Effects of Kinesiotaping for Hands Function in Rheumatoid Arthritis
Condition: Rheumatoid Arthritis
MeSH terms: Arthritis; Arthritis, Rheumatoid
Study type: Interventional

Summary: 
      The aim of this research is to compare the effects of I-shape and fan shape kinesiotape
      techniques on pain, range of motion, grip strength and ADLs of patients with Rheumatoid
      Arthritis. Randomized controlled trials done at Pain Clinic, Rawalpindi and Fauji Foundation
      Hospital, Rawalpindi. The sample size was 66. The subjects were divided in three groups, 22
      subjects in control group receiving conventional physical therapy treatment, 22 subjects in
      second group with I-Band application of kinesiotaping and 22 in the third group with
      fan-shaped application of kinesiotaping. Study duration was of 6 months. Sampling technique
      applied was non-probability convenience sampling. Only 25-50 years symptomatic female
      patients with established RA were included. Tools used in the study are Michigan Hand Outcome
      Questionnaire (MHQ), Numeric Pain Raiting Scale, Dynamometer and Goniometer. Data was be
      analyzed through SPSS 21.
    

Detailed description: 
      Rheumatoid Arthritis is an autoimmune systemic condition characterized by joint inflammation
      and extra-articular erosions. The symptoms of RA usually progress with age from mild to
      severe. The progression can either occur insidiously over a period of months or it can occur
      in weeks or overnight. RA with symptoms lasting less than six months is called as "early",
      while with symptoms lasting longer than this is known as "established". RA has significant
      direct costs, such as health-care costs, as well as indirect costs, such as lost income due
      to morbidity and reduced life expectancy. In the urban population of southern Pakistan,
      Karachi, the prevalence of RA is reported to be 0.142%, whereas in northern Pakistan the
      estimated prevalence is 0.55%. In 2014, the overall age-adjusted prevalence of RA ranged from
      0.53 to 0.55% (0.29-0.31% for males and 0.73-0.78% for females). In general, rheumatoid
      arthritis preferentially affects women with female to male ratio of about 3:1; however,
      patients with above 60 years of age have equal female to male ratio. The most prevalent age
      is 45-60 years. The disease severity increases with increase in the age and reaches to its
      peak in above 60 years of age.

      The joints of hand affected by of RA include polyarthritis of small joints like proximal
      interphalengeal (PIP), metacarpophalengeal (MCP) joints, wrist and metatarsophalangeal (MTP)
      joints. Patients experience morning stiffness in these joints which lasts unto several hours.
      The signs on examination involves swelling, stiffness, tenderness over the affected joints,
      decreased range of motion and deformity like; trigger finger, boutonniere and swan neck
      deformity. These signs results in loss of function and mobility. Moreover, the progression of
      RA occurs in four stages. Stage 1 has no destructive changes on x-ray, stage 2 shows
      periarticular osteoporosis and subchondral bone destruction on x-ray with no joint deformity,
      stage 3 reveals periarticular osteoporosis with cartilage and bone destruction on x-ray and
      significant joint deformity and stage 4 proceeds with stage 3 with the addition of bony and
      fibrous ankylosis Rheumatoid arthritis is a chronic, incurable disease. All of the currently
      known treatments are aimed at alleviating symptoms and increasing quality of life. Treatments
      aim to relieve pain and decrease the progression of RA in order to prevent disability and
      improve functional capability . The four most common components of Physical therapy for RA
      hands are exercise therapy, joint protection advice and provision of functional splinting and
      assistive devices, massage therapy and patient education. Exercise therapy includes ROM
      exercises, aerobic exercise and stabilization/coordination exercises. Joint protection
      includes rest and splinting that uses orthosis to prevent the development of deformities and
      support joints. Massage therapy involves manual trigger of an articular movement focused on
      the improvement of function, pain reduction, reduction of disease activity improve
      flexibility and welfare (dimension of depression, anxiety, mood and pain). Patient education
      is done to inform them about their disease and the various therapies available to help them
      live a better life. Additional interventional strategies include application of cold therapy,
      heat therapy, Transcutaneous Electrical Nerve Stimulation (TENS) and hydrotherapy exercises
      are also beneficial as they induce minimal loads on the joints during exercise.

      In 2016 Sarah Roberts et al conducted an RCT in order to check the effects of kinesio tape on
      pain and metacarpophalengeal joints of hands in patients with rheumatoid arthritis, the
      results revealed significant reduction in pain, improvement in ROM and enhanced grip strength
      in work and ADLs. Another study in 2016 conducted by Vilija Zebrauskaite et al in their study
      about the additive effects of kinesiotape for physiotherapy of patients with rheumatoid hand
      to correct to ulnar positioning of hand and improve hand function. The results were
      significantly positive with the hand function improved considerably in comparison with the
      group receiving only physiotherapy exercises. In 2019 Majid Farhadian et al conducted an RCT
      to investigate the effects of kinesio tape on pain, range of motion, hand strength and
      functional abilities in patients with hand osteoarthritis. The findings of this study
      revealed that Kinesio taping and hand training may help patients with HOA improve their
      discomfort, range of motion, hand strength, and upper-extremity functional capacities.
      Furthermore, these two approaches can be utilised in conjunction for the treatment of this
      illness.

      The previous studies have shown the positive effects of kinesiotape on hand functions of
      patients with RA. Since kinesiotape has vast variety of application techniques, and in order
      to determine the effectiveness of each application technique, current study is going to be
      conducted to compare the effects of I strip application technique and fan cut or web strip
      application technique.
    

Intervention name(s): Conventional Physical Therapy); Kinesiotaping with I shaped application; Kinesiotaping with Fan-shaped Application
Intervention type(s): Other; Other; Other
Intervention description(s): Participants will receive a Hand exercise program including 8 different movements according to Flat 20 (flexion, extension, radial deviation of the fingers, dorsal flexion, palmar flexion, ulnar deviation of the fingers, and opposition and abduction of thumbs.
Repetitions include 5 times during each session, as given in the study. Balanced resistive hand exercise with use of physio hand ball squeezes including finger abduction and adduction exercises with MCP extended and gross grip.
Each contraction to be held for 3-5 seconds with a 20-second rest between contractions. Five repetitions of each resistive exercise will be done.; Participants will receive Kinesiotape, by using I application technique from proximal to distal on dorsum of hand and forearm with less than 50% stretch of the subjects on both hands, once a week for a total time period of 4 weeks with 4 KT applications in total (19). Kinesiotape will be worn by the subjects for 3 days. basic hand exercises will accompny it. Weekly assessments will be completed for pain, ROM, joint stiffness, grip strength and ADLs.; Participants will receive exercise interventions as group A along with that the Kinesiotape will be applied, by using fan cut application technique on MCP joints involving extensor tendons of fingers on dorsal surface of both hands of subjects, once a week for a total time period of 4 weeks with 4 KT applications in total.
Kinesiotape will be worn by the subjects for 3 days. Less than 50% stretch with space correction technique. basic hand exercises will accompny it. Weekly assessments will be completed for pain, ROM, joint stiffness, grip strength and ADLs.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: rheumatoid arthritis; Kinesio Tape; hand strength; Metacarpophalangeal Joint