Journal of Rehabilitation Medicine 51-10

Effect of kinesio taping in chronic non-specific low back pain not significant and a combination of the above methods is recommended to achieve a good curative effect. Kinesio taping (KT) is the application of an elastic tape, which can be stretched up to 140% of its original length (approximately the stretch capability of normal skin), for treating musculature-related conditions (10). KT attached to injured skin or muscle regions may enhance muscle strength, relieve spasms, pain and oedema, improve blood circulation and lymph reflux, as well as stabilize joints and increase range of mo- tion (10–12). KT, as a rehabilitative taping technique designed to promote the body’s natural healing process, is widely applied in treatment of CNSLBP (13). Although the application of KT for patients with CNSLBP is increasing, overall comparison with other therapies of its effectiveness has been little reported. The aim of the current study was to systematically compare the effect of KT or KT plus conventional therapies (e.g. acupuncture, electric therapy or other physical therapy) applied to patients with CNSLBP with that of placebo taping or conventional therapies through assessment of VAS and ODI data. METHODS This meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines (PRISMA) (14). Search strategy Randomized controlled trials (RCTs) assessing the effect of KT on patients with CNSLBP, published in Chinese or English, up to 31 July 2018, were systematically retrieved from several databases: PubMed, Web of Science, Science Direct, Physioth- erapy Evidence Database (PEDro), Cochrane Library, Wanfang Data, Vip Data and China National Knowledge Infrastructure. Search terms were a combination of key words and free-text terms (“chronic non-specific low back pain” OR “non-specific low back pain” OR “low back pain” OR “back pain”) AND (“kinesio taping” OR “elastic taping” OR “taping”). Inclusion and exclusion criteria Inclusion criteria for the studies were: (i) the design of the study was an RCT and participants were patients with CNSLBP; (ii) patients with CNSLBP should present with an episode of chronic pain with limitation of motion in the lower back and demonstrate a normal low back on X-ray, computed tomography (CT) or magnetic resonance imaging (MRI); (iii) the study must compare the effect of KT and other non-elastic taping or other conventional therapy; (iv) the main outcomes of VAS and ODI in individuals with CNSLBP were tested. Exclusion criteria were: (i) the sample size was no more than 15 subjects (15) ; (ii) the full text was not available; (iii) relevant outcomes were lacking; (iv) the study was a systematic review, case report, comment or letter; (v) the study was published repeatedly; (vi) participants had clinical signs of spondylolis- thesis, lumbar stenosis, infectious pathologies in the spine, or 735 inflammatory diseases with spine involvement; (vii) participants had previously undergone spinal surgery. Retrieved article titles and abstracts were read to assess whether the study was eligible, with reference to the inclusion and exclusion criteria above; otherwise, the full text was read if the information was unclear. Data extraction Article selection and data extraction were completed inde- pendently by 2 reviewers, and a consensus was achieved by discussion. The following data were extracted from each included study: name of first author, year of publication, study characteristics (sample size, interventions, treatment frequency, outcomes measure, and follow-up time), and participants’ characteristics (mean age, sex, and duration of disease). If the original data was unclear or lacking, the corresponding author was contacted to obtain further information. Articles were excluded if the authors could not be contacted. Quality assessment The quality of each included study was assessed with a risk of bias assessment tool, as recommended by the Cochrane Col- laboration (16). This tool evaluates the selection, performance, detection, attrition, and reporting bias with 7 items. If discre- pancies were found for a specific item, a final agreement was reached by discussion with a third reviewer. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to evaluate the overall quality of the evidence and the strength of recommendations according to outcome (17). The grade of confidence in the estimate of effect was categorized into 4 levels: “very low”, “low”, “moderate”, and “high”. Quantitative data synthesis Meta-analysis was performed with RevMan 5.3 software. VAS and ODI were selected as outcome indicators. Weighted mean difference (WMD) data with its 95% confidence intervals (95% CI) was used as a measure of effect sizes to pool the results from each included study. Heterogeneity within the included studies was evaluated by Q test and I 2 index (18). A fixed effects model was applied for data synthesis when no significant heterogeneity was detected (p > 0.05 or I 2 < 50%) (19); otherwise, a random effects model was used if significant heterogeneity was found (p < 0.05 or I 2 ≥ 50%) (20). Sensitivity analysis In order to investigate the heterogeneity of sources, sensitivity analysis was conducted to assess the influence of each study on the combined result by removing studies one at a time. RESULTS Eligible studies A total of 203 articles were retrieved using the preli- minary search strategy. Of these, 53 repeated articles were excluded. After reading the abstracts, a further 95 irrelevant or ineligible articles were excluded. The full texts of the remaining 55 articles were reviewed J Rehabil Med 51, 2019

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