Section: Systematic Review. Article Title: Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabi...
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“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabilitation © 2016 Human Kinetics, Inc.

Note: This article will be published in a forthcoming issue of the Journal of Sport Rehabilitation. The article appears here in its accepted, peer-reviewed form, as it was provided by the submitting author. It has not been copyedited, proofed, or formatted by the publisher.

Section: Systematic Review Article Title: Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review Authors: Konstantinos Fousekis1, Evdokia Billis1, Charalampos Matzaroglou1, Konstantinos Mylonas2, Constantinos Koutsojannis, and Elias Tsepis1 Affiliations: 1Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece, Egio, Greece. 2Clinical and Sports Physiotherapist, Egio, Greece. Running Head: Elastic bandaging in sports and orthopedics Journal: Journal of Sport Rehabilitation Acceptance Date: May 24,2 016 ©2016 Human Kinetics, Inc.

DOI: http://dx.doi.org/10.1123/jsr.2015-0126

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabilitation © 2016 Human Kinetics, Inc.

Elastic bandaging for orthopedic and sports injuries prevention and rehabilitation: a systematic review.

Running title: Elastic bandaging usage in orthopedics Konstantinos Fousekis PhD,1 Evdokia Billis PhD,1 Charalampos Matzaroglou MD, PhD,3 Konstantinos Mylonas PT,2 Constantinos Koutsojannis, Elias Tsepis, PhD.4

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1. Assistant Professor in Physiotherapy, Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece. Egio 25100, Greece. 2. Clinical and Sports Physiotherapist, Egio 25100, Greece 3. Assistant Professor in Orthopedics and Traumatology, Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece. Egio 25100, Greece. 4. Associate Professor of Physiotherapy, Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece. Egio 25100, Greece.

Author contributions: All authors contributed almost equally to this work; Konstantinos Fousekis, Charalambos Matzaroglou, Evdokia Billis and Elias Tsepis designed the research; Konstantinos Fousekis, Konstantinos Mylonas and Charalambos Matzaroglou performed the research; Konstantinos Fousekis and Konstantinos Mylonas analyzed the data and all authors together wrote the paper.

Correspondence to: Konstantinos Fousekis, PT, PhD, Assistant Professor in Physiotherapy, Department of Physiotherapy, Technological Educational Institute (TEI) of Western Greece , Egio, Psaron 6, PC:25100, Greece, e-mail: [email protected] Telephone: +003 02691022058, Fax: +oo3 026910-61250

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabilitation © 2016 Human Kinetics, Inc.

Abstract Context: Elastic bandages are commonly used in sports to treat and prevent sports injuries. Objective: To conduct a systematic review assessing the effectiveness of elastic bandaging in orthopedic and sports injuries prevention and rehabilitation. Evidence Acquisition: We searched the following electronic databases: MEDLINE, CINAHL, SPORTDiscus, EMBASE and Physiotherapy Evidence Database (PEDro), with key words ‘elastic bandaging’ in combination, respectively, with (1) first aid, (2) sports injuries, (3) orthopedic injuries and (4) sports injuries prevention and rehabilitation. Research studies were selected based upon the use of the term ‘elastic bandaging’ in the abstract. Final selection was made by applying inclusion and exclusion Downloaded by on 01/15/17, Volume 0, Article Number 0

criteria to the full text. Studies were included if they were English, peer-reviewed clinical trials on the effects of elastic bandaging for orthopedic injuries prevention and rehabilitation. Evidence Synthesis: Twelve studies met the above criteria and were included in the final analysis. Data collected included number of participants, condition being treated, treatment used, control group, outcome measures and results. Studies were critically analyzed using the PEDro scale. Conclusions: The studies in this review fell into two (2) categories: studies in athletes (N=2) and non-athletes (N=10). All included trials had moderate-to-high quality, scoring (≥5 on the PEDro scale). The PEDro scores for the studies in athletes and non-athletes ranged from 5 to 6 out of 10 and from 5 to 8 out of 10, respectively. The quality of studies was mixed, ranging from higher to moderate methodological quality clinical trials. Overall, elastic bandaging can assist proprioceptive function of knee and ankle joint. Because of the moderate methodological quality and insufficient number of clinical trials, further effects of the elastic bandaging could not be confirmed. Key words: Elastic bandaging, injury prevention and rehabilitation, orthopaedics, sports physiotherapy

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabilitation © 2016 Human Kinetics, Inc.

Context The term sports taping is used to describe various techniques for supporting an anatomic region of an athlete with the usage of a fabric tape which either wrapped around an anatomical structure (e.g. joint) or is affixed on it (e.g. skin-muscle). The need for supporting an anatomical region is based on creating conditions for orthopedic injuries prevention and protection as well as for adequate control of an acute injury in terms of edema formation reduction and joint immobilization. 1-5

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The epidermal material used for sports taping is divided into three (3) types and respective techniques: a) the ‘elastic non-adhesive bandaging’ (ENAB) using elastic bandages (bandage), b) ‘taping’ using non-elastic adhesive bandage (tape), and c) ‘kinesiotaping’ using elastic adhesive tape (kinesiotape-elastic adhesive tape). 6 All three (3) types of sports taping are applied a) in joints with functional deficits due to previous injuries, and b) in myodermal structures for better proprioceptive activation and neuromuscular control or better metabolic function. In both cases, sports taping can increase the athlete’s sense of safety as it enhances joints stability and reduces occurrence of injuries.6-8 Although taping and kinesiotaping are the predominant therapeutic techniques used in orthopedic and sports rehabilitation,

9-12

ENAB is used a) for compression of an anatomic

region,13 b) for decreasing or accelerating the time needed to achieve maximal joint range of motion (ROM),13 c) to support other rehabilitative equipments such as cold-packs,14 and d) for partial or total joint immobilisation.15 ENAB is also extensively used in treating sports injuries in the acute stage and particularly during the first 48 hours of an injury. Bandaging of the injured area may limit damage only to the tissue already affected and prevent possible hypoxic damage

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabilitation © 2016 Human Kinetics, Inc.

of surrounding tissues. Furthermore, compression produced by the elastic bandage increases tissue pressure thereby reducing excessive oedema and hematoma formation. For this purpose ENAB can also be used in combination with other therapeutic interventions such as cryotherapy.16 Applications of ENAB are also common in post-operative rehabilitation because of their contribution in intra-articular bleeding elimination and analgesia.17,18 Additionally, compression of the extremities via elastic bandaging also increases venous return in patients with abnormal flow. 19,20

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Despite the clear supremacy of other taping techniques (taping-kinesiotaping) in terms of improving joint neuromuscular control and stability, 9-12 ENAB is used by many athletes both amateur and professional ones for injury prevention.13,21,22 On that basis, it has been reported that ENAB can improve position sense of a) of the knee in non-athletes 23 and in healthy dance athletes, 24 and b) the elbow in non-injured males. 25 Nevertheless, although a body of research exists regarding the potential efficacy of ENAB for either prevention or treatment of sports injuries, there has not yet been a systematic review of this literature, exploring ENAB's true clinical efficacy. Objective The purpose of this systematic review was to critically analyze previously published literature to determine the documented effectiveness of ENAB both as a preventative means and as a treatment strategy for orthopedic and sports injuries.

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabilitation © 2016 Human Kinetics, Inc.

Evidence Acquisition Published studies relating to ENAB were identified using a computerized literature search in PubMed, Sportdiscus, EMBASE, CINAHL and Physiotherapy Evidence Database (PEDro). Three (3) reviewers (KF, KM,CM) performed independent searches in February 2015. Keyword used in the search was “elastic bandaging” in combination with respectively “firstaids”, “sports injuries”, “orthopedic injuries” and “sports injuries prevention and rehabilitation”. Reference lists of identified studies were also evaluated for relevant literature.

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The lists were compared, and articles identified by the three reviewers were collected in full text. The initial search using multiple combinations of these key words resulted in 96 studies. The three (3) reviewers (KF, KM and CM) screened the full-text articles for inclusion in the review based on a set of inclusion and exclusion criteria. Inclusion criteria were as follows: studies (1) published in a peer-reviewed journals, (2) containing sufficient data to critically appraise the study according to PEDro criteria, (3) including, the use of ENAB as a treatment method (4) being published in English, (5) addressing treatment for an orthopedic condition, (6) involving adults. Pilots and case studies were not included in the analysis. A total of 12 research articles 18,24-34 met the inclusion criteria and were reviewed (Figure 1). The three reviewers assessed all selected studies for methodological quality according to standardized PEDro scale (Table 1). The PEDro scale is an evaluation checklist developed for the Physiotherapy Evidence Database by the Centre for Evidence-Based Physiotherapy.

35

This

scale examines quality based on 11 criteria, 10 of which are scored. Points were summed and presented as a score out of 10. For this review, investigations with PEDro scores of 6 and over out of 10 were considered of high quality, 4 to 5 of moderate quality, and 0 to 3 were

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabilitation © 2016 Human Kinetics, Inc.

considered of low quality. The PEDro scale examines mainly the internal validity and interpretability of the studies and not their clinical utility. All reviewers were unaware of each other’s results until all studies were independently assessed. Agreement upon the final score was achieved through discussion amongst the 3 reviewers. Levels of Evidence and Strength of Recommendation The level of evidence for the included studies and strength of recommendation for the

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use of ENAB in sports injuries prevention and rehabilitation was determined using the criteria suggested by the Oxford Center for Evidence Based Medicine. 36 Evidence Synthesis A total of 12 research articles were reviewed.

18,24-34

Summary of included studies is

presented in Table 2. The studies in this review included both, athletes 18,24,25,27-34

26,34

and non-athletes.

All included trials were of moderate-to-high quality, scoring an average PEDro score

of 5.6 on the PEDro scale (Table 3). The PEDro scores for the studies in athletes and nonathletes ranged from 5 to 6 out of 10 and from 5 to 8 of out of 10, respectively. RCT: Randomised Control Studies, CT:Clinical Trials, ENAB: Elastic non-adhesive bandaging, IPC: Intermittent pneumatic compression, OA: Osteoarthritis, VAS: Visual analogue scale, ACL: Anterior cruciate ligament, ROM: Range of motion Effects of ENAB in functional outcome after musculoskeletal-sports injury Four of the selected papers studied the effects of ENAB on functional outcomes in patients after sports injuries.

18,26-28

Gunay et al

26

evaluated the effect of using Aircast®

orthosis and ENAB application on the physical performance of 60 elite male football players

“Elastic Bandaging for Orthopedic and Sports Injuries Prevention and Rehabilitation: A Systematic Review” by Fousekis K et al. Journal of Sport Rehabilitation © 2016 Human Kinetics, Inc.

with ankle injuries. Battery of tests used included examination of ankle ROM, one maximum repetition test for the ankle dorsal and plantar flexors, fingertip rise test, jump tests and 10step/sec test. Their results showed that ENAB restricted non-weight bearing ankle dorsi/plantar flexion ROM by 9.85±3.74 degrees (p

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