|Year : 2023 | Volume
| Issue : 1 | Page : 32-36
Comparison of two thoracic kinesio-taping techniques on pulmonary function, oxygen saturation, and exercise capacity in COPD patients: A randomized clinical trial
BR Ganesh1, N Praneetha2, Varun Naik2
1 Department of Physiotherapy, Assam Down Town University, Assam, India
2 Department of Cardiovascular and Pulmonary Physiotherapy, KLE Institute of Physiotherapy, Belagavi, Karnataka, India
|Date of Submission||26-Oct-2022|
|Date of Decision||06-Apr-2023|
|Date of Acceptance||17-Jul-2023|
|Date of Web Publication||11-Aug-2023|
B R Ganesh
Department of Physiotherapy, Assam Down Town University, Guwahati, Assam
Source of Support: None, Conflict of Interest: None
Context: Chronic obstructive pulmonary disease (COPD), though a disease of the lung, the extrapulmonary manifestations contribute significantly to morbidity and mortality.
Aim: This study aims to evaluate and compare the effects of two different thoracic kinesio taping techniques on pulmonary function, oxygen saturation, and exercise capacity in patients with COPD.
Settings and Design: A randomized clinical trial was conducted across tertiary health-care hospitals in Belagavi, Karnataka.
Subjects and Methods: A total of 42 participants aged 30–65 years (51.58 ± 10.21 years) participated in the study. All participants underwent baseline evaluations for pulmonary function, oxygen saturation, and exercise capacity, following which they were randomly allocated to one of the two intervention groups. Both groups, Group A (diaphragmatic taping) and Group B (intercostal muscle taping), were given intervention for 15 days, with the applied tape changed on every 3rd day. Postintervention evaluation was performed on the 15th day.
Statistical Analysis: Mann–Whitney test was used for between-group comparison, and the Wilcoxon test was used for within-group comparison.
Results: A significant improvement was noted in all parameters in Group A except forced expiratory volume in 6 s (FEV6) (P = 0.47) and FEV1/FEV6 (P = 0.301) ratio when compared with preintervention values. In Group B, all the parameters showed a significant improvement compared to preintervention values. The between-group comparison showed that only FEV1/FEV6 (P = 0.018) ratio showed a significant improvement.
Conclusion: There is no significant difference between diaphragmatic taping and intercostal muscle taping technique. It was noted that both the techniques were equally effective in improving pulmonary function, oxygen saturation, and exercise capacity in COPD patients. Hence, thoracic kinesio taping, in addition to conventional physiotherapy treatment, can help in achieving better patient outcomes.
Keywords: Chronic obstructive pulmonary disease, Exercise capacity, Oxygen saturation, Pulmonary function, Thoracic kinesio taping
|How to cite this article:|
Ganesh B R, Praneetha N, Naik V. Comparison of two thoracic kinesio-taping techniques on pulmonary function, oxygen saturation, and exercise capacity in COPD patients: A randomized clinical trial. Indian J Phys Ther Res 2023;5:32-6
|How to cite this URL:|
Ganesh B R, Praneetha N, Naik V. Comparison of two thoracic kinesio-taping techniques on pulmonary function, oxygen saturation, and exercise capacity in COPD patients: A randomized clinical trial. Indian J Phys Ther Res [serial online] 2023 [cited 2023 Oct 1];5:32-6. Available from: https://www.ijptr.org/text.asp?2023/5/1/32/383675
| Introduction|| |
Chronic obstructive pulmonary disease (COPD) continues to be a major health concern worldwide. The characteristic features of COPD are chronic and persistent limitation to airflow. Among the various causative factors of COPD, smoking is the most common, followed by passive smoking, inhalation of organic and inorganic fumes, chemical agents, outdoor air pollution, and occupational dust. The presenting symptoms of COPD are often progressive dyspnea, cough, and sputum.
Dyspnea is termed as the uncomfortable feeling and difficulty experienced, which makes an individual aware of breathing. Altered breathing mechanics due to the pathological changes that take place in the lungs with the progression of the disease results in dyspnea which is most evident during exertional activities. Hyperinflation is defined as an increase in the volume of air that remains after a spontaneous expiration. Dynamic hyperinflation is common and has a significant effect on the exercise capacity of an individual.,
Exercise capacity can be termed as the maximum ability of a person to sustain physical exertion. Factors that limit exercise capacity differ for each person depending on the age, gender, general health status, and the severity of a disease, if any present. Hyperinflation in COPD occurs due to the expiratory flow limitations combined with the loss of the elastic recoil of the lung. Dynamic hyperinflation occurs when the ventilatory demand increases, leading to an increase in the tidal volume and respiratory rate. This increasing dynamic hyperinflation further triggers dyspnea, resulting in increased inactivity and fatigue. This inactivity and fatigue have a significant effect on the exercise capacity of an individual, with the current literature suggesting that therapeutic interventions employed toward this hyperinflation may lead to better exercise tolerance.
At present, the most effective non-pharmacological treatments for enhancing exercise capacity, alleviating breathlessness, and sustaining the overall health of COPD patients involve pulmonary rehabilitation. This rehabilitation approach includes exercise training, inspiratory and expiratory muscle training, airway clearance techniques, and a variety of breathing exercises.,
Among the various advancements and new evidence-based treatment strategies being employed in patient care, a novel technique is kinesio taping. Kinesio taping is a novel technique being used in the management of respiratory and postsurgical conditions. This technique is currently popular and effective in managing various sports and musculoskeletal-related conditions and also for pain management. Limited literature, which explores the effectiveness and utility of kinesio taping in respiratory conditions, suggests that it is accountable for improvements in pulmonary function but has no significant effect on respiratory muscle strength.,,,,
Previous studies conducted show conflicting results on the effectiveness of thoracic kinesio taping, which necessitate further investigation into the same. Moreover, to date, there is a paucity of studies available comparing the effects of two different thoracic kinesiology taping techniques. Hence, this study has been taken up to determine the difference between two thoracic kinesiology taping techniques on pulmonary function, oxygen saturation, and exercise capacity in COPD patients.
| Subjects and Methods|| |
The present study was approved by the Institutional Ethical Committee and is registered in the Clinical Trials Registry of India with CTRI number “CTRI/2022/03/040743.” The trial was a single-center study conducted at a tertiary care hospital in Belagavi, Karnataka. A total of 42 participants took part in the study. The inclusion criteria included all genders aged between 30 and 65 years, with a diagnosis of COPD for a minimum of 1 year of Stages 1 and 2 according to the GOLD classification, being able to comprehend instructions and being cooperative and willing to participate in the study. Participants having sensitive skin, scars, lesions, and wounds at the site of application, uncontrolled diabetes, diagnosed cases of malignancy, pregnancy, deep-vein thrombosis, altered sensations, allodynia, and active infection were all excluded from the study. All the participants were given a brief description and demonstration of the testing procedures to be done in a language they understood.
Pre-treatment assessment of FEV1, FEV6, FEV1/FEV6 ratio for pulmonary function, peak expiratory flow rate, oxygen saturation, and exercise capacity was conducted using Vitalograph COPD6, the Rossmax Peak Flow Meter, portable pulse oximeter, and 6-minute walk test respectively. After these evaluations, the participants were randomly divided into two groups, Group A or Group B, using the envelope method. Group A was given the diaphragmatic taping technique, while Group B was given the intercostal muscle taping technique. Postintervention evaluation for pulmonary function, oxygen saturation and exercise capacity were done on the 15th day.
The intervention was given for 15 days following, with the change of the applied tape on every 3rd day. A total of five sessions of kinesio taping were given in addition to conventional physiotherapy treatment of deep breathing exercises.
The Nitto Kinesiology Tape (Nitto Denko Corporation, Japan) was used (blue, pink, and skin color). Group A was given a diaphragmatic taping technique. The patient was seated in a chair without backrest and feet resting on the ground. One “I” shaped kinesio tape was applied anteriorly on the xiphoid process with 50%–75% tension and the tails of the tape were applied toward subcostal curvature with no tension. Posteriorly, a second “I” shaped kinesio tape was applied from the back. The base point of the tape was applied on the projection of the 12th thoracic vertebra with 50%–75% tension and the tails were applied toward the ribs without any tension.,
Group B was given an intercostal muscle-taping technique. The patients were seated on a chair. When the patient was at the end of the expiration, an “I” shaped kinesio tape was applied bilaterally on the fifth to sixth and ninth to tenth intercostal muscles transversally and on the anterior and posterior axillary line longitudinally with 50% tension.
Data were analyzed using the SPSS version 23 (armonk, Newyork, USA) software for Windows. The Kolmogorov–Smirnov normality test was used to determine if the data set was normally distributed. Mann–Whitney test was used for between-group comparison, and the Wilcoxon test was used for within-group comparison. The results were considered if P < 0.05.
| Results|| |
A total of 42 participants (24 males and 18 females, [Table 1] with a mean age of 51.3 ± 10.21 years participated in the study. The mean age, height, weight, and body mass index (BMI) of Group A are 55.14 ± 8.81 years, 159.95 ± 5.75 cm, 62.86 ± 8.17 kg, and 24.52 ± 2.83 kg/m2, respectively. The mean age, height, weight, and BMI of Group B are 47.62 ± 10.32 years, 161.81 ± 7.22 cm, 61 ± 7.59 kg, and 23.28 ± 2.43 kg/m2, respectively.
[Table 2] presents the within-group comparison for Group A, where it can be noted that a significant improvement is seen in the postintervention values for the FEV1, oxygen saturation, and exercise capacity. The within-group comparison for Group B is presented in [Table 3], and it is observed that a significant difference in the postintervention values is noted for all parameters being evaluated. Upon between-group comparison, the FEV1/FEV6 ratio was the only parameter that showed a significant difference in the postintervention values presented in [Table 4].
|Table 2: Within-group comparison for Group A: Diaphragmatic taping technique|
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|Table 3: Within-group comparison for Group B: Intercostal muscle taping technique|
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| Discussion|| |
The aim of this study was to compare the effects of two different thoracic kinesio-taping techniques. The results of our study suggest that kinesio taping was effective in improving pulmonary function, oxygen saturation, and exercise capacity in COPD patients.
The origin of kinesio taping is from Japan which was developed by Dr. Kenso Kase. It is based on the body's natural healing processes and arises from the science of kinesiology, which recognizes the importance of the muscles and movement for rehabilitation and in everyday life. Kinesio taping as an adjuvant to the standard therapeutic treatment is being explored with keen interest. Its application and benefits in the current literature suggest that it is effective in the management of various sports, muscular, and a few neurological and pediatric conditions.
The current study employed kinesio taping with interest in evaluating its effects on the pulmonary function using the FEV1, FEV6, FEV1/FEV6 ratio, PEFR, and oxygen saturation parameters, the results of which denote improvements postintervention when compared to the preintervention values. However, there was no significant difference noted in the FEV6 (P = 0.47) and FEV1/FEV6 (P = 0.301) ratio values when compared within Group A, which received diaphragmatic taping. Group B, on the contrary, which received intercostal muscle taping, showed a significant improvement in all four parameters used to assess pulmonary function when compared within the group.
The thoracic kinesio taping aims at promoting expiratory ventilation. This is accomplished by applying the tape around the outer edges of the thorax, following its natural movements during inhalation. As the individual exhales, the tape's elastic nature assists the expiration process by offering a counterbalancing effect., This mechanism of the tape properties may have resulted in the significant improvements noted in the postintervention values. However, no significant difference was noted when the comparison was performed between the groups [Graph 1]. These findings are in agreement with the findings of the study conducted by Metin et al., where they employed an intercostal muscle-taping technique and found significant improvements in the spirometry values postintervention.
Oxygen saturation is the measure of the amount of hemoglobin that is bound to oxygen compared to the amount of hemoglobin that remains unbound and is usually measured using a pulse oximeter. As shown in [Table 2] and [Table 3], a significant improvement is seen in the oxygen saturation when a comparison was made within the group. When between-group analysis [Table 4] was performed, no significant difference was seen in the effects of one intervention over the other. Daitx et al. concluded, in their study, that the application of kinesio taping in conjunction with physiotherapy improved the oxygen saturation of nonhypoxemic patients with COPD exacerbation.
Exercise capacity is largely affected due to the extrapulmonary manifestation of COPD, which, combined with the increasing dynamic hyperinflation, leads to further worsening of exercise capacity. The results of the present study suggest that a significant improvement was seen in the exercise capacity expressed as the improved 6-min walk distance in both the groups when compared within the groups. However, the improvements noted [Graph 2] do not differ significantly when between-group comparison was performed. Hombrados-Hernández et al., in their study, explored the effects of the diaphragmatic taping technique on the 6-min walk distance, where the immediate effect was assessed and concluded that kinesio taping did not have a significant effect in improving the performance in the 6-min walk test. Murat Tomruk et al., in their study, suggested that the improved 6-min walk distance may be due to the reduced severity of dyspnea and fatigue following kinesio tape application following a 6-week long protocol.
The results of this study suggest that thoracic kinesio taping helps improve pulmonary function, oxygen saturation, and exercise capacity when given as an adjunct to standard physiotherapy treatment. However, the results suggest that there is no significant difference between the diaphragmatic and intercostal muscle-taping techniques.
| Conclusion|| |
The findings of our study suggest that there was no significant difference in the effects of the diaphragmatic taping technique when compared to the effects of the intercostal muscle taping technique. The addition of thoracic kinesio taping to the standard physiotherapy treatment protocol should be considered for better results and improved overall condition of the patients suffering from COPD.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]