and structure of the search strategy likely to retrieve as many eligible studies as possible? Yes
2.4 Were restrictions based on date, publication format, or language appropriate? Yes
2.5 Were efforts made to minimise error in selection of studies? Probably yes
Concerns regarding methods used to identify and/or select studies Low

Two reviewers were independently involved in the data extraction process and any disagreements were resolved by discussion or through consultation with a third reviewer. Sufficient study characteristics appear to have been extracted to allow interpretation of results. Relevant study results appear to have been extracted. Risk of bias of included studies was assessed using the Cochrane Collaboration’s risk of bias tool for randomised controlled trials. Two reviewers were independently involved in the risk of bias assessment.

3.1 Were efforts made to minimise error in data collection? Probably yes
3.2 Were sufficient study characteristics considered for both review authors and readers to be able to interpret the results? Probably yes
3.3 Were all relevant study results collected for use in the synthesis? Probably yes
3.4 Was risk of bias (or methodological quality) formally assessed using appropriate criteria? Probably yes
3.5 Were efforts made to minimise error in risk of bias assessment? Probably yes
Concerns regarding methods used to collect data and appraise studies Low

The synthesis appeared to include all relevant studies. The method of analysis was explained and appeared appropriate. Heterogeneity was assessed and found to be moderate or high for several outcomes. Subgroup and sensitivity analysis were performed but did not fully address the source of the heterogeneity for all outcomes. Publication bias was assessed using Egger’s regression test and the fail-safe numbers test; publication bias may have been present for one outcome (range of motion at post-intervention). The quality of the individual studies was considered in the synthesis.

4.1 Did the synthesis include all studies that it should? Probably yes
4.2 Were all pre-defined analyses reported or departures explained? Probably yes
4.3 Was the synthesis appropriate given the degree of similarity in the research questions, study designs and outcomes across included studies? Probably yes
4.4 Was between-study variation minimal or addressed in the synthesis? Probably yes
4.5 Were the findings robust, e.g. as demonstrated through funnel plot or sensitivity analyses? Probably no
4.6 Were biases in primary studies minimal or addressed in the synthesis? Probably yes
Concerns regarding synthesis and findings High

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