http://www.hindawi.com/journals/bmri/2013/767106/

The KT in lymphedema therapy?.....never :-)

Hi Jakub, thank you for the article. Shall read it with scrutiny as there are also articles claiming that KT does help. It could possible have to do with the different stages of the lymphoedema.

dear Emilia, what do you mean by KT case?

Hi everybody

I agree with Esther.

There are some articles that speak that KT is effective en breast cancer, but It depends breast cancer and edema

No, it is not a true. I can agree that KT could be very helpful in muscle, tendon...generally musculoskeletal problems. I could accept that it is useful even in edema (but only posttraumatic) therapy, but only as an application when we would like to increase a blood microcirculation not very deep under a skin, only when the edema is after injury and we want to remove the hematoma.

In lymphedema the KT is a complete misunderstanding and useless. We have to increase the lymph flow in superficial floor - under the skin, fat tissue, superficial mucles, tendons and fascia. The minimal external pressure must be 30-40 mmHg (according to Poiseuille and Laplace laws the bigger the better, that is why in practice we use mutilayered compression therapy about 60 mmHg, and intermittent compression 90-140 mmHg for hard fibroses). When we put one the skin the KT (without tension or maximally 15%), what is the pressure? 0, 2, 5 mmHg!? I will also mention of dermatitis after KT apllication in lymphedema. The hypoalergic tape is a myth.

The KT in lymphedema is a waste of time and is not better than placebo. In Pubmed, Medline, PEDro there are not metaanalyses or well conducted RCT (according to Evidence Based Medicine) about positive impact on lymhedema. Our article is a first attempt in ascertaining the truth (with placebo, randomization, CONSORT rules etc).

KT is a commercial, not a real therapy.

Such discussions stimulate development of the science and clinical practice.

Jakub, as you mentioned there is a few of RCTs in the area of KT. RCT concerning KT applications in lymphoedema in only one (yours). I really appreciate your work, effort, and important results (they will be cited for sure), but there are some important issues:

1) KT method still needs for further research, development, and guidelines/procedures - we should participate in it, and then assess based on many evidences,

2) EBM paradigm, regarded generally as very important and useful, is still weak in rehabilitation, due e.g. lack of RCTs, comparative studies, and weak methodological issues (e.g. application of STARD, STROBE, CONSORT, possibility of the diagnosis related groups - especially in people with multiple diseases (where case studies may be more exact than RCTs) , influence of associated pharmacotherapy, used tape - in KT cases, related guidelines, procedures and standards, therapists qualifications - should we compare their certificates, years of experience, etc.? - as proposed by Paci in the case of NDT-Bobath method?) - I think there is still need for deep debate concerning quality of evidences in rehabilitation, including neurorehabilitation, especially possibility of long-term rehabiltiation with follow up, and within home rehabilitation, where KT and other methods may be useful,

3) My current experience concerning application KT in lymphoedema shows, that its efficacy varies across the cases - there is need for further research concerning possible factors influencing efficacy and associated indications and contraindications. There is not guidelines in this area, thus experience of the therapist is important. No doubt we should think about increasing amount of RCTs on KT use in lymphoedema, and then discuss comparing them (e.g. various methodologies, selected groups of patients, factors influencing efficacy) - moreover as in whole science there is need for confirmation your results by the other researchers,

4) Esther and I wrote about dermatitis in KT in our papers before - you are true, but we as scientists should estabilsh causes, occurence, possible procedures of prevention, and if such risk is accepted (or not) - I proposed some of them before, please find e.g.

Mikolajewska E. Alergia u pacjenta po terapii metoda kinesiotapingu – opis przypadku. Rehabilitacja Medyczna 2010; 14(4): 32-39.

Mikołajewska E. Kinesiotaping. Rozwiązania wybranych problemów funkcjonalnych. Wydawnictwo Lekarskie PZWL, Warszawa 2011 (last chapter).

Hi Jakub

I think the Kinesio Taping is another tool for our treatments, and much remains to be done. I agree with Emilia to 100%.

I agree with you, there dermatitis. I work in pediatrics, and there are many cases. Both Emilia as Esther has extensive experience in this matter.

Currently, the meta-analysis are being made in the field of traumatology, since there is greater numbers of ECA, as in low back pain or sports.

Currently, you are viewing the kinesiotaping is more comfortable for patients and has greater acceptance than other bandages. And as we have mentioned, is valid for a certain kind edema, so we have to investigate to know about what kind

I try to assess incidence of KT-related dermatitis in patients with neurological disorders, when they are particularly damaging due to possible sensation disorders. Please find my another paper:

Mikołajewska E. Side effects of kinesiotaping – own observations [Skutki uboczne kinesiotapingu - obserwacje własne]. Journal of Health Sciences, 2011, 1(4): 93-99.

Subsequent research is in peer-review now.

I'm sorry for arrive late to this question.

First of all, congratulations for your well done RCT. But I'm not accept this phrase "KT is a commercial, not a real therapy" at this moment and in this way.

Because we need more RCT.

in the case that you had 10 RCT (KT vs Lymphedema) we only can accept this phrase for Lymphedema application, like you know.

But I want say something about your RCT

1)Your documentation about KT effects used Meta-analysis, but my question is, Well done Meta-analysis?

http://www.em-consulte.com/article/868641/le-taping-%C2%A0-a-l-epreuve-des-faits%C2%A0-revue-des-revue

Don't forget that too much of the KT research is not in English and it is not indexed.

2) I think you understood "the possible effect" of KT in Lymphedema like an ineffective compression bandage. Me Too.

please revised this

http://www.theratape.com/education-center/wp-content/uploads/2012/11/Kinesio-Study-Rabbit-Hind-Leg-Blood-Flow.pdf

Maybe the KT mechanism in lymphedema can be different to the compression and is not clear at all.

3) maybe your placebo did something more than nothing.

“Kinesiology Taping Applications and the Function of the Upper Limb in the Women after Mastectomy”. (Lipinska A. 2009.The Journal of Hand Surgery (European Volume)).

to conclude, I only can congratulate for your RCT but at the moment, I am not sure about nothing.

we need more well done RCT.

PD.-I recommend you too the investigation of Yukio Kataoka (Effects of with and without kinesio taping application while supine position on heart rate, blood pressure and peripheral circulation,2012 in Journal of kinesio Taping therapy)[In Japanese]

Emilia, inspired by your work I've also researched side effects.

Dermatitis that sometimes occurs is by the material or by material removal?

what do you think?

Hello Francisco,

Nice to see you in this conversation. Can you help me to the whole SR by Aurélie Morichon , Adrien Pallot that you mentioned here above?

Regarding your question on irritating the skin when removing the tape.

According to J. J. Escobar-Chávez et al The Tape-Stripping Technique as a Method for Drug Quantification in Skin in the J Pharm Pharmaceut Sci (www. cspsCanada.org) 11 (1): 104-130, 2008. 'Tape stripping with adhesive tape is a widely accepted and used method to examine the localization and distribution of substances within the stratum corneum.'

So yes, there is a small possibility that the removal of elastic therapeutic tape causes dermatitis through mechanical irritation.

But I am of the opinion that other factors are of more importance.

I have written a little on this subject in my book. Am attaching a pdf of the two pages (38-39) from my book (including references) and look forward to your reaction.

There are many brands of this elastic therapeutic (kinesio) tape and I am afraid some have very aggressive glues. It is difficult to obtain adequate information on the content of the glue. I would welcome that every tape company was open and would give us this information.

In response to Jakub statement: we need to start with description of technique and tape used for the study. KT-tape is not the same as Kinesio Tex Tape developed by Dr Kase and used by the practinioners in the Kinesio Taping Method. Using KT-tape for your study and claiming that Kinesio Taping Method is not effective is wrong.

I agree with you

This therapy in lymphedema is a waste of time. It does not matter is a tape called Kinesio Tex Tape, Kinesiotaping or something. The following discussion is waste of time too. You are wrong, but you are blind and you cannot see that K-tape is the same as patch on the skin, tape at the post office for packages etc. I understand that you all are therapists and earn money on K-tape courses run by you and during your patient treatment. That why you do not want to believe in science and facts from RCTs about K-tapes and lymphedema.

That is my last response.....good luck in cheating patients

http://www.ncbi.nlm.nih.gov/pubmed/23558699

Fact or fashion? That is a good question, specially in lymphology...

No comment....

Oh Oh... dear Jakub,

I do not really think that saying that we are clinicians cheating our patients is very polite and respectful and not worthy of a person that is an associate professor!

I am not used to being addressed in this fashion and I do not deserve this.

Please refrain from being so unkind to me and my colleagues and come off your high horse.

Are you a physiotherapist? If so, how many years of experience do you have?

You should be giving the example and remain openminded.

The researcher, University lecturer and clinician should be in contact always to ensure good practice. Our profession is more than worth it.

Now to get back to the original question....

dear Emilia,

I would argue that this taping method has become part of treatment options. I know of very many that use it as a complementary measure.

Public opinion: in this case the patients opinion have been of imminent importance. Taping has become common as a result. The reasoning and working models/hypothesis are being researched as we speak and so they should.

I find it fascinating that this 'method' works (in so many different areas, not only pain and lymphdrainiage) and am MORE than intriged as to HOW. Look forward to more research into the mechanisms behind this.

Thank you all for very valuable and sometimes hot discussion. It was a good way to show various opinions, from skeptic to enthusiastic. It seems this discussion should be continued (maybe elsewhere) despite dissonances. Some of us remember (still continouing) discussion on Adrian Owen's research in patients with disorders of consciousness, and we are aware that he is one of the best scientists in the world (peer with Steven Laureys of course) in DoCs. Discussions are so creative :)

I am deeply convinced our discussion may develop into novel research on KT efficacy depending on clinical condition. All of us (including Jacob) may have important impact to it. Let our disagreement and emotions change into engine and positive energy need for further research. We are professionals. Every evidence (positive: to support experience, negative: to avoid mistakes or errors) can help us to provide better therapy for our patients. It is not only domain of clinicians - I strongly belive most of us are both clinicians and researchers (so do I). Research should always support clinical practice, but clinical practice should stimulate research also.

I have been a practicing Sports Physiotherapist for 32 years and believe that all of our care should be as grounded in evidence as possible. However, Whether you agree or not, we can not, or maybe will not, currently place our clinical practice paradigms on the same path of plodding progression as pharmaceutical or surgical intervention. We must use our clinical wisdom, as imperfect as it may be, to guide us in the direction of best serving our patients that sit in front of us, not fooling them, being honest with the hard evidence that is foundational to our care as well as its shortcomings. WE must strive to prove the effectiveness of our interventions without being wisdom paralyzed by a lack of evidence. Research of our intervention strategies is the key to securing our role in the delivery of healthcare in the future

I agree with Andrew:

1) Evidence is only one part of EBM paradigm, another parts are clinical experience and knowledge, clinical reasoning and common sense (including validity and reliability of the evidence in particular case).

2) I conduct research on (inter alia, of course) NDT-Bobath approach in contemporary neurorehabilitation. Despite NDT-Bobath method is one of the leading methods in contemporary neurorehabiltiation, there is still few evidences. Sometimes research are complicated, sometimes qualifications of therapists need compartment (if internationally recognized), moreover method is changing/developin in time, etc.

3) Generally neurorehabilitation is still rather based on knowledge and experience of the individual therapist (or members of the interdisciplianry theraputic team). But number of evidences will increase, I hope.

4) What we can do in case of weak evidences? There is another challenge for clinicians.

Dear Taiar Redha, thank you for resume - I think all of us may agree with you.

I find kinesiology taping as a good complementary tool, I use it a lot in paediatrics, infants and small children has no placebo, as they do not understand what I expect. It has good effect for children with hypermobility among others. However a lot of research is needed. As I understand it there seems to be interesting research done but not available to "all" as it is not written in English. No thoughts to translate and publish in English?

There is a new research in Spanish. It's a AEVNM's newsletter. It's about paeditrics

http://atenasl.com/pdf/Noticias_VNM_13.pdf

Anna is right, a lot of publications are not in english.... maybe at least half of all the publications done are never read by english speakers.... We know so very little about publications from Japan, Korea, Russia and so many other countries.

This does make you wonder how evidence based we are working in every aspect of our profession, taping included.

The other BIG problem remains that a lot of the research on taping that is being published is still on healthy often young people, not on patients.

I think that is largely down to the individual practitioner. I am sure that for the majority of techniques we use in clinical practice, there are research papers to support and argue the use of it in our practice. I would say the decision is largely down to the practitioner having an understanding of evidence-based practice, and maintaining their CPD through regularly reading journals with a critical eye for methodological flaws in study design.