Effect of kinesio taping™ on the balance in the elderly

Abstract

BACKGROUND:

It is known, among the elderly population, the decrease in functional capacity to perform daily free-living activities, with the occurrence of falls quite frequently. The muscular component must be prepared for a better performance in motor tasks, reason why the application of Kinesio Taping^™ band appears as an intervention to consider, so the aim of this study is to analyze the effect of the Kinesio Taping^™ method on the balance of a senior group.

METHOD:

A sample of 28 subjects was divided into 2 groups: a control group (CG) and an experimental group (EG). The balance was assessed using two scales: The Time-UP & Go Test (TUG) and Berg Balance Scale (BBS). At first, individuals from both groups were assessed using both Scales. Subsequently, to the individuals belonging to EG, the Kinesio Taping^™ method was applied (KT^™), in the anterior tibial and peroneal in both lower limbs in CG KT^™ was applied as a placebo. A day later, in a second visit, the performance of both groups was again evaluated using the mentioned scales.

RESULTS:

In CG, no statistically significant differences were observed in between testing days, (TUG day 1 vs TUG day 2: p = 0.842); (BBS day 1 vs BBS day 2: p = 0.157). On the other hand, statistically significant differences were observed in the experimental group, where TUG performance was faster after KT^™ (p = 0.001) and BBS was higher (p = 0.002).

CONCLUSION:

The results demonstrate that the Kinesio Taping^™ application had positive effects on balance and these results could help the prevention of falls in the elderly.

Keywords

Balance muscle activation anterior tibial peroneal

1 Introduction

The aging process is characterized for being continuous, irreversible, and universal, implying the occurrence of several changes in the organism, which are reflected in the biological, psychological, social and psychosocial dimensions of the individual [1]. This process leads to a reduction in the capacity for homeostatic adaptation to situations of functional overload, progressively changing the organism and making it more susceptible to intrinsic and extrinsic aggressions. Aging compromises the components responsible for postural balance, such as the central nervous system, vestibular system, sensory and proprioceptive system, which can lead to imbalances and falls [2].

Falling is not an inevitable result of aging, however, environmental and behavioral factors (rushing or being distracted) are most often seen as causing falls as intrinsic factors (personal/health) are rarely recognized [3]. Fall risk assessment and interventions must be effective in addressing each individual risk factor [4]. Careful assessment is part of the approach to preventive and rehabilitation programs in physiotherapy, not only for the prevention of falls, but also for the treatment of chronic-degenerative disorders [2].

To analyze the risk of falling, instruments have been developed to assess the functionality, balance, speed and gait of each elderly person [5]. Among these instruments, the Time Up & Go test (TUG) has an 87% overall prediction of falls in older people with and without history of falling [6] and the Berg Balance Scale (BBS) was originally developed as a balance tool, however researchers commonly use it to ascertain the risk of falling in this population [7] with a sensitivity of 0,73 and specificity of 0,90 [8], so this instruments stands out in balance measurement and risk of fall prediction, proving to be easy to apply and with results of intra-reliability (ICC 0.88) and inter-observer (ICC 0.77) considered favorable [9].

One method that has been used to improve balance is the Kinesio Taping^™ (KT) [10] bands application. This method, developed by the Japanese Kenzo Kase in 1979, has been used to modify and activate the proprioceptive system and consists of the application of an elastic adhesive band without chemical substances, with the same texture and elasticity to human skin [11]. According to the literature, the KT^™ method promotes pain reduction, improves flexibility, proprioception, and alignment in postural balance, which can lead to better functional performance [2]. Also, it was demonstrated that KT^™ has positive effects on function mobility and balance in older adults (TUG and BBS data), because it not only contributes to foot posture, but also increases sensorial input so that may reduce the risk of falling, after a two-week period of use [8].

Although the physiological benefits of the KT^™ bands are still being analyzed [8], the KT^™ method has been increasingly used in several areas of Physiotherapy, such as, in increasing proprioception [12, 13], in stretching [14], in improving range of motion and blood circulation n [15]. This research intends to increase the scientific evidence of the KT^™ method, creating an added value on its potential for application in the elderly, so the aim of this study is to analyze the effect of the Kinesio Taping^™ method on the balance of a senior group.

2 Method

2.1 Participants

The subjects of the study were all users of the Daycare facilities around the geographic area of the Research Center. Before the beginning of the study, an authorization was required to the responsible of each one of the Daycare facilities. After that, a written informed consent was given to the subjects, and all the ethical issues related to data collection in Human Beings had been addressed, the procedures followed during the study were in accordance with the Helsinki Declaration. The project was approved by the Ethics Committee of the Institution responsible for the project. The participants were recruited, according to their consent in participating, and were separated in order to create homogeneous groups in relation to age, and gender, with different abilities and difficulties. The inclusion criteria was independency in walking, the absence of comorbidities that could affect the ability to walk and go up and down stairs, and had no hearing or vision problems that would affect their ability to participate in the study. The sample was composed by 28 subjects, divided into two groups: Control Group (CG) and Experimental Group (EG).

2.2 Procedures

This study was carried out in two visits, a control visit (m1) and an experimental visit (m2), separated by one day (Fig. 1).

Fig. 1

Study design.

Participants were divided in two groups, CG and EG. All the participants carried a KT^™ band, but in CG, the application was placebo. For these evaluations, the person responsible for applying the tests was not the same expert that applied the KT^™ method. At study visit 1 (m1), both groups were evaluated, without the application of the KT^™ method and after this, the KT^™ bands were applied to both lower limbs, in both groups. At the study visit 2 (m2), one day after placing the bands, the performance of both groups was evaluated using the scales mentioned above (Fig. 1).

KT^™ bands were applied by an expert to the anterior tibial and peroneal muscles along their entire path, in the form of “I”, from proximal to distal, promoting the facilitation [16] (Fig. 2). The muscle groups were placed in a stretching position, followed by the application of KT^™ bands with 15 to 25% tension, which is recommended for the intended effect [16]. Although the activation time of the KT^™ bands varies between 20 and 30 minutes [16], a longer time interval between each measurement was stipulated, so that the properties inherent to the KT^™ bands were activated. In m2, individuals were again evaluated, according to the previous procedures. The bands were removed after this reevaluation.

Fig. 2

Photo of KT^™ method bands applied.

TUG test started with the individual sitting on a chair. This test was applied a first time, to familiarize the individual with the procedure, the best of two trials was retained for statistical procedures.

After performing the TUG, BBS was applied. The evaluator (not the same person who applied the KT^™ on the subjects) explained the intended movements and encouraged individuals to perform them, to be able to assess their difficulty.

2.3 Assessment tools

2.3.1 Time-Up & Go Test

The Time-Up and Go Test (TUG) is a simple functional test and widely used in clinical practice and has a TUG has very high interrater reliability in community-dwelling older adults (intraclass coefficient of 0.98) [17]. In this test the individual is asked to get up from a chair, without the aid of the upper limbs, walk three meters, return, and sit down again, recording the time spent performing this task [17]. Times shorter than 10 seconds, a value considered normal, suggest independent individuals with no risk of falling, while measurements above 20 seconds demonstrate difficulties for daily tasks [17]. Times between 11 and 20 seconds are expected for the elderly population, with partial independence and low risk of falling.

2.3.2 Berg Balance Scale

Berg Balance Scale determines the risk factors for loss of independence and for falls in the elderly. BBS is a scale that meets several proposals: quantitative description of the functional balance skill, monitoring the progress of individuals, and evaluating the effectiveness of interventions in clinical practice and research [18].

BBS assesses functional performance based on 14 tasks. Each can be assigned from zero points (inability to perform the task) to four points (ability to perform the task independently) [5]. The total score ranges from 0 to 56 points, and the higher the final score, the better the individual’s balance. Thus, each point less on the scale corresponds to an increase in the risk of falling, with values below 36 points meaning a risk of falling by almost 100% [5]. The reliability study about BBS scale demonstrated Cronbach’s alpha to be 0.83 for 113 elderly adults and 0.97 for 70 patients with stroke [19].

2.3.3 Kinesio Taping^™

As previously mentioned, KT^™ bands were used for this study. These bands are water resistant, hypoallergenic, without medication and with hypoallergenic adhesion [19], with a longitudinal stretching from 55 to 60% of your resting position or total elasticity from 120 to 140% which facilitates involving tissues and joints with greater precision [6].

2.4 Data analysis

First, the normality of the data was verified using the Shapiro-Wilk’s test, as well as the homogeneity of the variances with Levene’s test. The comparison between m1 and m2 was performed using a paired student t-test. The level of significance used was α= 0.05.

In cases where the distribution was not considered normal, non-parametric statistics were used. For all the analyses Statistical Package for the Social Sciences (SPSS), version 27.0, was used.

3 Results

The sample descriptive data is presented in Table 1. There are no statistical differences in relation to age, weight and height between groups.

Table 1
Participants characterization

Groups (n) Age Weight Height

Year (sd) Kg (sd) m (sd)

CG (15) 78.93 (9.29) 70.93 (10.87) 1.59 (0.10)

EG (15) 78.60 (5.99) 68.67 (9.39) 1.59 (0.10)

Groups (n)	Age	Weight	Height
CG (15)	78.93 (9.29)	70.93 (10.87)	1.59 (0.10)
EG (15)	78.60 (5.99)	68.67 (9.39)	1.59 (0.10)

CG – Control Group; EG – Experimental Group.

Table 2 shows the comparison between CG and EG in the TUG test. Analyzing the results, it is possible to verify that there are no significant differences in the CG performance between testing days, since in the TUG m1 has an average time of 17.06 (9.35) s and in the TUG m2 an average time of 17.2 (9.35) s showing no differences between evaluation days (p = 0.842). On the other hand, analyzing the results of the EG, it appears that there were statistically significant improvements in the TUG test time, since an average time performance of 13.07 (6.57) s was obtained in the TUG m1 and 11.65 (5.55) s in the TUG m2 showing statistical differences between the performance with and without KT^™ (p = 0.001).

Table 2

Mean (sd) of Time-Up & Go test performance

Groups	TUG ^m1	TUG ^m2	p value	Effect size
	time (s)	time (s)		(cohen d)
CG	17.06 (9.35)	17,2 (9.35)	0.356	0.51
EG	13.07 (6.57)	11.65 (5.55)	0.001 ^*	1,36

CG – Control Group; EG – Experimental Group; TUG – Time-Up & Go test; ^M1 – 1^st data collection; ^M2 – 2^nd data collection; ^*p < 0,05.

Analyzing the results from BBS Scale (Table 3), it is possible to verify that in the CG there were no statistically significant differences (p = 0.157) when comparing the testing day scores, where in the BBS ^m1 an average of 46.15 (9.39) points was obtained and, in the BBS ^m2 an average of 46.31 (9.27) points was reported. Regarding the EG, the results show significant differences (p = 0.002), since an average of 44.20 (6.71) points was obtained in the BBS m1 and an average of 46.20 (7.03) points in the BBS m2.

Table 3

Mean (sd) Berg Balance Scale test results

Groups	BBS ^m1	BBS ^m2	p value	Effect size
	time (s)	time (s)		(cohen d)
CG	46.15 (9.39)	46.31 (9.27)	0.157	0.35
EG	44.20 (6.71	46.20 (7.03)	0.002 ^*	1,41

CG – Control Group; EG – Experimental Group; BBS – Berg Balance Scale test; ^M1 – 1^st data collection; ^M2 – 2^nd data collection; ^*p < 0,05.

4 Discussion

The purpose of this study was to investigate the influence of the KT^™ method in balance in the elderly, and, to accomplish this purpose, an elderly group was evaluated in two tests: the TUG test and the BBS test in two different days. The main results showed that the KT^™ application seems to increase the performance in TUG test and the score in BBS.

The influence of the KT^™ method is not consensual. There are investigations that affirm that the method does not present benefits in the joint amplitudes in university students[20], in the ankle proprioception in healthy individuals [21], in the contractile properties and muscle performance in soccer players [22]. On the other hand, several studies [12 –15] claim that it has benefits in terms of increased proprioception, stretching, improved range of motion and blood circulation. It is important to notice that all these studies were conducted in groups youngers than the ones in this study, and this age difference may be a reason for the discrepancies on the results.

In a recent study held in an elderly population, Saltan et al., [8] concluded that KT^™ has beneficial effects in balance improvement in elderly, using the TUG and BBS, showing that the application of KT^™ in the foot can improve the results in these evaluations. Our findings are in agreement with the ones obtained in the abovementioned study, where the KT^™ method shows improvement in both tests results as well. Additionally, in the present study, the improvement could be noted after 24 h of application, not only after two weeks as in the results presented by Saltan et al., [8].

Although a study [2] demonstrated that the KT^™ method did not induce neuromuscular activity or alter balance in elderly women. The reason for those results may have to do with the fact that the sample was composed of healthy older adults, where the progression can’t be so significative, even with the KT application. However other authors [12 , 23–25] state that the proprioception stimulus, transmitted by contact with the KT^™ bands is conducted to cutaneous mechanoreceptors, which consequently allow an improvement of information about movement and joint position. These studies [12 , 23–25] can confirm the results obtained in the BBS, since we have also seen significant improvements regarding balance in the elderly.

In relation to the time spent until KT^™ starts effects, Lumbroso et al. [26] state that two days after the application of the KT^™ bands, there were evident changes in muscle strength and range of motion, enhancing a generalized improvement in the results of the tests performed. In the present study, the tests were performed after one day of application, and this could be the explanation for the improvement obtained, where it is defended that only 30 minutes after the application can show effects [16].

Nuno S. [27] states that the use of the KT^™ method in a distal joint can alter the proximal joint movement in individuals with functional ankle instability, allowing correction and improvement in the quality of movement. Since in our investigation there were significant improvements in the TUG scale, and although we have not investigated possible changes in the functional instability of the ankle, we believe that the fact that the KT^™ was placed in a distal joint, may have led to an improvement in quality of the movement of the proximal muscles and thus improved the quality of movement that led to the results we obtained.

For physical examination assessing the risk of fall among the elderly, the TUG test, which has a relatively stable sensitivity, and BBS, which has a relatively stable specificity, can be used in combination to increase diagnostic accuracy of the risk of fall [26 –28]. According to Donoghue et al. (2009) [29], for BBS results to be considered a true change, the difference between the first and second evaluation must be higher than 4 points of difference. Even though, the changes in CG in this study are 0 points in average, and in EG are 2 points, showing a tendency of increase stability, even not reaching the 4 points addressed in the mentioned study. Also, the combination of these two tests (BBS and TUG) could be a better approach to evaluate improvement in balance than one of them alone. Concerning the results obtained in this study, since the only change between m1 and m2 was the application of KT^™ in lower limbs of the EG, we can assume that KT^™ method had a positive effect on the test results.

This study was limited in some aspects, namely the balance tests being performed one day after the application, the tests were not randomized and the sample size is small and so not fully representative of the elderly community. Despite these limitations, the results indicate that there is a positive influence of the KT^™ on balance in this elderly group, also no negative side effects of KT^™ were observed and none of the participants reported any discomfort during assessment. Considering our results and the scarcity of investigations that relate this technique to the elderly, further investigations should be carried out to generalize the results and confirm the influence of the KT^™ method on balance improvement.

5 Conclusion

This study contributes with promising findings that KT^™ method may have positive effects regarding balance in the elderly, since the scales used showed significant improvements in the measurements of the experimental group. However, further investigation should be held to address the longtime effect of these improvement in stability, helping to avoid a higher risk of falls.

Conflict of interest

The authors have no conflict of interest to report.

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