International Journal of Therapies and Rehabilitation Research [E-ISSN: 2278-0343] http://www.scopemed.org/?jid=12

IJTRR 2015, 4: 5 I doi: 10.5455/ijtrr.00000098

Original Article

Open Access

Effect of kinesio taping on pain post laporoscopic abdominal surgery: randomized controlled trial Sayed A. Tantawy1, Dalia M. Kamel2 ARTICLE INFO

ABSTRACT

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Purpose to investigate the effect of Kinesio® Tex Taping on pain and physical tolerance post laporoscopic abdominal surgery. Subjects& Methods: 65 Patients with recent abdominal surgeries were recruited and randomly divided into 2 groups: the study group (n= 32), received kinesiology taping applied immediately postoperatively and changed every 48 hours until the 8th day postoperatively in addition to the standard postoperative care. While the control group (n= 33) received the standard postoperative care only. The measurements of pain numerical rating scale, visual analogue scale, and 2 minutes’ walk test were taken after the first, third and eighth days. While, patient’s global impression of change was taken only at the eighth day. Results: both study and control groups revealed a highly significant differences of the first 3 parameters between the first& third and third & eight days (P< 0.05). Between groups, the first day showed that there was non-significant difference. The third and eighth days showed highly significant differences (P< 0.05). Patient’s global impression of change showed a highly significant difference between the study and control groups on the eight’s day (P< 0.005). Conclusion: the data suggest that the kinesio taping is very effective in treating postoperative abdominal pain.

Article History: Received: Sep 07, 2015 Accepted: Oct 07, 2015 Published: Oct 10, 2015

____________________________ Key Words: Kinesio taping, Postoperative pain, abdominal surgery

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AUTHORS AFFILIATIONS 1Sayed

A Tantawy: Department of Physiotherapy, Center of Radiation, Oncology and Nuclear Medicine, Cairo University Hospitals, Cairo University, Egypt Dalia M. Kamel: Department of Physical Therapy for obstetrics & Gynecology. Faculty of Physical Therapy, Cairo University, Egypt. Department of Physiotherapy, College of Medical Health& Sciences, Kingdom of Bahrain Corresponding Author: Sayed A. Tantawy Email: [email protected]

INTRODUCTION Major abdominal surgeries induce neuro- humoral changes responsible for postoperative pain, various organ dysfunctions and prolonged hospitalization. Inadequate pain control is harmful and costly thus an appropriate pain therapy must be used to those patients 1. Many studies concluded that postoperative pain is one of the most common therapeutic problems in hospitals 2-4. It can increase morbidity, leading to reduced breathing and cough suppression, facilitating retained pulmonary secretions and pneumonia 5, and delaying normal gastric and bowel function 6, thus contributing to a longer recovery period 7. There are many medical and complimentary strategies aim to reduce postoperative pain, increase patients’ comfort and may shorten hospital stay, although this has not been shown by compelling evidence. Pain is not an unavoidable consequence of surgery, in the majority of patients postoperative pain is preventable with adequate analgesics and by the appropriate use of newer techniques 7, 8. A number of surveys have shown a

Tantawy S et al., International Journal of Therapies and Rehabilitation Research 2015; 4 (5): 250-255

high prevalence of significant pain after surgery 9, 10. The recognition of the inadequacy of postoperative pain management has prompted the development of corrective efforts by surgeons, anesthesiologists 11, 12, and pain management groups 13. In physiotherapy, there are many techniques and modalities can be used to manage both acute and chronic pain of various origins. One of the newer interventions is the Kinesio® Tex tape (KTT), which is a commonly used intervention in the management of a number of clinical conditions as well taping is purported to facilitate and inhibit muscle activity 14. Despite conflicting evidence regarding its efficacy, taping continues to be a widely used therapeutic intervention 14. KTT mimics the thickness and flexibility of the skin. KTT claims to aid the muscle and lymphatic systems and provide mechanical support without restricting movement in contrast with standard rigid taping techniques. According to the manufacturers of KTT, the tape causes micro convolutions, or folds, in the skin which causes a lifting of the skin away from the tissue beneath. This facilitates a release in pressure on tender tissues underneath and provides space for lymphatic fluid movement. It is claimed that this can help relieve pain, prevent over-contraction, facilitate lymphatic drainage, and improve joint position and kinesthetic awareness 15. Further to our knowledge, the data to support using KTT for postoperative pain is so limited so it needs more researches to be done and that was our aim in this study to investigate the effect of KTT on postoperative pain after various abdominal surgeries.

Material and Methods 65 Patients (35 females, 30 males) underwent abdominal laparoscopic operations (cholecystectomy and appendectomy) recruited from the general surgery department at Al Kaser Al Aini University Hospital. The hospital’s ethical committee approved the study. The patients, approval consents were obtained to participate in the study. All the volunteered patients were randomly divided into two groups, fig. 1. Study group (n= 32), they received a clear explanation about the taping procedures, that was applied immediately postoperatively and changed every 48 hours until the 8th day postoperatively in addition to the standard postoperative care. The control group (n= 33) received the standard postoperative care. Inclusion criteria were age between 30 – 50 years old, underwent laparoscopic cholecystectomy or appendectomy. While the exclusion criteria were age below 30 or above 50, cardiopulmonary chronic diseases, diabetes, and postoperative complications (e.g. fever, wound infection...). I-

The assessment tools: 12-

Pain numerical rating scale Visual analogue scale (VAS)

34-

2 minutes walk test Patient’s global impression of change (PGIC)

The first three out comes were done the first, third, and eighth day postoperative. The PGIC was done only at the eighth day postoperative. 1- Pain numerical rating scale (PNRS) It is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0–10 integers) that best reflects the intensity of their pain16. The common format is a horizontal bar or line17. Similar to the pain VAS, the PNRS is anchored by terms describing pain severity extremes 16. PNRS is a valid test and has test- retest reliability in both literate and illiterate patients18. 2- Visual analogue scale It is self-completed by the respondent. It is 10 cm (i.e.100 mm) line and the patient was asked to place a line perpendicular to the VAS line at the point that represents their pain intensity. A higher score indicates greater pain intensity. Based on the distribution of pain VAS scores in postsurgical patients who described their postoperative pain intensity as none, mild, moderate, or severe, the following cut points on the pain VAS have been recommended: no pain (0–4 mm), mild pain (5–44 mm), moderate pain (45–74 mm), and severe pain (75– 100 mm) 19. 3- 2 minutes’ walk test (2MWT) The individual walks without assistance for 2 minutes and the distance is measured. If physical assistance is required to walk, this should not be performed. Patient Instructions (quoted from Rossier & Wade, 200120): “Cover as much ground as possible over 2 minutes. Walk continuously if possible, but do not be concerned if you need to slow down or stop to rest. The goal is to feel at the end of the test that more ground could not have been covered in the 2 minutes.” It was found that 2MWT was sensitive to change after cardiac surgery and showed moderate correlation with measures of physical functioning in this population 21. 4-Patient’s global impression of change (PGIC) It was done at the 8th day postoperative to assess the patient’s overall perception about his/her status since underwent the surgical procedure 22. 1 Very Much Improved 2 Much Improved 3 Minimally Improved 4 No Change 5 Minimally Worse 6 Much Worse 7 Very Much Worse

Tantawy S et al., International Journal of Therapies and Rehabilitation Research 2015; 4 (5): 250-255

II- Treatment intervention 1-Kinesio Taping Applications Applied immediately after surgery, patients from the study group were given the following KT applications: (1) Muscle inhibition application—on external abdominal oblique muscles on the left side; (2) Muscle facilitation application—on internal abdominal oblique muscles on the right side; (3) Fascial application on the liver area / intestinal area23. All the collected data were inserted in the SPSS to apply both descriptive and inferential statistical analysis. One way ANOVA was used to compare the outcomes within groups while paired t-test was used to compare the outcomes between groups. The level of significances was at 0.05.

explanations to this reduction are, Kinesio Tape’s elasticity creates skin folds which can lift the skin to increase space between skin and muscle to improve circulation of blood and lymph. Since this space contains a variety of nerve receptors that send specific information to the brain. Kinesio tape modulates the information that is sent by the receptors to the brain and makes less reactive responses in the body. This process allows the body to have an adaptive normal function by moving out of the barriers which naturally slow down the recovery process 24. In addition taping activates neurological suppression in order to reduce pain and increase joint range of motion25. Also kinesio tap lift the fascia and soft tissue above the areas of pain, align fascial tissues and provide positional stimulus through the skin 25. Yoshida and Kahanov 26 also stated that Kinesio tape is to decrease pain by stimulating the neuromuscular system; assists in restoration of proper muscle function and realignment of joints as a result of injury or disease. Finally, Kinesio tape enhances comprehensive body function by improving the flow of blood and lymphatic fluid throughout the body.

Results 65 Patients (35 females, 30 males) were participated in the current study with the mean age (40.83± 5.99). They underwent different laparoscopic abdominal surgeries; the study group (15 appendicectomy, 14cholecystectomy) and the control group (17 appendicectomy, 13cholecystectomy). Regarding VAS, both study and control groups showed within groups a highly significant difference on VAS between the first& third and third & eight days (P< 0.0001& F= 18.52) and (P< 0.0001& F=10.12) respectively. While between groups, the first day showed nonsignificant difference (P> 0.70). Both third and eighth days showed significant difference (P< 0.0001). In addition, Pain numeric rating scale, the study and control groups revealed highly significant differences between the first& third and third & eight days (P< 0.0001& F=91.20) and (P< 0.0001& F=78.30) respectively. While results between groups showed in table (1) Furthermore, the 2 minutes walking test, within groups both study and control showed highly significant differences between the first& third and third & eight days (P< 0.001), fig. (2). While results between groups showed in table (1) Lastly, Patient’s global impression of change (PGIC) revealed a highly significant difference between the study and control groups on the eight’s day (P< 0.005), table 2.

Another possible theory to be taken into account for the analgesic effects of KT is the gate control theory of pain modulation. The tape has been suggested to stimulate neuromuscular pathways via afferent feedback. Increased afferent stimulus to large-diameter nerve fibers might reduce pain perception level due to an input decrease from the small diameter nerve fibers conducting nociception 23, 27. Thelen et al. 28 refer to this theory in their work on KT applications in shoulder pain. Also, Gonz´alez-Iglesias et al.29 achieve pain-relief effects of KT applications in patients with acute whiplash injury. Another hypothesis is that KTT relives pain because sensory modalities operate within interconnecting, intermodal and cross-modal networks30. the keratinocytes may be non-neural primary transducers of mechanical stimuli done by the KTT, so probably via a signal transduction cascade mechanism (e.g. intracellular Ca2+ fluxes) to evoke a response on adjacent Cfibers 31. Despite of not assessing the long lasting effect of KTT in the current study, but Castro-Sanchez et al. 32 approved that KTT has long-lasting which being sustained for four weeks after the end of the therapy. The mechanism by which one week of taping would cause a long-lasting reduction in pain is not clear. Perhaps the week of taping engendered a greater confidence and greater awareness of the back while moving, thus preventing movements that were detrimental to the healing of the affected lumbar tissues.

Discussion The current study showed significant (P< 0.0001) pain reduction in study group on both the VAS and NPRs and the possible Table 1. PNRS and 2 minutes walk test in both groups

Physiotherapy in patients after laparoscopic cholecystectomy (CHL) is impeded by postoperative pain which causes a decline

Tantawy S et al., International Journal of Therapies and Rehabilitation Research 2015; 4 (5): 250-255

PNRS

First day

Study Control

Third day Eight day 2 minutes walk test

First day

Study Control Third day Study Control Eight day Study Control Table 2. PGIC in both study and control groups.

Study Control

Figure1 the flow chart of the study

Mean (SD) 9.06 (0.75) 9.00 (0.74) 4.62 (0.77) 5.03 (0.80) 0.68 (0.71) 1.16 (0.74) 90.17 (3.08) 85.90 (16.48) 140.03 (4.18) 134.80 (4.29) 160.31 (4.81) 155.03 (3.93)

Mean (SD) 1.41 (0.50) 1.96 (0.88)

t-value - 0.37

P value 0.72

- 2.00

0.05*

-2.50

0.01*

1.37

0.17

4.73

0.001*

4.61

0.001*

t-value -2.92

P value 0.005

75 eligible patients underwent laparoscopic cholecystectomy/ appendectomy 6 decline to participate 2 above 50 years old 2 lack of patient consent

Control group (n=33)

Study group (n= 32)

Received the standard postoperative care only

Received kinesiotaping + the standard postoperative care

Follow up (n=30) *Developed fever 2nd day n=1 *Missed the 8th day assessment n=2

Follow up (n= 29) * Developed fever 2nd day n=1 * Developed skin itching from the tape n=1 *Missed the 8th day assessment n= 1

Assessment for both groups at 2nd, 3rd and 8th days postoperative 1- Pain numerical rating scale 2- Visual analogue scale (VAS) 3- 2 minutes walk test 4- Patient’s global impression of change (PGIC) only at the 8th day postoperative

Tantawy S et al., International Journal of Therapies and Rehabilitation Research 2015; 4 (5): 250-255

200 150 Study

100

Control

50 0 First day

Third day

Eighth day

Figure 2. Two minutes walk test between groups.

in patients’ activity, reduces respiratory muscles’ function, and affects patients’ ability to look after them. These previously mentioned problems were highlighted in the current study and another study done by Krajczy et al. 23 who reported that KT applications CHL had a significant influence on the decrease of pain perception level as well as an increase in effort tolerance and reduced the level of pain relief medicines’ consumption in comparison with patients from the control group. Further to our knowledge there were two studies 23, 27 reported the possibility of employing KT in post cholecystectomy surgery. So far, it has proved useful in stabilizing postoperative wounds. There is still lack of literature reports on analyzing the influence of KT on the subjective pain perception, effort tolerance in postsurgery patients. The current study showed that KT methods had a significant positive effect on the pain perception, effort tolerance and the patients, overall experience in post abdominal surgeries not only the CHL but also for the appendicectomy patients. It seems that KT, as a complement to complex physiotherapy, might contribute to faster regaining of independence in case of patients post abdominal surgeries and improve their quality of life.

Conclusion The current study revealed that KTT has a significant reduction in pain perception, increase the tolerance effort and improve the patient total experience. This gives a support for KTT in postoperative pain. We recommend further researches to apply KTT in another abdominal surgeries and assess another post operative complications as well apply KTT in post-thoracic surgeries.

Conflict of interest : The authors declare that there is no conflict of interest.

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