Physiotherapy Theory and Practice

An International Journal of Physical Therapy

ISSN: 0959-3985 (Print) 1532-5040 (Online) Journal homepage: http://www.tandfonline.com/loi/iptp20

Effects of Kinesio Taping on breast cancer-related

lymphedema: A meta-analysis in clinical trials

Karina Tamy Kasawara, Jéssica Monique Rossetti Mapa, Vilma Ferreira,

Marco Aurélio Nemitalla Added, Silvia Regina Shiwa, Nelson Carvas Jr &
Patricia Andrade Batista

To cite this article: Karina Tamy Kasawara, Jéssica Monique Rossetti Mapa, Vilma Ferreira,
Marco Aurélio Nemitalla Added, Silvia Regina Shiwa, Nelson Carvas Jr & Patricia Andrade Batista
(2018): Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis in clinical
trials, Physiotherapy Theory and Practice, DOI: 10.1080/09593985.2017.1419522

To link to this article: https://doi.org/10.1080/09593985.2017.1419522

Published online: 08 Jan 2018.

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PHYSIOTHERAPY THEORY AND PRACTICE
https://doi.org/10.1080/09593985.2017.1419522

REVIEW

Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis

in clinical trials
Karina Tamy Kasawara, PT, PhDa, Jéssica Monique Rossetti Mapa, PTb, Vilma Ferreira, PTb,
Marco Aurélio Nemitalla Added, PT, MScc,d, Silvia Regina Shiwa, PT, PhDd, Nelson Carvas Jr, MScb,e,
and Patricia Andrade Batista, PTb
a
Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil; bDepartment of Physical Therapy, Ibirapuera
University, São Paulo, Brazil; cDepartment of Physical Therapy, Santa Casa of São Paulo, São Paulo, Brazil; dDepartment of Physical Therapy,
Guarulhos University, Guarulhos, Brazil; eDepartment of Post-graduation, Institute of Medical Assistance to the State’s Public Service, São
Paulo, Brazil

ABSTRACT ARTICLE HISTORY

Background: Lymphedema is known as a secondary complication of breast cancer treatment, Received 16 August 2016
caused by reduction on lymphatic flow and lymph accumulation on interstitial space. The Kinesio Accepted 23 February 2017
Taping (KT) has become an alternative treatment for lymphedema volume reduction. The objec- Revised 27 January 2017
tive of the study was to evaluate the literature through a systematic review on KT effects on KEYWORDS
lymphedema related to breast cancer. Kinesio Taping; Neoplasm;
Methods: Search strategies were performed by the following keywords: “Kinesio Taping,” “Athletic Lymphedema; Mastectomy
Tape,” “Cancer,” “Neoplasm,” “Lymphedema,” and “Mastectomy” with derivations and different
combinations. The following databases were accessed: SCIELO, LILACS, MEDLINE via PubMed, and
PEDro, between 2009 and 2016. Studies published in English, Portuguese, and Spanish were
considered for inclusion. The studies’ methodological quality was assessed by the PEDro scale.
Results: Seven studies were identified by the search strategy and eligibility. All of them showed
positive effect in reducing lymphedema (perimeter or volume) before versus after treatment.
However, with no effects comparing the KT versus control group or others treatments (standar-
dized mean difference = 0.04, confidence interval 95%: −0.24; 0.33), the average score of the
PEDro scale was 4.71 points.
Conclusions: KT was effective on postmastectomy lymphedema related to breast cancer; how-
ever, it is not more efficient than other treatments.

Introduction Sunemi, 2015). The reduction in lymph transport that

Breast cancer is the most common cancer diagnosed in
women worldwide; in the United States, one in eight
women (12%) will develop invasive breast cancer during
her lifetime. In 2015, 231,840 new cases of invasive breast
cancer were expected to be diagnosed in American women
(U.S. Breast Cancer Statistics, 2016).
Mastectomies and other breast cancer therapies can
produce complications, such as infection, skin necrosis,
seroma, scar tissue adhesions, pain, motor or sensory
nerve damage, muscle weakness, a limited range of
motion (ROM), and lymphedema (Nascimento, De
Oliveira, De Oliveira, and Amaral, 2012).
The upper limb lymphedema that is associated with
breast cancer has a prevalence from 24% to 49% and
may be present immediately after surgery or arise years
after treatment. Most cases occur during the first
18 months after surgery (Pinheiro, Godoy, and
is often observed in the upper limb after breast cancer
surgery increases the risk of infection, fibrosis, com-
partment syndrome, skin changes, decreased sensitivity
and function, and functional morbidity in the affected
area (Leal, Dias, Carrara, and Ferreira, 2011). The pre-
sence of lymphedema can cause pain, swelling, and
weight gain in the affected limb as well as deformities
caused by the swelling, skin with an orange peel
appearance, and other secondary problems, such as
cellulitis and thrombosis, which may compromise the
affected limb’s functionality (Pinheiro, Godoy, and
Sunemi, 2015).
Treatment for lymphedema has traditionally
involved either drugs or physical therapy. Early and
appropriate treatment decreases the incidence of com-
plications and improves the prognosis of the clinical
status (Devoogdt et al., 2010). The International Society

CONTACT Karina Tamy Kasawara, PT, PhD karina.tamy@gmail.com Department of Obstetrics and Gynecology, University of Campinas, Campinas,
Brazil.
© 2018 Taylor & Francis
2 K. T. KASAWARA ET AL.
of Lymphology recommends complex decongestive
therapy (CDT), which includes lymphatic drainage
and elastic compression to improve lymphatic flow by
removing excess lymph tissue and maintaining a
reduced circumference of the region. Inelastic compres-
sion is done by wrapping the area in layers, performing
exercises that increase muscle activity and ROM, and
using the indicated skincare (Pinheiro, Godoy, and
Sunemi, 2015).
In addition to these traditional treatments, Kinesio
Taping (KT) has emerged as an alternative treatment
that can be added to CDT because the low pressure
produced by KT on the skin improves lymphatic flow
(Cendron, Paiva, Darski, and Colla, 2015). KT stimu-
lates dermal mechanoreceptors, promoting sensory and
mechanical stimuli; its active elastic acts upon the lym-
phatic system and reduces the congestion of lymphatic
flow in the area where it is applied, which decreases the
circumference of the affected limb (Pinheiro, Godoy,
and Sunemi, 2015). Therefore, the objective of this
study was to systematically review the literature and
evaluate the effects of KT on breast cancer-related
lymphedema.
Methods
This was a systematic review with a meta-analysis
regarding the effect of KT on lymphedema secondary
to mastectomy related to breast cancer. This systematic
review was registered at PROSPERO (http://www.crd.
york.ac.uk/prospero/): (CRD42015027023). All the
PRISMA standards (www.equator-network.org)
(Padula et al., 2012) and recommendations for systema-
tic review development were followed.
Eligibility criteria
Clinical studies of women diagnosed with lymphedema
following a mastectomy for breast cancer who also under-
went KT therapy were considered for inclusion. Exclusion
criteria were disregarded case reports and case series,
duplicate studies that were indexed in more than one of
the health science databases, and studies that used KT for
congenital or primary lymphedema related to types of
cancer other than breast cancer or lymphedema in the
lower limbs. Therefore, studies that were not related to the
proposed theme and did not present a comparison group
(i.e., control group or other treatment) were excluded.
Search strategy
To fulfill the purpose of this study, a search of scientific
articles in the following electronic databases was
performed: Scientific Electronic Library Online
(SCIELO), Latin American and Caribbean Health
Sciences (LILACS), Medical Literature Analysis and
Retrieval System Online (MEDLINE) (accessed via
PubMed), and the Physiotherapy Evidence Database
(PEDro) from 2009 to 2016. In addition, a manual
search of the references from already published studies
was conducted to identify scientific studies related to
the topic of this systematic review. The full search
strategies used in the mentioned databases are shown
in Table 1. Studies were selected in the English,
Portuguese, and Spanish languages.
Study selection and data extraction
In the first stage of the study selection, two authors
independently performed the search in the databases
(KTK and JMRM) and reviewed the titles and summa-
ries of articles identified by the search strategies. The
complete article was assessed for abstracts that did not
provide sufficient information about the proposed
theme. During the second phase, the same reviewers
independently assessed the full articles and made their
selections according to the eligibility criteria.
The same reviewers worked independently and per-
formed a duplicate extraction of the data regarding the
characteristics of the methodological studies, interven-
tions, and outcomes using standard forms; disagree-
ments were resolved by a third reviewer (VF). The
outcome of using KT to reduce postmastectomy lym-
phedema resulting from breast cancer was analyzed.
Quality assessment methodology
The included studies considered both randomized con-
trolled trials and non-randomized trials. These publica-
Table 1. Search strategies combination for screening studies
published on scientific database.
#1 “Mastectomy” OR “Lymphedema” OR “Neoplasm” OR “Early
Detection of Cancer” AND “Kinesio Taping”
#2 “Lymphedema” AND “Kinesio”
#3 “Lymphedema” AND “Athletictape”
#4 ”Lymphedema” AND “Athletic” AND “Tape”
#5 “Mastectomy” AND “Kinesiotaping”
#6 “Mastectomy” AND “Kinesio”
#7 “Mastectomy” AND “Kinesio” AND “Taping”
#8 “Mastectomy” AND “Athletictape”
#9 “Mastectomy” AND “Athletic” AND “Tape”
#10 “Neoplasm” AND “Kinesiotaping”
#11 “Neoplasm” AND “Kinesio”
#12 “Neoplasm” AND “Kinesio” AND “Taping”
#13 “Neoplasm” AND “Athletictape”
#14 “Neoplasm” AND “Athletic” AND “Tape”
#15 “Cancer” AND “Kinesiotaping”
#16 “Cancer” AND “Kinesio”
#17 “Cancer” AND “Athletictape”
#18 “Cancer” AND “Athletic” AND “Tape”

tions were evaluated methodologically following the
criteria of the PEDro Scale (Shiwa et al., 2011).
The PEDro Scale is composed of 11 criteria based on
the Delphi Scale except 2 criteria (8 and 10). The
methodological quality was assessed as follows: (1) the
source of the subjects and requirements for the study
were specified; (2) the choice of study subjects was
random; (3) the person who determined the random-
ness of a subject was unaware of the group to which he
would belong; (4) at the beginning, the study groups
should have had similar prognoses; (5) the subjects
participated in a “blind” form; (6) the therapists applied
the study of the “blind” form; (7) the evaluators mea-
sured the key result of the “blind’ form; (8) the key
result was assigned to 85% of the subjects after they
were divided into groups; (9) all subjects included
within the results received either the treatment or the
control condition as a group, where this was not the
case, data for at least one key outcome were analyzed by
“intention to treat;” (10) the results of the statistical
comparisons were described using only the key results;
and (11) these findings will provide precision measure-
ments and variabilities that should be included in the
outcomes (Shiwa et al., 2011).
The PEDro Scale uses a procedure that qualifies the
article according to its score on the 11 criteria: (Y)
where Yes = one point and is consistent with the
criteria while (N) No = zero points (not consistent
with the criteria). After the article is evaluated by the
11 criteria, the scores are summed with the highest
score being 10, whereas the number one criterion is
not adding the final score. Reviewed articles with full
marks (10 points) are considered to be of high metho-
dological quality, while items with a minimum score (0
points) are considered low quality.
Statistical analysis
The effects of KT treatment were measured by the differ-
ence between the post- and pretreatment mean and stan-
dard deviation (SD) values after including the mean
variance of continuous data and calculating the SD, as
previously described (Follmann, Elliott, Suh, and Cutler,
1992). These data were imputed with each respective con-
fidence interval (CI). The heterogeneity was measured with
I2 and Tau2 tests and followed by a forest plot evaluation.
Studies were considered to have heterogeneity when
I2 > 50% and Tau2 > 1 readings were associated with
statistical significance (p < 0.10); in this case, the reason
for the heterogeneity was investigated. A sensitivity analysis
was used to assess the robustness of the results. A meta-
PHYSIOTHERAPY THEORY AND PRACTICE 3
analysis of random effects was carried out and calculated
using the R statistical analysis software (version 3.3.2).
Results
Study description
Sixteen studies were located using the search strategy.
Of these, only seven studies (Malicka, Rosseger,
Hanuszkiewicz, and Woźniewski, 2014; Melgaard,
2016; Pekyavas et al., 2014; Pop et al., 2014; Smykla
et al., 2013; Taradaj et al., 2016, 2014; Tsai et al., 2009)
met all the established inclusion criteria and were ana-
lyzed in this systematic review (Figure 1).
The total number of women included for analysis in
this review was 303, with an average of 43.2 participants
per study; the lowest number of participants was 10
(Melgaard, 2016), while 70 patients made up the sample
size in the largest group (Taradaj et al., 2016) (Table 2).
Perimetry was an evaluation method of upper limb
lymphedema in five studies (Malicka, Rosseger,
Hanuszkiewicz, and Woźniewski, 2014; Melgaard,
2016; Pekyavas et al., 2014; Pop et al., 2014; Tsai
et al., 2009). In all perimetry evaluations, studies were
conducted to compare the affected limb and its lym-
phedema to the contralateral limb; however, studies
differ in relation to their distance and the reference
points used for comparison.
The volumetry was measured by Smykla et al. (2013)
and Taradaj et al. (2016), who used the measurement
equipment itself as volume measures (Optoelectronic
Perometer 40 T). Tsai et al. (2009) evaluated the volu-
metric displacement of water, and Pekyavas et al. (2014)
assessed the volume of lymphedema using the Frustum
Formula. Malicka, Rosseger, Hanuszkiewicz, and
Woźniewski (2014) calculated the upper limb volume
by The Limb Volumes Professional 5.0 program.
No study showed any risks or adverse effects with
the use of KT in the treatment of lymphedema follow-
ing breast cancer treatment, and all studies indicated
the positive effects of the technique when compared to
the pre-volume of the limb and the volume after the
intervention. However, when compared with other
intervention groups or no intervention, KT had no
significant effect in five studies (Malicka, Rosseger,
Hanuszkiewicz, Woźniewski, 2014; Pekyavas et al.,
2014; Smykla et al., 2013; Taradaj et al., 2016; Tsai
et al., 2009). In contrast with study of Pop et al.
(2014) that revealed a significant difference between
the study and the control group (p < 0.001) and
Melgaard (2016) showed a greater reduction on upper
4 K. T. KASAWARA ET AL.

Studies identified at scientific Additional studies identified by

database manual search
Scielo (n=0) (n = 5)
PEDro (n=4 )
Pubmed (n=12)
Lilacs (n=0)

Studies duplicate
Total of studies included by search
removed (n = 6)
strategy (n=21)

Studies excluded by
Studies selected
title and abstract
(n =15)
(n = 8)

Studies included by the Studies excluded by the

inclusion criteria exclusion criteria
(n = 7)
(n = 0)

Studies included for

final analysis

(n = 7)

Figure 1. Flowchart of the study selection process for inclusion in this systematic review with meta-analysis.

limb circumference in four levels out of seven with KT
treatment.
Considering patients comfort and experience with
KT, only three studies (Melgaard, 2016; Pekyavas
et al., 2014; Tsai et al., 2009) have evaluated their
quality of life and satisfaction with KT as a treatment
for lymphedema following a mastectomy.
Methodology quality description
The average score of the seven clinical trials evalu-
ated was 4.71 (SD 1.8) in a total of 10 possible
points (Table 3). Melgaard (2016) had the highest
score (7 points), even though it was a pilot study
with a small sample size (n = 10). Moreover, this
study (Melgaard, 2016) showed a favorable treat-
ment that used KT along with other physical
therapy techniques to reduce lymphedema following
mastectomy for breast cancer.
Meta-analysis
Pop et al. (2014) study did not provide sufficient data to
perform a meta-analysis, authors were contacted by
e-mail; however, we did not receive data information in
order to proceed with the statistical analysis. Thus, six
studies (Malicka, Rosseger, Hanuszkiewicz, and
Woźniewski, 2014; Melgaard, 2016; Pekyavas et al.,
2014; Smykla et al., 2013; Taradaj et al., 2016; Tsai et al.,
2009) were considered for the meta-analysis (Figure 2).
Figure 2A is a comparison of the treatment group
and the control group. In the Smykla et al. (2013),
study analysis was performed considering the KT
group as the treatment group and the quasi-KT group
as a control group. Likewise, in the study, Pekyavas
Table 2. Studies included in this systematic review with meta-analysis description.
Study (year) Study design Population description Measurements Treatment protocol Outcome
Tsai et al. (2009) Clinical 41 Participants with unilateral lymphedema Volumetry by water displacement and SG: skincare, 30 min of MLD, 1 h of
SG presented initial water displacement
study, secondary to breast cancer, moderate-to- perimetry by arm circumference IPC, 20 min of exercise and KT. (ml) of 505.3 (SD 312.9) and final 488.4 (SD
randomized, severe level measurement (≥2 cm in 1 or more Treatment started after 4 weeks of316.8), with significant reduction on
controlled, SG (n = 20): modified CDT + KT measures = lymphedema) control period forearm and water composition on upper
single-blind. CG (n = 21): CDT + bandage Water composition by Bioimpedance CG: skincare, 30 min of MLD, 1 h of
limb
pilot study (Inbody 3.0, Biospace, Seoul, Korea) IPC, 20 min of exercise and CG presented initial volume (ml) of 513.7
bandage (SD 262.2) and final of 426.0 (SD 215.5).
4 weeks of treatment, 2 h per However, without any significant difference
session, 5 times/week, follow-up for
on volumetry and perimetry between 2
3 months groups (p > 0.05)
Pilot study with a sample size limitation.
The KT may substitute bandage in patients
with low acceptance
Smykla et al. (2013) Clinical 65 Participants with unilateral lymphedema Volume evaluated by “Optoelectronic All groups received routine The initial mean volume on KT group was
study, secondary to breast cancer, moderate-to- Perometer 40 T,” connected to a computer. treatment, including skincare, 9414.01 cm3 and reduced to 8015.15 cm3
randomized, severe level (stage 2 and 3, or lymphedema This device emits infrared radiation (378 45 min of IPC, 1 h of MLD, and (p = 0.002), on quasi-KT group was
single-blind. volume difference of ≥20%). Divided in LED diodo). Evaluation performed before bandage (50–60 mmHg) 9621.33 cm3 and reduced to 8041.02 cm3
pilot study three groups and after treatment KT group: 3 times/week, 4 weeks of (p = 0.002) and on MCT group was
KT group (n = 20) intervention, KT applied without 10,089.41 cm3 before treatment and
Quasi-KT group (n = 22) any tension on tape anchor and reduced to 5021.22 cm3 (p = 0.000001)
MCT group (n = 23) then 5–15% of tension. KT was The KT group and quasi-KT group showed
maintained during 3 consecutive similar results; however, MCT group
days presented higher reduction on
Quasi-KT group: same intervention lymphedema volume
as KT group and tapes without
therapeutic effects common
surgical plasters
MCT group: bandage during
4 weeks
Pekyavas et al. (2014) Clinical 45 Participants with lymphedema Perimetry evaluated in both arms with 10 Sessions of treatment (10 There was a significant reduction on
study, postmastectomy, stages 2 and 3. Divided in 5 cm space between each measurement consecutive days), home-based lymphedema volume before and after
randomized, three groups: G1 (n = 15): CDT, MLD, point (wrist to axilla) exercise treatment on G1 (p = 0.023), G2
single blind exercise, and bandage Volumetry was calculated by Volume G1: CDT, skincare, 30 min of MLD, (p = 0.008), and G3 (p = 0.008)
G2 (n = 15): CDT and KT applied behind the Frustum formula bandage, and exercise During the 4-week follow-up period, there
bandage . G2: CDT with MLD, skincare, was a lymphedema volume reduction on
G3 (n = 15): CDT, without bandage and with ( ) exercise, bandage with KT G2 (p = 0.04), without any change on G1
KT G3: CDT with MLD, skincare, and G3
exercise, KT without bandage KT was applied with CDT
Follow-up for 4 weeks (skincare + MLD + bandage + exercise)
with a positive effect and may be
recommended as an alternative treatment
for lymphedema postmastectomy
(Continued )
PHYSIOTHERAPY THEORY AND PRACTICE
5
 6

Table 2. (Continued).
Study (year) Study design Population description Measurements Treatment protocol Outcome
Pop et al. (2014) Clinical 44 Participants with lymphedema Perimetry evaluated in sitting position by
Treatment was performed 3 times/The mean reduction on lymphedema was
study, non- postmastectomy, stages 1 and 2. Divided in measurement apparatus developed by the week during 21 days 55% on SG and 27% on CG (p < 0.001)
randomized two groups: SG (n = 22): KT and exercise. CG authors. The upper limb was bent at 90° SG: 20 min of upper limb elevation
The elevation of upper limb and KT
(n = 22): KT applied in opposite direction with extension of the elbow joint, and the
before KT application, which wasapplication was effective on SG comparing
(proximal to distal) and conventional clinical lymphedema was measured every 4 cm applied in spiral and directional
to CG. Moreover, SG presented better ROM
control (10% of stretch) and grip strength
K. T. KASAWARA ET AL.

CG: KT was applied in opposite 10 Participants on SG classified the

direction (proximal to distal) treatment as “very good” and just 4
without upper limb elevation participants had the same opinion on CG
Malicka, Rosseger, Clinical 28 Participants with grade I secondary Perimetry evaluated in 6 levels SG: 4 applications of KT, once aSG had a significant reduction on
Hanuszkiewicz, and study, lymphedema. SG (n = 14): KT. Volumetry calculated by The Limb Volumes week. Tape with 1 cm wide base lymphedema after 4 weeks of KT
Woźniewski (2014) randomized, CG (n = 14): none anti-edema treatments Professional 5.0 program and tails divided in 4 parts (15% of
intervention (p = 0.0009), whereas no
pilot study stretch). The SG was divided in two
difference was found in CG (p = 0.36)
subgroups of KT application However, comparing 2 groups (SG vs. CG),
● Subgroup 1: KT at arm and there was no difference (p = 0.3)
forearm and anastomosis Considering the subgroup 1, a significant
● Subgroup 2: KT at arm and difference on lymphedema was found after
forearm 4 weeks’ treatment (p = 0.01); and at
CG: none anti-edema treatments subgroup 2, there was a lymphedema
reduction after 2 weeks (p = 0.01) and
4 weeks (p = 0.01)
Taradaj et al. (2016) Clinical 70 participants with lymphedema level 2 Volume evaluated by “Optoelectronic All groups received pneumatic All groups showed a significant decrease in
study, and 3 (20% of difference in volume between Perometer 40 T,” connected to a computer. drainage for 45 min, 3 times/week lymphedema volume comparing to the
randomized healthy and affected upper limb) This device emits infrared radiation (378 and MLD for 50 min, 3 times/week. initial evaluation
G1 (n = 22): KT LED diodo) In a total of 4-week treatment However, there was a significant upper
G2 (n = 23): quasi-KT G1: KT without tension (up to 15% limb volume reduction in G3 (45.02%), by
G3 (n = 25): bandage stretch), once a week contrast G1 (22.45%), and G2 (24.04%)
G2: quasi-KT without therapeutic G1 vs. G2 (p = 0.7)
effects, once a week G1 vs. G3 (p = 0.00008)
G3: compression multilayered G2 vs. G3 (p = 0.00022)
bandage with external compression
40–50 mmHg, applied for 24 h
Melgaard (2016) Clinical 10 Participants with unilateral secondary Perimetry measured in 7 levels (cm): G1: CDP, bandage with low-stretch, Out of 7 measurements, KT was effective in
study, lymphedema level 2 after breast cancer metacarpophalangeal joints, wrist, 8 cm MLD, skincare, exercise, and 4 measures (metacarpophalangeal joints,
randomized, treatment above wrist; 15 cm above wrist, elbow, compression garment. Monday– elbow, 10 cm above elbow, and muscle
pilot study G1 (n = 5): standardize treatment + bandage 10 cm above elbow, and muscle deltoideus Friday for 4 weeks deltoideus) and bandage was favorable in 3
with low stretch G2: CDP, KT, MLD, skincare, others measurements (wrist, 8 cm above
G2 (n = 5): standardize treatment + KT exercise, and compression garment. wrist, 15 cm above wrist)
2 days every week (i.e., Tuesday Participant reported “feel free with the
and Friday) for 4 weeks tape” and “. . .with the bandage I cannot
use my usual clothes”
The treatment with KT was considered
cheaper (432.86 Euro) than bandaging cost
(1059.75 Euro)
KT: Kinesio Taping; SG: study group; CG: control group; MLD: manual lymphatic drainage; CDT: complex decongestive therapy; IPC: intermittent pneumatic compression; min: minutes; h: hours; cm: centimeters; G1: group
one; G2: group two; G3: group three; ROM: range of motion; MCT: multilayered compression therapy group; CDP: complete descongestive physiotherapy.
 PHYSIOTHERAPY THEORY AND PRACTICE 7

Table 3. Studies methodological quality description according to PEDro Scale Score.

Item
Studies (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Total score
Tsai et al. (2009) Y Y Y Y N N Y Y N N Y 6/10
Smykla et al. (2013) Y Y Y Y N N N N N Y Y 5/10
Pekyavas et al. (2014) Y Y N Y N N N Y N Y Y 5/10
Pop et al. (2014) N Y N N N N N N N N N 1/10
Malicka, Rosseger, Hanuszkiewicz, and Woźniewski (2014) N Y N Y N N N N N Y Y 4/10
Taradaj et al. (2016) Y Y Y Y N N N N N Y Y 5/10
Melgaard (2016) Y Y Y Y N N Y Y N Y Y 7/10
The PEDro Scale Score classified the study by their methodological quality, which (Y) Yes = 1 point and (N) No = zero points. The item number (1) is not
considered for the total score.

Figure 2. Standardized mean difference on lymphedema reduction comparing Kinesio Taping treatment versus control treatment.

et al. (2014) G3 (CDT + KT) was considered the treat-
ment group and G1 the control group. In Taradaj et al.
(2016), G1 (KT) was considered treatment group and
G2 (quasi-KT) as control group. The heterogeneity of
these studies was not statistically significant (p = 0.78),
I2 = 0% and Tau2 = 0. As a result of the analysis, there
was no significant difference (standardized mean dif-
ference = 0.04, 95% CI: −0.24; 0.33) between partici-
pants who completed their KT treatment and those
who underwent a comparison group on reduction of
their lymphedema volume associated with breast cancer
treatment.
As shown in Figure 2B, in the study of Smykla
et al. (2013), the KT group was considered as the
treatment group, while the multilayered compression
therapy group was the control group. According to
Pekyavas et al. (2014), the G3 (CDT + KT) group was
the treatment group, while G2 (CDT + bandage + KT)
was the control group. In Taradaj et al. (2016), G1
(KT) was considered treatment group and G3 (ban-
dage) was considered control. The heterogeneity (I2)
of the studies was 3.15%, Tau2 = 0.004 with a
p = 0.39. Similarly, to the other comparison of treat-
ment versus control analysis, there was no statistically
significant difference (standardized mean differ-
ence = 0:12, 95% CI: −0.16; 0.41).
Discussion
KT had a positive effect reducing upper limb lymphe-
dema volume in patients postmastectomy comparing
before and after treatment. However, when comparing
to control group or others treatments, KT has no sig-
nificant effect on lymphedema volume reduction. The
8 K. T. KASAWARA ET AL.
methodological quality assessed by the PEDro Scale
classifies studies in the intermediate category (4.7
points).
The use of KT has been questioned in several clinical
conditions, such as in patients with musculoskeletal
pain (Added et al., 2016; Castro-Sánchez et al., 2012;
Luz Júnior et al., 2015; Parreira et al., 2014) as this
method does not always significantly reduce pain.
However, in other esthetic and clinical conditions,
such as cellulitis, a randomized clinical trial showed
positive results with the prerogative that KT generates
a different traction stimulus on the top of the skin
(Silva et al., 2014). Nevertheless, other studies have
shown the same positive effect on reducing the lym-
phedema volume in the lower limbs, increasing lymph
flow using KT in experimental animal models (Shim,
Lee, Lee, 2003) and in clinical study in humans (De
Godoy, Braile, and Godoy, 2003).
In this investigation, five studies (Melgaard, 2016;
Pekyavas et al., 2014; Pop et al., 2014; Smykla et al.,
2013; Tsai et al., 2009) analyzed any associated proces-
sing techniques, which made it difficult to assess the
isolate effect of KT by itself as a standalone therapy
strategy. Furthermore, the KT protocol changed from 3
times a week for 3 weeks (9 sessions) (Pop et al., 2014)
up to 5 times a week for 4 weeks (20 sessions) (Tsai
et al., 2009). The length of time that KT was worn each
day included “as long as possible” (Tsai et al., 2009),
which translated to an average of 22 h daily (Pekyavas
et al., 2014) for three applications a week, which was
approximately 56 h (Pop et al., 2014) for up to three
consecutive days (72 h) (Smykla et al., 2013). All trials
followed the application recommendation for KT,
which must be maintained for no longer than
3–5 days due to the reduction of the effect of the elastic
polymer (Castro-Sánchez et al., 2012; Wallis, Kase, and
Kase, 2003). Likewise, the orientation used to keep KT
fixed on the skin also varied.
Several authors have suggested that the use of KT in
lymphedema cases has a positive effect due to the surface
tension in the skin and also because of the application
technique in a centripetal direction, which respects the
anatomy of the lymphatic system and can encourage the
flow of lymph (Martins et al., 2016; Shim, Lee, and Lee,
2003; Silva et al., 2014). In addition to the reduction of
lymphedema volume, other studies have evaluated the
improvement in ROM (Pop et al., 2014; Taradaj et al.,
2016); it is understood that these factors are associated
with patients’ quality of life. Lymphedema implies an
impairment of the activities of daily living and also has
social and emotional impacts (Pekyavas et al., 2014; Tsai
et al., 2009). In such cases, treatment of the lymphedema
using KT offers comfort and convenience as well as the
possibility of proper hygiene in the upper limbs for these
patients (Finnerty, Thomason, and Woods, 2010).
Regarding the patient’s quality of life before and/
or after treatment, Tsai et al. (2009) applied two
questionnaires: (1) European Organization for
Research and Treatment of Cancer Quality of Life
(EORTC QLQ-30) and (2) European Organization
for Research and Treatment of Cancer Quality of
Life (EORTC QLQ-BR23). These questionnaires
were administered at the beginning and also at the
end of the treatment; their comparison revealed a
significant change in regard to the patients’ quality
of life, mostly in an improved emotional state.
Pekyavas et al. (2014) used the Short Form 36, a
general questionnaire, to assess quality of life, and
the results of the questionnaires comparing the appli-
cation at the beginning and end of the treatment did
not achieve significant results. However, the partici-
pants were accepting of the use of KT according to
the questionnaire.
The Visual Analogue Scale was used by Tsai et al. (2009)
and Pekyavas et al. (2014) to assess the quality of life of
patients treated with KT; both studies presented a positive
result at the end of treatment. Moreover, all studies
(Pekyavas et al., 2014; Pop et al., 2014; Smykla et al., 2013;
Tsai et al., 2009) suggested that the comfort and conveni-
ence of the intervention were better with KT than with a
compression bandage, especially in cases in which a ban-
dage is contraindicated.
Among the limitations of this systematic review is the
lack of standard nomenclature for the term “Kinesio
Taping” which does not constitute a MeSH Term and
therefore hindered the search for articles related to this
theme. In addition, the low methodological quality of the
studies included in this systematic review does not allow a
final conclusion on the indication of KT’s use as a techni-
que for reducing lymphedema in patients postmastectomy
for breast cancer.
In this systematic review, it was possible to evaluate
the performance of KT in the treatment of postmas-
tectomy lymphedema in breast cancer patients by
examining studies that had applied KT in different
forms. The use of KT was considered effective, but an
evaluation of these studies using the PEDro Scale does
not make them highly reliable for recommending the
use of KT as an alternative for the treatment of
lymphedema.
In conclusion, KT was effective on reducing postmas-
tectomy lymphedema related to breast cancer; however, it
is not more efficient than others treatments. Despite these
promising results, more studies with a high methodological
quality are needed to determine the best use of KT in
reducing postmastectomy lymphedema due to breast
 PHYSIOTHERAPY THEORY AND PRACTICE 9

cancer; so, it may be incorporated routinely in the clinical Nascimento SL, De Oliveira RR, De Oliveira MM, Amaral
treatment of lymphedema. MT 2012 Complications and physical therapeutic treat-
ment after breast cancer surgery: A retrospective study.
Fisioterapia E Pesquisa 19: 248–255.
Declaration of Interest Padula RS, Pires RS, Alouche SR, Chiavegato LD, Lopes AD,
Costa LO 2012 Analysis of reporting of systematic reviews
The authors declare no conflict of interest. in physical therapy published in Portuguese. Brazilian
Journal of Physical Therapy 16: 381–388.
Parreira P, Costa L, Hespanhol LC, Lopes AD, Costa LO 2014
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