Kinesio Taping® of the Metacarpophalangeal Joints and its Effect on Hand Function in Individuals ...

118 Pages·2015·4.63 MB·English

by  Archie Roberts

Kinesio Taping® of the Metacarpophalangeal
Joints and its Effect on Hand Function in
Individuals with Rheumatoid Arthritis.

Submitted in partial fulfilment of the requirement for the degree

Masters in Upper Limb Rehabilitation
Faculty of Health Sciences
University of KwaZulu Natal

Sarah Roberts
211559468
March 2015
DECLARATION
I, Sarah Roberts, declare that the research project “Kinesio Taping® of the
Metacarpophalangeal Joints and its effect on Hand Function in Individuals with Rheumatoid
Arthritis” is my own work and has not been submitted in any form to any organisation or
university. All sources that were used or quoted have been indicated by means of complete
references.

Sarah Roberts Date

Kinesio Taping® of the Metacarpophalangeal Joints and Page ii
its Effect on Hand Function in People with Rheumatoid Arthritis.
ACKNOWLEDGEMENTS

I would like to thank the following people who assisted and supported me without whom this
study would not have been possible:

Doctor Serela Ramklass and Professor Robin Joubert for all their guidance, encouragement
and expert advice.

My husband, parents and children for their support and for always believing in my ability to
complete my studies.

My work colleagues for their patience and fairness.

The Kinesio Taping® International Association for the provision of Kinesio® Tex GoldTM tape
for the study.

The South African Society of Hand Therapists (SASHT) for a grant towards the study.
Kinesio Taping® of the Metacarpophalangeal Joints and Page iii
its Effect on Hand Function in People with Rheumatoid Arthritis.
TABLE OF CONTENTS
Declaration............................................................................................. ii
Acknowledgements ............................................................................... iii
Table of Contents................................................................................... iv
List of Tables.......................................................................................... vi
List of Figure........................................................................................... vii
List of Appendices.................................................................................. viii
Abbreviations and Acronyms.................................................................. ix
Definition of Terminology........................................................................ x
Abstract.................................................................................................. xiii
CHAPTER 1 INTRODUCTION.................................................................................... 1
1.1 Introduction............................................................................................. 1
1.2 Background............................................................................................ 1
1.3 Problem Statement................................................................................. 3
1.4 Research Question................................................................................. 3
1.5 Purpose of the Study.............................................................................. 4
1.6 Significance of the Study........................................................................ 4
1.7 Outline of Chapters................................................................................. 5
1.8 Conclusion.............................................................................................. 6
CHAPTER 2 LITERATURE REVIEW.......................................................................... 7
2.1 Introduction............................................................................................. 7
2.2 Rheumatoid Arthritis............................................................................... 7
2.2.1 Prevalence of Rheumatoid Arthritis........................................................ 7
2.2.2 Defining Rheumatoid Arthritis................................................................. 8
2.2.3 Stages of Rheumatoid Arthritis............................................................... 8
2.2.4 Pathomechanics of Deformities in Rheumatoid Arthritis........................ 8
2.2.5 Rheumatoid Arthritis in the Metacarpophalangeal Joints....................... 9
2.3 Conservative Rehabilitation Interventions for Rheumatoid Arthritis....... 10
2.3.1 Splinting.................................................................................................. 10
2.3.2 Exercise.................................................................................................. 10
2.3.3 Modalities............................................................................................... 11
2.3.4 Assistive Devices.................................................................................... 11
2.3.5 Joint Protection....................................................................................... 11
2.3.6 Kinesio Taping®...................................................................................... 13
2.3.6.1 Contraindications and Precautions for the use of Kinesio Taping®........ 17
2.7 Conclusion.............................................................................................. 18
CHAPTER 3 METHODOLOGY................................................................................... 19
3.1 Introduction............................................................................................. 19
3.2 Research Design.................................................................................... 19
3.3 Research Setting.................................................................................... 19
3.4 Ethical Clearance................................................................................... 21
3.5 Sampling................................................................................................. 21
3.5.1 Participant Recruitment.......................................................................... 21
3.5.2 Informed Consent................................................................................... 22
3.5.3 Sample Size........................................................................................... 22
3.6 Instrumentation....................................................................................... 24
3.6.1 Rationale Behind the Choice of Data Collection Instruments................. 24
3.6.2 Description of Data Collection Instruments............................................ 25
3.6.2.1 Range of Motion – MCP Ulnar Deviation................................................ 25
3.6.2.2 Grip Strength.......................................................................................... 26
3.6.2.3 Michigans Hand Outcomes Questionnaire............................................ 27
3.6.2.4 Visual Analogue Scale............................................................................ 27
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its Effect on Hand Function in People with Rheumatoid Arthritis.
3.7 Data Collection Procedure...................................................................... 28
3.7.1 Pilot Study.............................................................................................. 28
3.7.1.1 Demographics of the Pilot Project Sample............................................. 28
3.7.1.2 Process of the Pilot Study...................................................................... 28
3.7.1.3 Adjustments made Based on the Pilot Study Findings........................... 29
3.7.2 Training of the Assessor......................................................................... 29
3.7.3 Data Collection Process......................................................................... 29
3.7.3.1 Pretest, Post Test Measures.................................................................. 30
3.7.3.2 Interventions........................................................................................... 32
3.8 Data Management.................................................................................. 37
3.9 Data Analysis.......................................................................................... 38
3.9.1 Confounders........................................................................................... 38
3.10 Reliability and Validity............................................................................. 38
3.10.1 Reliability................................................................................................ 38
3.10.2 Validity of Research Design................................................................... 40
3.11 Ethical Considerations............................................................................ 40
3.12 Conclusion.............................................................................................. 41
CHAPTER 4 RESULTS............................................................................................... 42
4.1 Introduction............................................................................................. 42
4.2 Characteristics of the Experimental and Control Groups....................... 42
4.2.1 Characteristics of the Experimental Group............................................. 42
4.2.1.1 Gender of the Participants...................................................................... 42
4.2.1.2 Ethnicity of Participants.......................................................................... 43
4.2.1.3 Age Range of Participants...................................................................... 43
4.2.1.4 Disease Duration of Participants............................................................ 43
4.2.2 Characteristics of the Control Group...................................................... 44
4.2.2.1 Gender of the Participants...................................................................... 44
4.2.2.2 Ethnicity of Participants.......................................................................... 44
4.2.2.3 Age Range of Participants...................................................................... 45
4.2.2.4 Disease Duration of Participants............................................................ 45
4.3 Results.................................................................................................... 45
4.3.1 Pain........................................................................................................ 46
4.3.1.1 Pain Results for the Experimental Group............................................... 46
4.3.1.2 Pain Results for the Control Group......................................................... 47
4.3.2 Metacarpal (MCP) Ulnar Deviation......................................................... 48
4.3.2.1 MCP Ulnar Deviation Results for the Experimental Group..................... 48
4.3.2.2 MCP Ulnar Deviation Results for the Control Group.............................. 49
4.3.3 Grip Strength.......................................................................................... 50
4.3.3.1 Grip Strength Results for the Experimental Group................................. 50
4.3.3.2 Grip Strength Results for the Control Group.......................................... 51
4.3.4 Michigans Hand Outcomes Questionnaire............................................. 52
4.3.4.1 MHQ Results for the Experimental Group.............................................. 52
4.3.4.2 MHQ Results for the Control Group....................................................... 53
4.3.5 Comparison between the Experimental and Control Group................... 55
4.4 Conclusion.............................................................................................. 56
CHAPTER 5 DISCUSSION......................................................................................... 58
5.1 Introduction............................................................................................. 58
5.2 Characteristics of the Sample................................................................. 58
5.3 Kinesio Taping®...................................................................................... 58
5.3.1 Kinesio Taping® and Pain in RA.............................................................. 58
5.3.2 Kinesio Taping® and Range of Motion in RA.......................................... 59
5.3.3 Kinesio Taping® and Grip Strength in RA............................................... 60
5.3.4 Kinesio Taping® and the MHQ in RA...................................................... 61
5.4 Comparison between Kinesio Taping® and Joint Protection (JP) in RA. 62
5.5 Conclusion.............................................................................................. 62
Kinesio Taping® of the Metacarpophalangeal Joints and Page v
its Effect on Hand Function in People with Rheumatoid Arthritis.
CHAPTER 6 CONCLUSION....................................................................................... 63
6.1 Limitations.............................................................................................. 65
6.2 Recommendations ................................................................................. 65
REFERENCES....................................................................................... 67
APPENDICES........................................................................................ 78
Kinesio Taping® of the Metacarpophalangeal Joints and Page vi
its Effect on Hand Function in People with Rheumatoid Arthritis.
LIST OF TABLES
Table 3.1 Retirement Facilities included in the sample........................................ 20
Table 3.2 Recruitment means for each Retirement Facility.................................. 21
Table 3.3 Demographics of the pilot project sample............................................ 28
Table 3.4 Representation of the data collection process..................................... 29
Table 3.5 Representation of the procedure for the experimental group............... 34
Table 3.6 Representation of the procedure for the control group......................... 36
Table 4.1 Gender of participants in the experimental group................................. 42
Table 4.2 Age range of participants in the experimental group............................ 43
Table 4.3 Gender of participants in the control group.......................................... 44
Table 4.4 Age range of participants in the control group..................................... 45
Table 4.5 Pain measured with the VAS for the experimental group..................... 46
Table 4.6 Pain measured with the MHQ for the experimental group.................... 46
Table 4.7 Paired t-test for changes over time for pain for the experimental 46
group.....................................................................................................
Table 4.8 Pain measured with the VAS for the control group............................... 47
Table 4.9 Pain measured with the MHQ for the control group............................. 47
Table 4.10 Paired t-test for changes over time for pain for the control group........ 47
Table 4.11 Descriptive statistics for MCP ulnar deviation in the experimental 48
group.....................................................................................................
Table 4.12 Paired t-test for changes over time for MCP ulnar deviation for the 48
experimental group...............................................................................
Table 4.13 Descriptive statistics for MCP ulnar deviation in the control group....... 49
Table 4.14 Paired t-test for changes over time in MCP ulnar deviation for the 49
control group.........................................................................................
Table 4.15 Descriptive statistics for grip strength for the experimental group........ 50
Table 4.16 Paired t-test for changes over time in grip strength for the 50
experimental group...............................................................................
Table 4.17 Descriptive statistics for grip strength for the control group.................. 51
Table 4.18 Paired t-test for changes over time in grip strength for the control 51
group.....................................................................................................
Table 4.19 Descriptive statistics for the MHQ for the experimental group.............. 52
Table 4.20 Paired t-test for changes over time in MHQ scores for the 53
experimental group...............................................................................
Table 4.21 Descriptive statistics for the MHQ for the control group....................... 54
Table 4.22 Paired t-test for changes over time in MHQ scores for the control 54
group.....................................................................................................
Table 4.23 Group statistics for independent samples t-test between 55
experimental and control group at week 7............................................
Table 4.24 Independent samples t-test at week 7 for comparison between the 56
experimental and control group outcomes...........................................
Kinesio Taping® of the Metacarpophalangeal Joints and Page vii
its Effect on Hand Function in People with Rheumatoid Arthritis.
LIST OF FIGURES
Figure 2.1 Cut of the tape - I-strip, Y-strip, X-strip, fan-strip............................... 14
Figure 3.1 Flow diagram of sample size.............................................................. 24
Figure 3.2 15cm Goniometer............................................................................... 25
Figure 3.3 Jamar Hydraulic Hand Dynamometer................................................ 26
Figure 3.4 Visual Analogue Scale for pain assessment...................................... 27
Figure 3.4 Application of Kinesio Taping®........................................................... 32
Figure 4.1 Ethnicity of participants in the experimental group............................. 43
Figure 4.2 Disease duration of participants in the experimental group............... 43
Figure 4.3 Ethnicity of participants in the control group...................................... 44
Figure 4.4 Disease duration of participants in the control group......................... 45

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its Effect on Hand Function in People with Rheumatoid Arthritis.
LIST OF APPENDICES
Appendix 1 Provisional ethical clearance – BREC................................................ 78
Appendix 2 Site permission letters........................................................................ 79
Appendix 3 Final ethical clearance – BREC.......................................................... 85
Appendix 4 Recertification application approval notice – BREC........................... 89
Appendix 5 Participant letter with informed consent.............................................. 90
Appendix 6 Screening questionnaire..................................................................... 94
Appendix 7 Background information sheet............................................................ 96
Appendix 8 Michigans Hand Outcomes Questionnaire......................................... 97
Appendix 9 Scoring sheet...................................................................................... 104

Kinesio Taping® of the Metacarpophalangeal Joints and Page ix
its Effect on Hand Function in People with Rheumatoid Arthritis.
ABBREVIATIONS AND ACRONYMS

ADL – Activities of daily living
BREC – Biomedical Research Ethics Committee
cm - centimetre
ISOM – International Standards of Measurement
JP – joint protection
kg - kilogram
MCP – metacarpophalangeal
MHQ – Michigan Hand Outcomes Questionnaire
mm – millimetre
OT – Occupational Therapist
OTs – Occupational Therapists
PADCA – Pietermaritzburg and District Council for the Care of the Aged
PIP – proximal interphalangeal
RA – rheumatoid arthritis
ROM – range of motion
SPSS 22 - Statistical Package for Social Sciences version 22
TENS - transelectrical nerve stimulation
UKZN – University of KwaZulu Natal
VAS – Visual Analogue Scale
Kinesio Taping® of the Metacarpophalangeal Joints and Page x
its Effect on Hand Function in People with Rheumatoid Arthritis.