Participants’ perceptions of Kinesio tape for carpal tunnel syndrome: A qualitative study

Participants

Participants for the RCT were recruited from the general population in Southern California by advertising at public facilities, clinics, common public places, snowball sampling as well as social media following approval from the Institutional Review Board. To be included in the study participants were adults over 18 years of age and fluent in English who reported symptoms of CTS and demonstrated a positive Phalen’s Test or Tinel’s Test. ¹⁸ Qualifying symptoms of CTS included pain, numbness, and tingling of the forearm, wrist, or hand within the median nerve distribution. Exclusion criteria included undergoing current treatment for CTS, a history of surgical carpal tunnel release, an allergy to adhesives, compromised skin integrity, or past history of traumatic event, surgery, or congenital impairment of the forearm, wrist, or hand. In addition, individuals with the following conditions were excluded: pregnancy, diabetes not controlled by medication, radiculopathy (e.g., cervical radiculopathy, diabetic radiculopathy), and thoracic outlet syndrome. Signed informed consent was obtained from all participants prior to the study. Individuals randomized to the Intervention Group were asked to volunteer for a face-to-face recorded semi-structured interview of approximately 30 minutes immediately following enrollment in the study in order to capture the perceptions of the use of Kinesio tape, none declined. Of the 44 adults who participated in the single blind RCT, 15 were randomized to the intervention group (i.e., Kinesio tape), and participated in the interviews which are the focus of this paper.

Data collection

Three intervention groups were part of a randomized controlled trial examining the efficacy of the dorsal application of Kinesio tape for CTS: A Sham Group with a 4 inch strip of Kinesio tape applied to the participant’s shoulder worn continuously between visits (scapular spine), the Intervention Group with Kinesio tape applied to the dorsal surface of the forearm, wrist, and digits one and five and worn continuously between visits, and the Splint Protocol group assigned to wear a wrist cock-up splint nightly or as able and lumbrical stretching exercises throughout the day. A total of 68 participant wrists (44 participants) were in the study.

Study procedures consisted of completing a demographic questionnaire, obtaining baseline and subsequent measurements of grip and pinch, completion of pain scale questionnaires, the Boston Carpal Tunnel Questionnaire, ¹⁹ and application of the intervention. Participants were encouraged to record daily activities, pain ratings, and perceptions of the Kinesio tape while completing functional tasks within the context of their daily lives in symptom journals. The symptom journal was collected at each of the subsequent meetings during the intervention period. The journals were a means of capturing the daily experiences of the participants. Symptom journals were transcribed and entered verbatim alongside the interview transcription onto an Excel spreadsheet, no data were missing.

The use of semi-structured interview questions guided the conversation while still allowing participants to raise other important issues. ²⁰ Interviews were guided by the Theory of Occupational Adaptation, ²¹ in which occupational performance is described as one’s ability to perform daily activities, and will be referred to as functional performance. This framework focuses on the person, the environment, and the interaction of the two; and for which successful performance or mastery of a task requires adaptation of either the person (internal mastery) or the environment (external mastery). ²¹ Six open ended questions were asked, such as “Tell me about wearing the Kinesio tape?,” with follow-up questions under each question and centered around understanding the experience of wearing the Kinesio tape and its impact or effect on pain and functional performance (see Table 1). Interviews were conducted from February 2018 to October 2018, lasting approximately 30 min, ranging 9 to 61 min. Interviews were recorded and transcribed verbatim. All participants had equivalent levels of participation, except those who wrote or spoke more than others in the symptom journals or interviews.

OPEN IN VIEWER

Table 1.

Semi-structured interview guide.

1. Tell me how carpal tunnel syndrome forearm wrist hand pain has affected your daily occupations such as work or taking care of your home?

a. Can you give me an example?

b. Are there any other areas such as in dressing that carpal tunnel syndrome has affected you?

2. Tell me about wearing the Kinesio tape?

a. How was it in regard to comfort?

b. Did it feel “in the way”? Tell me about that.

c. How did you like the look of the Kinesio tape?

3. Do you feel wearing the Kinesio tape impacted your ability to do your job? Please share.

a. Do you feel the Kinesio tape assisted? If so, how?

b. Can you give me an example?

3. Describe how the Kinesio tape impacted your activities of daily living, such as dressing?

a. Tell me about that.

b. Anything else you do at home?

4. How do you feel the Kinesio tape influenced sleep and rest?

a. Can you provide a specific example?

5. Have you noticed any changes in your participation with leisure activities with the Kinesio

Tape on?

a. Can you describe that more for me?

6. What is the most important message that you want us to take away from this interview?

Is there anything else that you would like to add about any of the topics that we've discussed or other areas that we didn't discuss but you think are important.

Data analysis

Data analysis followed a modified grounded theory procedural approach as the intent was to answer specific research questions related to understanding participant’s experiences wearing the Kinesio tape for CTS, if Kinesio tape had an effect on functional performance, and the perceived effectiveness of Kinesio tape as an intervention. ²²

Participants were coded with pseudonyms and all qualitative data from the interviews, demographic questionnaire, and symptom journals were managed through a computer assisted qualitative data analysis software (CAQDAS), Dedoose (Version 8.0.35). ²³ Descriptive coding was applied to analyze the data. ²⁰ Three researchers coded the transcripts independently, followed by two of the researchers clarifying and confirming the codes. The same two researchers continued to condense the codes by developing coding schemes and applying frequency mapping and code co-occurrence within Dedoose, to identify categories until the emerging themes were identified and consensus reached. The symptom journals provided indirect daily responses from participants while the interviews provided direct responses at the end of the study.

The same researcher, a registered occupational therapist with advanced certification in Kinesio Taping, proposed the study, completed the tape application, and conducted the post semi-structured interviews. In this way rapport and familiarity developed between the researcher and the participants; however, this also presented opportunity for response bias. In order to mitigate for researcher and response bias, open-ended questions were asked in the interviews, and both positive and negative aspects of participants’ experiences were collected, reported, and coded. Furthermore, interview and symptom journal content were independently coded by two researchers in addition to the interviewer. The daily symptom journals served as an indirect communication method to elicit natural responses without the researcher present. Dedoose was used to further address researcher bias by structuring the data analysis process.

Impact of CTS on functional performance

Limited range of motion, pain, and weakness among other symptoms made it difficult for participants to engage in meaningful roles and increase self-efficacy. For example, CTS-related tension and decreased range of motion impacted Grace’s ability to engage daily activities. She commented,

In general, I can’t bend my wrist, I’ll start getting an increase in pain, and that affects a lot of the daily things I do.

Daily tasks that were most commonly impacted were in the areas of work, leisure, self-care, and driving. Related to work, fourteen participants commented that working on the computer increased symptoms of CTS. Additionally, eight participants specifically identified writing required in their work and daily life as increasing symptoms of pain, numbness, and tingling. Impacted leisure activities included crafting, swimming, jogging, boxing, working out, doing bench presses, and yoga. In terms of self-care, respondents described dressing and household chores such as cleaning and meal preparation as activities noticeably impacted by CTS. Lastly, a significant majority of participants (n = 12) identified driving as impacted by CTS pain and numbness.

Effect of Kinesio tape on pain

Participants reported both immediate pain relief with Kinesio tape and increased pain relief over time even for those with chronic symptomology. Example statements include:

[I felt] immediate relief with tape on [Joy],

Impact of Kinesio tape on chronic pain

One of the surprise findings, came from four of the participants who having experienced CTS pain for 7.5–10 years reported Kinesio tape to be effective in decreasing pain. Lee commented,

It’s not typical for me to go this long without symptoms.

Effect of Kinesio tape on functional performance

The impact Kinesio tape had on pain translated to positive impact on daily life activities for 14 of the 15 participants who identified Kinesio tape as positive and effective, particularly on decreasing pain. The quicker the pain was gone, the more involvement and engagement participants reported. For example, Cinthia expressed,

When the tape was on it made me feel more at ease, that I was like Oh, I’m gonna feel less pain. And then, because there was less pain I was able to come out of my shell.

Work

Fourteen of the 15 participants reported a significant decrease in pain and increase in amount of time without pain during functional work-related activities such as using computers, small devices, and writing. Some participants reported being able to engage in these activities for three or more hours with zero pain while wearing the Kinesio tape. Sue explained,

Usually I feel it is difficult to grip my pen for a long period of the time, but the tape helped open my hand and release some pressure from my wrist.

Leisure

One third of the participants reported improved engagement in leisure activities while wearing Kinesio tape. They identified increased engagement in specific tasks such as holding a book while reading and manipulating their smart phones. They also identified increased engagement in high intensity, high repetition activities such as yoga, bouldering, working out, setting up a campsite, and playing the string bass. Lee found that she experienced less pain while practicing yoga and Molly felt stronger and climbed higher on the rock wall. In addition to these examples, two participants experienced an extended duration of participation in high intensity physical activities. Lee reported being able to hike and camp without pain.

I spent the day hiking and did not feel my hands swell and fill as usual. I was able to set up the campsite including grasping, twisting, and pulling without numbness or tingling with the tape on.

Functional tasks

In addition to work and leisure, participants reported being able to return to a wide array of functional tasks while wearing the Kinesio tape. These included daily tasks of personal care and home management to community activities such as running errands and driving a car. Being able to return to such basic life management tasks elicited positive emotional responses as well. Josey shared,

I did cooking tasks yesterday, like whisking, without pain. That was wonderful!

“I did not have any symptoms today, even though I painted the kitchen and ran errands”. Overall, however, the emphasis of the comments about returning to functional tasks was on the everyday activities that keep life going.

Some of the everyday tasks discussed extended into the community, such as driving and errands. Several (n = 12) participants reported a decrease in symptoms while driving and ability to drive for longer periods of time. Randi felt better even on short 20–40 min drives. Grace expressed surprise when reporting being able to drive 2 hours without pain when the tape was on.

Now, I drove two hours to my mom’s home and noticed my arms and wrists did not feel tired, no pain on my palms and wrists.

Perceptions of wearing Kinesio tape

Together, all 15 participants made 219 positive comments regarding the wearing of Kinesio tape. They also commonly compared Kinesio tape to their experiences with wearing orthotic devices, and discussed both difficulties and recommendations related to the use of Kinesio tape.

Strength and stability

said Derek when summarizing his perceptions of wearing Kinesio tape. While not every participant used such illustrative language, the majority of them expressed positive perceptions of the tape.

I felt more stabilized [Kay],

Tape not in the way

Participants liked wearing the Kinesio tape as it was comfortable, did not restrict movement or involvement in activities and tasks for daily living.

I would always try to be so careful on the way I move my hands or position my hands so that pain would not increase, but with the tape, I'm just back to my normal. I don't have to be so conscious on the way I move my hands or rest my hands because the pain is almost gone [Valerie].

Problems with Kinesio tape

Two participants said they experienced

no change in pain or function [Donna], and

I don’t think it made a huge difference for me [Josey].

Self-application request

All participants requested to learn the Kinesio tape application method, but only if trained first and received some education and protocols.

I think I do enjoy the feeling that it gives me, but I feel like I would probably change it every day, I wouldn’t wear it for three days

When issues of tape management arose, such as if it unraveled or lost adherence over the digits before returning to the lab, the participants stated a desire to contact the researcher for problem solving and guidance, though none of them did and waited for the next visit. Even in light of the problems encountered with using Kinesio tape on the hand, all 15 participants stated they would use the dorsal application of Kinesio tape again if someone showed them how.

Occupational Adaptation framework

The Occupational Adaptation framework focuses on the person, the environment, and the interaction of the two. It emphasizes that successful performance of a task requires adaptation of either the person (internal mastery) or the environment (external mastery). ²¹ In this study, the dorsal application of Kinesio tape on the forearm, wrist, and fingers was an adaptation of the person that enabled increased functional performance in their environments.

Evidence suggests that Kinesio tape provides proprioceptive input which leads to increased action potentials in the cerebral cortex resulting in muscular co-contraction and joint stability.^13,24 Participants commented that the Kinesio tape helped them feel as if their hand were stable and supported when in an open position, which is necessary for engaging in daily activities. The co-contraction provided by the tape may have contributed to the feeling of stability participants reported in the wrist, leading to increased engagement in functional tasks.

While the focus of non-surgical interventions for CTS has been on wearing orthoses and completing lumbrical exercises, functional performance is often inhibited. Orthoses have been shown to biomechanically position the wrist in neutral and relieve CTS symptoms, ⁷ but this intervention limits successful engagement with functional tasks, further limiting external mastery. Researchers have acknowledged this limitation and recommended alternative interventions in hand therapy which allow individuals to participate in meaningful activities.^16,25–27 Kinesio tape is one such intervention, as it has been shown in this study to result in greater internal and external mastery.

External mastery

It is increasingly understood that symptom relief and return to function is the measure of success for interventions for musculoskeletal conditions of the hand, wrist, and forearm such as CTS. ²⁸ This is consistent with the Occupational Adaptation framework concept of external mastery. There is growing evidence for using occupation-based assessment tools and intervention activities for therapeutic treatment of hand injuries.^25,29–31 Jack and Estes ²⁷ found that a holistic, client-centered, and occupation-based approach to the treatment of hand injures, resulted in improved patient outcomes. Similarly, Colaianni and Provident ²⁶ found that such interventions increased client motivation, satisfaction and adherence, and promoted a faster functional recovery due to the relevance of the activities to the individual’s daily life and interests. Functional treatment activities increased confidence and decreased fear. Results of this study indicate that wearing the Kinesio tape increased client confidence and engagement in personal care, household activities, and community engagement. Several participants had a significant increase in the amount of time they were able to sustain their participation in activities, and others were able to return to high intensity, high repetition leisure activities. Most of the participants expressed symptom relief and improved function in self-care, home management, driving, work, community engagement, and/or leisure activities.

Internal mastery

Internal mastery, according to the Occupational Adaptation framework, is the belief in the ability to succeed in accomplishing a task, though adaptations of the person or environment may be needed for successful task completion. ²¹ The use of Kinesio tape to manage CTS symptoms is an adaptation to the person that has been shown to improve participant’s perceptions and report of external mastery in this study. Their response to the experiences of external mastery was to express the desire to learn to apply the tape themselves. The Occupational Adaptation model illustrates the interrelationship between internal and external mastery, showing how improvements in one lead to increases in the other in a cyclical manner. ²¹ In the case of wearing Kinesio tape for CTS, it appears that not only did Kinesio tape adaptation to the person lead to perceptions of increased self-efficacy and environmental mastery, but the improved external mastery also led back to a drive for increased internal mastery. This was evidenced by participants requesting to learn how to apply the tape themselves.

The need for an intervention that can be functionally integrated into daily life appealed to participants. They indicated that self-application of the Kinesio tape would allow them greater flexibility of wearing schedules. Being able to remove the tape for cosmetic concerns such as peeling edges, exposure to water or soap, following exercise, or due to skin sensitivity may enhance compliance with the use of the intervention. It is possible that being able to self-manage the dorsal application of Kinesio tape could improve adherence to the intervention, which is a known weakness of orthoses and exercises.^7,8

It is recommended that application of Kinesio tape be overseen by a skilled professional, as clinical reasoning skills are necessary in order to ensure correct application and understanding of Kinesio tape properties, education, and problem management.

Implications for a younger demographic

It is possible, though not established, that the young average age of participants in this study reflects a societal trend toward CTS in younger people. Studies have identified that repetitive use of the fingers and wrist may contribute to symptoms of CTS. ³² Office workers who use computers 4 hours a day or more experience a high incidence of CTS.^33,34 Furthermore, those who use computers and work for extended periods of time may be the primary at-risk population for CTS. This description may increasingly apply to young adults in screen culture.

Limitations

Limitations of the study include the application of Kinesio tape on first and fifth digits. The problems with tape adhering during activities that included water may have interfered with results. Participants were from Southern California and may not include other geographical or environmental challenges when wearing Kinesio tape for upper extremity rehabilitation. The sample was limited to the intervention Kinesio Tape Group of the RCT and therefore sampling was not continued through saturation.

Recommendations for future studies could focus on gathering participants perceptions over a longer period of time, perhaps including the experiences of individuals applying and using the tape. Other recommendations include gathering perspectives from participants in other geographical areas outside Southern California. Longer study duration for the comparative study between orthosis, orthosis types, and Kinesio tape are recommended as well.