CRITICALLY APPRAISED PAPER (CAP) Yasukawa, A., Patel, P., & Sisung, C. (2006). Pilot study: Investigating the effects of Kinesio Taping in an acute pediatric rehabilitation setting. American Journal of Occupational Therapy, 60(1), 104 110. https://doi.org/10.5014/ajot.60.1.104 CLINICAL BOTTOM LINE The evidence from this research may be used in the pediatric rehabilitation setting to yield functional improvements in upper extremity function. On the basis of the findings of this study, practitioners can use Kinesio Tape in pediatric rehabilitation to see improvements in upper extremity functions among pediatric patients. Therapists must take into consideration the level of evidence (Level III) and limitations of this study before using the results in practice. The study was a quasi-experimental design with pre- and posttest measures and no control group. Additionally, the findings of the study were based on one trial of Kinesio Taping; this is not long enough to support the use of Kinesio Taping as a common intervention. More research regarding Kinesio Taping in pediatric rehabilitation must be conducted to strengthen the findings of this study. Further research might also investigate the Melbourne Assessment and its effectiveness in determining changes in upper extremity function among children. With more rigorous research on Kinesio Taping and assessments to measure the benefits and changes in function, occupational therapists will be able to confidently implement Kinesio Tape to improve upper extremity function among the pediatric population. RESEARCH OBJECTIVE(S) Study the effect of Kinesio Taping on upper extremity function among children admitted into an inpatient acute rehabilitation program DESIGN TYPE AND LEVEL OF EVIDENCE Level III: Quasi-experimental design with pre- and posttest measures
PARTICIPANT SELECTION How were participants recruited and selected to participate? Children were admitted to the Pediatric Inpatient Program at the Rehabilitation Institute of Chicago with varying diagnoses. Therapists on the unit recommended children who had adequate cognition, motivation, and behavior for the study. Inclusion criteria: Participants had decreased muscle strength of the upper extremity (assessed as poor to fair through manual muscle testing) or abnormal muscle tone (measured with the Modified Ashworth Scale) that interfered with functional upper extremity use. Children selected needed to have adequate motivation and cognition to complete the Melbourne Assessment of Unilateral Upper Limb Function and no significant behavioral problems. Exclusion criteria: Children with significant sensory and motor loss in the body area studied (manual muscle test score of zero to trace) or significant spasticity on the Modified Ashworth Scale (score of 3 or 4) PARTICIPANT CHARACTERISTICS N= (Number of participants taking part in the study) 15 #/ (%) Male 5/(33.3%) #/ (%) Female 10/(66.7%) Ethnicity Not stated Disease/disability diagnosis Right hemiplegia/encephalitis Left hemiplegia and cerebrovascular accident (CVA) Left hemiplegia and seizure Right hemiplegia, CVA, and brain tumor Right hemiplegia and brain tumor Traumatic brain injury Right hemiplegia and traumatic brain injury Right hemiplegia and brain stem CVA Generalized muscle weakness and cerebral palsy
C2 C6 spinal cord injury lesion and brain tumor Left-shoulder arthritis, sickle cell disease, and multifocal osteomyelitis Spinal cord injury C5 C6 incomplete and tetraplegia INTERVENTION AND CONTROL GROUPS Group 1: Experimental group Brief description of the intervention How many participants in the group? Where did the intervention take place? Who delivered? How often? Kinesio Tape was applied proximally to distally on the weakened muscle to assist with muscle movement, joint stability, and alignment. 15 Pediatric Inpatient Program at the Rehabilitation Institute of Chicago Qualified and experienced occupational therapist, certified in Kinesio Taping Kinesio Tape was applied one time after the pretest. For how long? Kinesio Tape was removed during the follow-up meeting, 3 days after the tape was applied. INTERVENTION BIASES Contamination: Co-intervention: Explanation: Only one group participated in this study. Explanation: During the study, participants received multiple interventions during their inpatient stay, including receiving medications. Timing of intervention:
Explanation: Because the intervention took place over 3 days, maturation was not a concern. Site of intervention: Explanation: All participants received treatment in the same location. Use of different therapists to provide intervention: Explanation: The same occupational therapist applied Kinesio Taping to all participants. This therapist was not involved in the assessment phase. Baseline equality: Explanation: Participants had a variety of conditions that affected their baseline functioning before the intervention. MEASURES AND OUTCOMES Measure 1: Melbourne Assessment of Unilateral Upper Limb Function Name/type of measure used: What outcome is measured? Is the measure reliable (as reported in the article)? Is the measure valid (as reported in the article)? When is the measure used? The Melbourne Assessment was developed to measure function among children with cerebral palsy to score the quality of upper extremity function. The assessment is based on 16 criterionreferenced items, including movements involving reaching, grasping, drawing, release, manipulation, pointing, and hand-to-hand transfer. The quality of upper extremity function, including reach, grasp, release, and manipulation Not Reported Not Reported Administered pretape, posttape, and at the follow-up meeting after 3 days of wearing the tape MEASUREMENT BIASES
Were the evaluators blind to treatment status? Explanation: Only one group participated in this study; there was no control group. Was there recall or memory bias? Explanation: There were not any components requiring recall or memory. Other measurement biases: (List and explain) N/A RESULTS List key findings based on study objectives: The functional status of the upper limb was improved after application of the Kinesio Tape, as measured by the Melbourne Assessment. Raw score means for the Melbourne Assessment showed statistical significance regarding improvements from the pretest to the posttest (p <.02) as well as over the 3-day period (p <.001). Was this study adequately powered (large enough to show a difference)? Explanation: No power analysis was reported in the study. Were the analysis methods appropriate? Explanation: The researchers used analysis of variance to compare the measures from the pretest, immediately after intervention, and the posttest. Were statistics appropriately reported (in written or table format)? Explanation: A small table was provided with means and standard deviations for three measurements of the Melbourne Assessment. These statistics were the most appropriate to be reported. Was participant dropout less than 20% in total sample and balanced between groups? YES NO Explanation: No participants dropped out of the study. What are the overall study limitations?
This pilot study included a small sample size with no control group. Without a control group, it is difficult to attribute the observed improvements in the Melbourne Assessment measures to only the Kinesio Taping intervention. These findings were based on one trial with Kinesio Taping after 3 days, which is not long enough to support this as a common intervention. Therefore, therapists must use caution when using Kinesio Tape with pediatric patients until stronger evidence is available. CONCLUSIONS State the authors conclusions related to the research objectives. The authors concluded that Kinesio Tape may be associated with upper extremity function and control improvements in an acute pediatric rehabilitation setting. This work is based on the evidence-based literature review completed by Amy Bercovitz, BS, OTS; Brooke Stamper, BA, OTS; and Martina Allen, OTD, OTR, faculty advisor, Indiana University. CAP Worksheet adapted from Critical Review Form Quantitative Studies. Copyright 1998 by M. Law, D. Stewart, N. Pollack, L. Letts, J. Bosch, and M. Westmorland, McMaster University. Used with permission. For personal or educational use only. All other uses require permission from AOTA. Contact: www.copyright.com