Kinesiology Tape Application for Postoperative Ocular Edema: A Pilot Study

Nicole D. Wood^*, Abbey Glenn

Department of Acute Therapy Services, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona.

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Abstract

Occupational therapists (OTs) often adapt and implement specific treatment techniques and modalities to improve patient outcomes by improving patient positioning and reducing edema and pain. One such modality is the use of kinesiology tape (K-tape), an elastic therapeutic tape that alleviates pain, provides joint support, and manages edema. A pilot study was conducted with 20 patients to determine whether using K-tape after two specific neurosurgery procedures that cause occluded eyes would assist in reducing postoperative edema and ecchymosis in the operative-side eye and face, thereby reducing pain and increasing overall patient satisfaction. In 10 patients, K-tape was used in addition to the postoperative standard of care (cryotherapy and head-of-bed elevation to greater than 30°). The 10 control patients received only the standard of care. Patient surveys and OT documentation found that using K-tape for postoperative patients with ocular edema was more beneficial than the standard of care alone in assisting with edema and hematoma reduction and faster eye-opening. Patients completed verbal surveys up to three times during their stay, depending on length of stay. Patients tolerated this easy, cost-effective modality. Patients reported reduced pain, pressure, and swelling, which suggests that K-tape be considered by OTs as an additional modality in acute care.

RUNNING TITLE: Kinesiology tape for ocular edema

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ABBREVIATIONS:

ADL, activities of daily living; CI, co-investigator; HIPAA, Health Insurance Portability and Accountability Act; ICU, intensive care unit; IRB, institutional review board; K-tape, kinesiology tape; OT, occupational therapist; PI, principal investigator; POD, postoperative day; REDCap, Research Electronic Data Capture

INTRODUCTION AND BACKGROUND

The role of the occupational therapist (OT) in the acute care environment can be quite complex. Acute care OTs possess a variety of skills that are adapted and implemented to achieve outcomes for various patient populations. One such population consists of patients who undergo neurosurgical procedures to remove and/or clip aneurysms or tumors. The role of OT is highlighted in working with neurosurgical patients, specifically in rehabilitating functional deficits and promoting recovery from neurological impairments following resection of brain tumors¹ and in identifying deficits that often remain underassessed and, therefore, overlooked, both pre- and postoperatively². Specific to this study, orbitozygomatic and pterional approaches were evaluated because they result in complete or near complete closure of the operative eye. In an assessment of the postoperative functional and cosmetic outcomes of 250 patients with orbitozygomatic surgery (169 with follow-up), 73.4% (124 of 169) of patients experienced periorbital and eyelid swelling, and 25.8% (39 of 151) experienced diplopia³.

Kinesiology tape (K-tape), an elastic therapeutic tape, is widely used in the athletic and sports medicine field for both injury prevention and rehabilitation after injury and by numerous disciplines in the rehabilitation field. More recent evidence supports its use for lymphedema management⁴, edema management, and pain relief^5-7. Dr. Kenso Kase, a Japanese scientist and chiropractor, developed the kinesiology taping method in the 1970s. K-tape was designed to incorporate elastic fibers that expand to 130% to 140% of the original length of the tape, along with a glue backing with a wavelike pattern⁸. The ingredients of the brand of K-tape used at our institution (Kinesio Tex Gold FP tape; Kinesio, Albuquerque, NM) include a latex-free, proprietary blend of cotton and elastic or a blend of cotton and polyester, considered medical grade and activated by heat⁹. The mechanism of action of the tape is thought to result from lifting the skin to create space between its layers, thereby reducing the pressure on pain receptors under the skin, improving lymphatic and blood flow, and creating a massage-like effect during active movement¹⁰. Specifically, when a lymphatic correction method is used, channeling is thought to occur through a directional pull of the tape, allowing fluid to travel to less congested areas through superficial lymphatic pathways⁸.

Facial application of K-tape after oral and maxillofacial surgery, including extraction of molars, is well-researched. Two systematic reviews and a meta-analysis of six of 10 articles reported that K-tape after mandibular third molar surgery in randomized control trials revealed a statistically significant reduction in swelling and pain score before the seventh postoperative day (POD), and more specifically within 48 hours^5,11,12. Two of the studies reported that K-tape was a viable and affordable treatment option associated with less reliance on analgesics to reduce swelling and control pain compared to the control treatment^13,14. Tozzi et al¹⁵. noted that, despite persistent swelling, K-tape gave patients the impression of swelling reduction, which detracted from their pain and morbidity.

With the exception of the aforementioned studies, additional evidence supporting the use of K-tape in facial applications is widely varied and scarce. To our knowledge, the only article reporting the use of K-tape for ocular swelling is what appears to be a letter to the editor by Costin¹⁶ describing a single case in which K-tape was utilized under the eye to treat swelling (festoons) following plastic surgery. The taping was utilized nightly for 3 months, with reductions in both edema and ecchymosis. No other evidence was identified to specifically support the novel application of K-tape in reducing postoperative ocular edema.

Because of the preponderance of neurosurgery patients treated at our institution, OTs work with a large population of postcraniotomy patients treated using orbitozygomatic and pterional approaches. Both of these surgical approaches are widely used for the resection of aneurysms in the anterior circulation, as well as for the resection of tumors in the anterior and middle fossae^3,17. Of relevance to this study is the fact that both approaches result in complete or near-complete eye closure on the operative side due to postoperative inflammation and swelling because of the proximity of the surgical site to the eye. Anecdotal reports by OTs at our institution indicate that the application of K-tape in this patient population results in decreased ocular edema, increased comfort, and improved eye-opening. Authors hypothesize that the application of K-tape results in similar findings of decreased swelling, pain, and pressure and improved speed of eye-opening. We expected to see differences between patients with K-tape application plus standard of care and those receiving only standard of care (cryotherapy and head-of-bed elevation). An additional objective was to highlight the important role of OT in identifying appropriate patients for K-tape application as an adjunct modality to aid healing. The purpose of this pilot study was to assess the reduction of swelling, pain, and pressure on the operative eye after the use of kinesiology tape. The goal was to improve patient satisfaction and indirectly improve functional outcomes.

METHODOLOGY

At our institution, OT is a consultative service with referral initiated by a prescribing provider and is ordered for the majority of postoperative neurosurgical patients. OT staff were educated on the purpose of the study and inclusion criteria. The evaluating OT determined the presence of ocular edema as a result of their surgical approach based on clinical observation. OTs evaluated patients as potential study participants after operations for multiple types of aneurysms, including basilar tip, posterior inferior cerebellar artery, anterior communicating artery, posterior communicating artery, and internal carotid artery terminus aneurysms; meningioma; or trauma, including an orbital wall blowout fracture with reconstruction. The OT then notified the principal investigator (PI; N.D.W.) or the co-investigator (CI; M.A.G.), who determined potential enrollment. Institutional review board (IRB) approval was received from St. Joseph’s Hospital and Medical Center (Phoenix, AZ) for this pilot study using a single-blinded randomization design. The IRB protocol stated no more than 20 participants could be included within a 1-year period.

Part of the IRB process included receiving written permission from all neurosurgeons performing these surgeries, indicating their awareness and support of this study and of the possible postoperative application of K-tape. These neurosurgeons included the president and chief executive officer of Barrow Neurological Institute (Phoenix, AZ), where the surgical procedures were performed. The PI also met with his nurse practitioner, the director of advanced practice nursing, on several occasions to discuss this study and gain input prior to submitting it to the IRB.

The PI (N.D.W.) and the CI (M.A.G.) were the only OTs who initiated contact with each patient to complete the informed consent and HIPAA (Health Insurance Portability and Accountability Act) paperwork and to apply or modify the K-tape application to patients randomized to the intervention group. The PI also trained the CI in the proper application of K-tape to ensure that the CI had adequate baseline information about its application and use. The PI is a Certified Kinesiology Tape Practitioner (CKTP), having attended at least three K-tape courses from Kinesio University (https://kinesiotaping.com), completed more than 24 hours of in-person or online coursework, and passed a 200-question written examination to qualify for this certification. Our institution uses Kinesio Tex tape, and the contraindications to this brand of K-tape include not to apply it over an active malignancy site or active cellulitis or infection, over open wounds, or over deep vein thrombosis if not anticoagulated for 48 hours, and not to apply it if the patient has a known reaction to the product⁹.

Patients were included if they met the following inclusion criteria: age 18 years or older, postcraniotomy or posttrauma status with facial edema on the ipsilateral side, central line removed if on the operative side, ability to follow simple commands, consent with or without their caregiver via their primary language using video remote interpretation as needed, current status as an acute care hospital patient, and medically stable status as defined by hospital parameters. Exclusion criteria included tape allergy or sensitivity, facial hair impeding tape application (with shaving declined), facial trauma not cleared by the plastic surgery or trauma team for K-tape application, placement of an ipsilateral central line that was not removed by POD 1, and intraoperative complications. The majority of these postoperative patients had ocular edema surrounding the affected eye and temple, causing the ipsilateral eye to be swollen shut. There were rare instances in which only the temple or area above the ear was swollen enough to benefit from K-tape, as it causes pain with chewing. Patients eligible for enrollment provided written consent.

For the intervention group, signage was posted in hospital rooms for patient, family, physician, and nurse reference discussing the purpose of the tape; asking that the tape not be removed to maximize the length of K-tape application, which is typically 3-4 days; and providing the name and telephone number of the OT who applied the tape for consultation if questions or issues arose (Supplemental Material 1). Participants in this intervention group also received an IRB-approved brochure created by the PI with information regarding the history of K-tape, its purpose, and the removal process along with the PI’s contact information (Appendix A).

A precise method of K-tape application was critical to draw the ocular edema away from the operative area into the lymphatic system. Kinesio Tex Gold FP tape was used because it is best for lowest-tension applications, neurological conditions, and postsurgical applications. The PI chose this tape and method of application based on recommendations in the course “Kinesio taping assessments, fundamental concepts, and corrective techniques,” offered by Kinesio University (https://kinesiotaping.com). K-tape was applied in a fanned pattern of 5 or 6 strips on the operative side of the face, incorporating the forehead, temple, upper eyelid as appropriate, and cheek areas to facilitate drainage into the supraclavicular area. With more than 300 of the approximately 800 lymph nodes present in the body, this area is the watershed of the lymphatic system²³. The fanned pattern is the most appropriate application for patients with facial swelling and bruising because it provides a low level of stimulus to the skin for lymphatic correction, which is best for edema and ecchymosis. It is usually applied with only one anchor at the insertion point, with 0% tension. The fanned strips are placed with paper-off tension, with additional stretch occurring when the patient turns the head or neck to the contralateral side during the taping procedure (Figure 1). This method is outlined in our staff competency as well (Supplemental Material 2).

Figure 1: Photograph of kinesiology tape application for postoperative ocular edema on left side of a patient’s face. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

At our institution, it is a departmental policy to complete an outcome measure during the initial evaluation to justify the need for OT intervention. The Boston University Activity Measure for Post Acute Care (AM-PAC) self-care outcome measure was used for five of 10 patients in the intervention group and nine of 10 patients in the control group. This is a subjective measurement that was documented before the enrollment of study participants to rate their ability to complete six basic self-care tasks. Three of the remaining five participants in the intervention group had an oculomotor examination, one was assessed with the Functional Status Scale–Intensive Care Unit (ICU), and one did not have an outcome measure documented by the OT. The one remaining participant in the control group had an oculomotor examination. Outcome measure selection was the result of differences in patient presentation (i.e., whether they could participate in an oculomotor examination or only a functional ADL (activity of daily living assessment) and therapist preference.

Patient data (e.g., medical record number, account number, sex, age, surgical approach, surgeon, comorbidities, and race) were entered into each patient’s secure and confidential Research Electronic Data Capture (REDCap) software account. Other information gathered included OT and physical therapy goals where applicable, surgical complications if known, the extent of cryotherapy and head-of-bed elevation if known, and whether the tape was present at discharge.

A three-statement standard-of-care survey (Appendix B) was administered to the 10 patients in the control group. A six-statement ocular taping survey (Appendix C) was administered to the 10 patients in the intervention group. Both surveys consisted of statements on topics such as pain, pressure, and swelling, as well as knowledge-based questions, to which patients responded using a five-point Likert scale ranging from strongly agree to strongly disagree. The 10-point numeric rating scale was added to both surveys as a means of pain assessment.

Survey administration ranged from 1 to 3 days total depending on the patient’s length of stay. Six of the 10 control group study participants had OT ordered on POD 1 and K-tape applied, three had K-tape applied on POD2, and one had K-tape applied on POD 4. The timing of K-tape application was based on the patient’s medical stability, when the prescribing practitioner ordered OT, whether the PI or CI were working that day to apply K-tape, and when the primary OT had informed the PI or CI about a patient’s ocular edema and potential study participation (Table 1). Surveys were occasionally administered on days when the PI or CI were unavailable. Therefore, two OTs who consistently worked these days were designated to follow up with the patients. They recorded responses in the electronic health record, and the PI kept a paper copy in a secured research binder. The surveys were administered verbally to the patient and recorded by the OT on a data collection sheet. These responses were then manually entered in REDCap software, which allowed a maximum of three surveys to be entered per patient. Administration days varied due to time constraints, patient availability, and work schedules. For instance, if K-tape was applied in the morning, the PI or CI returned later in the day to administer the survey. Some patients had the K-tape applied for a longer or shorter duration based on what time of the day the K-tape was applied, the work schedules of the PI and CI, and patient availability to complete the survey.

Data are reported as numbers and percentages. Descriptive statistics including mean, range, and median values are reported.

Table 1: Survey results for patients with facial edema who received standard of care plus K-taping (intervention group; n=10) or standard of care only (control group; n=10)

Patient Group, Record ID	Visit	Question 1: I understand that using ice and elevating my head can assist in decreasing the swelling around my eye.	Question 1a: How frequently do you complete icing?	Question 1b: How frequently do you elevate your head?	Question 2: I had less pain around my eye after the kinesiotape was applied.	Question 3: I had less pressure around eye after the kinesiotape was applied.	Question 4: How much pain are you currently experiencing?	Question 5: I believe the kinesiotaping around my eye assisted with reducing swelling.	Question 5a: How long did it take you to notice the change in swelling?	Question 6: I was out of bed at least 3 times today (could include sitting in the chair, bathroom, or walking).
Intervention Group
2	1	Strongly agree	Minimal	Minimal	Neither or N/A	Neither or N/A	3			Agree
	2	Strongly agree	Nighttime	A lot	Neither or N/A	Neither or N/A	0	Strongly agree	5 hours	Strongly agree
	3	Neither or N/A	Once at night	Daily	Disagree	Agree	2	Agree	Next day	Strongly agree
3	1	Strongly agree	All morning	All morning	Strongly agree	Strongly agree	4	Agree	Immediate	Strongly agree
	2	Strongly agree	None	75%	Agree	Agree	4	Agree	A little bit after it was on; I feel like it gives good support	Disagree
4	1	Strongly agree	3X a day	Daily	Agree	Agree	7	Agree	No answer	Strongly agree
	2	Strongly agree	3X a day	Daily	Agree	Agree	7	Agree	Less than 12 hours	Strongly agree
	3	Strongly agree	3-4X a day	Usually	Neither or N/A	Agree	7	Disagree	No answer	Strongly agree
6	1	Strongly agree	2-3X a day	2-3X a day	Neither or N/A	Neither or N/A	7	Neither or N/A	Not more than 2 hours; no change noted yet	Strongly agree
7	1	Strongly agree	Daily	All day	Agree	Neither or N/A	5	Neither or N/A	No change noted day 1 at 3.5 hours after application	Strongly agree
	2	Strongly agree	No answer	No answer	Agree	Agree	4	Agree	No answer	Strongly agree
8	1	Not completed
	2	Strongly agree	Not enough	Daily	Strongly agree	Strongly agree	5	Strongly agree	Per wife less than 2 hours	Disagree
10	1	Strongly agree	Not as much as I should	Most of the day >30	Agree	Strongly agree	3	Agree	1 day	Strongly agree
	2	Strongly agree	3X a day	Daily	Neither or N/A	Neither or N/A	0	Agree	Less than 24 hours	Strongly agree
12	1	Not completed
	2	Strongly agree	No ice here	<30	Neither or N/A	Neither or N/A	4	Agree	Less than 10 hours	Strongly agree
	3	Strongly agree	3X a day	1 hour	Agree	Disagree	9	Agree	No answer	Strongly agree
14	1	Not completed
	2	Strongly agree	All the time	All the time	Strongly agree	Strongly agree	9	Neither or N/A	No answer	Strongly agree
	3	Agree	No answer	No answer	Agree	Agree	9	Agree	Less than 12 hours	Strongly agree
20	1	Strongly agree	All day	1/2 the time	Strongly agree	Agree	0	Agree	2 hours	Strongly agree
	2	Strongly agree	As much as possible	As much as possible	Agree	Agree	4	Strongly agree	No answer	Strongly agree
	3	Strongly agree	A lot	A lot	Strongly agree	Strongly agree	1	Strongly agree	Within 24 hours	Strongly agree
Control Group
1	1	Agree	I don't	Nurses do it			7			Strongly agree
5	1	Strongly agree	All day	Minimally			7			Strongly agree
	2	Agree	Overnight	Noncompliant			5			Strongly agree
	3	Strongly agree	As much as possible 4X a day	As much as possible >35			5			Strongly agree
9*	1
11	1	Strongly agree	4X a day	All the time			6			Agree
13	1	Strongly agree	As often as I can	As often as I can			7			Strongly agree
	2	Strongly agree	All day	All day			6			Strongly agree
	3	Strongly agree	All throughout	All day			6			Strongly agree
15	1	Strongly agree	2-3X a day	All day			2			Disagree
16	1	Strongly agree	In the morning	All day			5			Strongly agree
17	1	Not completed
	2	Strongly agree	2-4X a day	Don't know			0			Neither or N/A
	3	Strongly agree	2-4X a day	Most the day			0			Strongly agree
18	1	Agree	Once	All day			6			Strongly disagree
	2	Agree	None	None			5			Agree
19	1	Agree	Often	Always			6			Strongly agree
	2	Agree	1-2X a day	45 at all times			1			Agree

RESULTS

The primary objective of this study was to determine whether the added modality of K-tape application benefitted neurosurgery patients after craniotomies that used the orbitozygomatic or pterional approach. An additional objective was to highlight the important role OTs play in identifying appropriate patients for K-tape application as an adjunct modality to aid healing. Researchers compared two groups of 10 patients each whose postoperative care was managed with the two treatment approaches: (1) the standard of care (cryotherapy and head-of-bed elevation) and (2) the standard of care plus K-tape application.

Twenty patients met the inclusion criteria over the study period and provided informed consent (Table 2). Depending on the time of K-tape application during the day, the survey was first administered on POD 1 for six patients, on POD 2 for three patients, and POD 4 for one patient. There were no statistical differences between the control and intervention groups at baseline.

Eighteen patients underwent surgery with either a pterional or orbitozygomatic approach, one patient underwent surgery with an eyebrow supraorbital approach, and one patient underwent an orbital wall reconstruction with open reduction internal fixation of the right eye due to trauma, with the initial trauma and surgery causing postoperative ocular edema. In the control group, four patients had a pterional approach, and four had an orbitozygomatic approach. In the intervention group, seven patients had a pterional approach, and three had an orbitozygomatic approach.

Table 2: Demographic and clinical characteristics of patients who received standard-of-care postcraniotomy management with (intervention group) and without (control group) K-tape application

Characteristic	Intervention Group (n=10)	Control Group (n=10)
Sex
Female	9	7
Male	1	3
Age, y
Mean	56	51
Median (range)	61 (27–75)	51 (25–81)
Operative approach or trauma	Pterional, 7; orbitozygomatic, 3	Trauma, 1; mini-pterional, 1; pterional, 3; orbitozygomatic, 3; retrosigmoid, 2
Length of stay, mean (range), d	5.4 (2–17)	6.6 (2–22)

Survey Results

Participants were asked to complete a survey by giving an answer from a 5-point Likert scale with options of strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree. On the K-tape survey of six statements, three statements related to the application of K-tape elicited agreement or strong agreement that this modality reduced pain, pressure, and swelling (Table 3 and Figure 2). For the statement, “I had less pain around my eye after the Kinesio tape was applied,” 24% (n=5) strongly agreed, 43% (n=9) agreed, 29% (n=6) selected neither or not applicable (N/A), 5% (n=1) disagreed, and none strongly disagreed. For the statement, “I had less pressure around my eye after the Kinesio tape was applied,” 24% (n=5) strongly agreed, 43% (n=9) agreed, 29% (n=6) selected N/A, 5% (n=1) disagreed, and none strongly disagreed. For the statement, “I believe the Kinesio taping around my eye assisted with reducing swelling,” 20% (n=4) strongly agreed, 60% (n=12) agreed, 15% (n=3) N/A, 5% (n=1) disagreed, and none strongly disagreed. Results reflect the total number of surveys administered; however, caution is advised because the number of surveys per patient varied based on the length of stay, neurological status, patient availability, and time of discharge.

Results indicate that implementing K-tape as an additional modality for postoperative ocular edema is associated with positive outcomes, as reported by the patients themselves in a series of surveys. Most of the 10 patients who underwent K-tape application either agreed or strongly agreed that this modality reduced pain and alleviated pressure around the eye (Table 3). Objective documentation by multiple OT practitioners varied considerably. For example, pain was documented for only two of 10 patients in the intervention group by the treating OT even though some participants had more than one treatment intervention or session. In the intervention group, the OT responsible for administering and documenting the survey was not the treating OT. In the control group, pain was documented five times by the treating OT. Treating OTs documented eye edema in all 20 participant charts. Comments with regard to edema improvements and changes were documented where applicable (i.e., if the patient was seen more than one time).

Our review of patients’ charts and our discussions with the nursing staff and patients and their families revealed that the postoperative standard of care of cryotherapy and head-of-bed elevation was not always rigorously implemented, which slowed the clearing of edema and ecchymosis. However, OTs educated the nursing staff and the patients and their families on the value of using ice and elevating the head of the bed.

The level of alertness of the patients sometimes differed during their hospital stay, with some patients removing the K-tape even after agreeing to its application. Two patients removed the K-tape one or two times; in one case, the PI reapplied the K-tape, and in the other case, the PI documented that the patient’s edema had reduced enough to justify not reapplying. Furthermore, some nurses and at least one physician removed the K-tape despite posted signage indicating its purpose (Appendix A and Supplemental Material

Figure 2: Survey results for 10 postcraniotomy patients with ocular edema who were managed with the standard of care (cryotherapy and head-of-bed elevation) plus kinesiology taping (n=21 responses). Responses varied based on the number of surveys the patient completed, which varied depending on length of stay, discharge, and patient alertness. Most patients agreed or strongly agreed that the application of kinesiology tape helped reduce pain, pressure, and swelling. (A) Patient responses to question 2 (“I had less pain around my eye after the Kinesio tape was applied”): strongly agreed, 5 (24%); agreed, 9 (43%); neither or N/A, 6 (29%); disagreed, 1 (5%); and strongly disagreed, 0 (0%). (B) Patient responses to question 3 (“I had less pressure around my eye after the Kinesio tape was applied”): strongly agreed, 5 (24%); agreed, 9 (43%); neither or N/A, 6 (29%); disagreed, 1 (5%); and strongly disagreed, 0 (0%). (C) Patient responses to question 5 (“I believe the Kinesio taping around my eye assisted with reducing swelling”): strongly agreed, 4 (20%); agreed, 12 (60%); neither or N/A, 3 (15%); disagreed, 1 (5%); and strongly disagreed, 0 (0%). Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Table 1: Descriptive statistics for K-tape effectiveness

Symptom, Postoperative Day	N	Minimum	Maximum	Median
Pain
0	1	5	5	5.0
1	1	4	4	4.0
2	7	3	5	4.0
3	6	2	5	3.5
4	4	3	5	4.5
Pressure
0	1	5	5	5.0
1	1	3	3	3.0
2	7	3	5	4.0
3	6	2	5	4.0
4	4	3	3	4.5
Swelling
0	1	4	4	4.0
1	1	3	3	3.0
2	7	4	5	4.0
3	6	2	5	4.0
4	4	3	5	4.5

DISCUSSION

This study of the use of K-tape for ocular edema showed promising results based on subjective reports from the participants and objective documentation by OT practitioners, including edema reduction, as evidenced by wrinkling of the skin, and hematoma reduction. The numeric pain scale results were similar for the control group (range, 0–7) and intervention group (range, 0–9), which was not surprising, given that pain could have been from the surgical site and subsequent edema as well as ocular edema. Most patients in the intervention group strongly agreed or agreed with question 2 on the survey, which stated, “I had less pain around my eye after the Kinesio tape was applied.” The majority of patients in the intervention group strongly agreed or agreed with the statement, “I had less pressure around my eye after the Kinesio tape was applied.” Although OT documentation was not standardized, all 20 patients had eye edema information documented, including improvements or changes.

Even with the effect of multiple factors, including the operative approach and the location of the aneurysm, surgical complications, and tumor type, as well as patient length of stay, timing of OT being ordered, and timing of the PI or CI being alerted of ocular edema, this study was able to show that K-tape alone assisted with eye-opening in at least one patient (Figure 1). On the basis of the survey results, we found that K-tape is potentially a good additional modality when used in conjunction with cryotherapy, head-of-bed elevation, and mobilization of the patient out of the bed.

Implications for OT Practice

Assessing a patient’s visual abilities falls within the scope of practice of the OT because of its specific ties to ADL, instrumental ADL, safety, and functional mobility performance¹². The role of OT in the acute care environment is to evaluate current function, including the ability of patients to care for themselves. The OTs obtain patient-centric information about meaningful occupations, roles, and routines within the home and community; anticipate environmental challenges and barriers within the home; provide interventions that directly enable participation; and assist with safe discharge planning. OTs who work in acute care settings have an obligation to help patients achieve success, such as by optimizing their visual function by aiding their ability to open a swollen eye after surgery or trauma. Such assistance helps improve binocular vision and eye teaming, which are crucial for balance, mobility, self-care, and visual perception. Thus, the use of K-tape, along with other treatment interventions to improve function, can increase patient satisfaction and facilitate timely and safe discharge planning.

Deficits in binocular vision, especially those due to edema and ecchymosis resulting from a surgical approach, can affect overall functional performance, quality of life, and patient satisfaction. Prescribing providers should therefore continue to order OT postoperatively for patients, particularly when ocular edema is likely to occur. In addition to evaluating patients for edema and hematoma, the OT should also implement an oculomotor examination consisting of pursuits, convergence and divergence, saccadic movements, and confrontation of visual fields. The application of K-tape can assist with edema reduction, allowing OT to complete appropriate assessments and recommendations as needed, such as diplopia assessment. To provide optimal care for their patients, OTs should be trained in the application of K-tape as an adjunct modality. If at least one OT has additional knowledge or certification in K-tape application, other OTs can easily be educated on its use through demonstration and application, and a competency can be created for staff (Supplemental Material 2). At our institution, we do not bill the patient for the cost of the tape but use it as adjunct therapy within our treatment session, with supporting documentation. Our OT department has a budget for modalities and equipment such as K-tape, exercise bands, adaptive equipment for ADLs, and other commonly used items within the scope of OT. However, for those institutions that do not have a budget for supplies, the tape is inexpensive, with a roll of K-tape costing approximately $15. Checking other possible contraindications is recommended if using other elastic tape brands (e.g., Rock Tape, KT Tape). Recommendations for further studies include the use of both objective and subjective measurements as well as more standardization of when measurements are taken (e.g., consistently obtaining measurements on POD 1).

Study Limitations

This study was limited by its reliance on subjective reporting. Because the sample size was small (20 total patients), obtaining an objective physical measurement of edema with a paper tape measure was potentially achievable and was initially considered. The smaller sample size resulted in an underpowered study, and inconsistent chart documentation of symptom onset and pain rating precluded statistical analysis of these variables. This indicates that our findings support further research in the future.

Several OTs at our institution have implemented this modality for appropriate patients over the past several years and have seen good results with edema reduction. Therefore, the PI chose a small sample size to avoid rendering this modality unavailable for patients outside of the study. The PI initially wanted to manually measure patient facial edema using a 5-point anatomical measurement from the tragus of the ear with a paper measuring tape, but it was found that this could be difficult to complete on days when the PI or CI were not present. The PI did not want to risk an error in measurement by the other two OTs designated to administer the surveys. In hindsight, this method would likely have been the most accurate form of measurement within the acute care setting, but it would have required that the PI or CI work 7 days a week to ensure accurate measurements or specifically train additional OTs in proper and accurate measurement. An edema grading scale would not have been an accurate measurement due to the sensitivity of the facial edema; any palpitation was usually painful to the patient, and the edema was never pitting on the patient’s face.

Subjective reporting showed favorable results regarding K-tape application, but responses from participants may have been biased. It was noted that the number of surveys completed ranged from one to three for the control group and the intervention group, based on length of stay, patient availability, and time of discharge. It was also noted that responses to question 1 on both surveys and question 5 on the intervention survey varied for individual patients depending on the day (Table 1). Another limitation was inconsistency as to whether the survey was administered on the same day as K-tape application or on the next day. It was unclear why one of the patients in the intervention group had only one survey, from the second visit, completed in REDCap. This patient experienced multiple complications, including external ventricular drain replacement, waxing and waning levels of alertness, and longer ICU length of stay. It was noted that only two surveys could be completed for one of the control group participants due to a neurocognitive change that made the patient unable to subjectively participate in the survey. If objective assessment with measuring tape was chosen, the patient could have continued to participate because the measuring would have been the sole responsibility of the PI and CI. The standard of care (cryotherapy and head-of-bed elevation) was also not consistently charted by staff members, whether as a pain intervention or a nursing progress note, or consistently completed by the patients. Therefore, we could not determine how well the standard of care for postoperative patients was implemented for either the intervention or control group. Furthermore, patient pain levels ranged widely during hospitalization and were inconsistently documented, sometimes recorded before and sometimes after administration of pain medication; level of cognitive alertness was recorded for some patients and not for others. The study was able to record only the current level of pain subjectively reported by the patient at the time of survey administration, which varied greatly depending on the patient and OT availability. It is unclear to what degree pain rating numbers were affected by recent receipt of pain medication, cryotherapy, head-of-bed elevation, and/or K-tape application. Although the numeric rating scale is a valid scale, it is also a subjective measurement that allows a patient to give a range of numbers that can vary greatly. There could have been potential response bias because the surveys in both groups were administered by OT staff. There also could have been experimenter bias because OT documentation assessing eye-opening and the effect of K-tape varied greatly.

This study had great potential to show functional outcomes before and after study implementation. As stated above, the majority of the patients were administered the Boston University AM-PAC self-care outcome measure during the initial OT evaluation, which was before they were contacted for the study. It would have been a great opportunity for the study to include ongoing, daily scoring of this scale or another outcome measure, whether it was after tape application or only for the control group, to see whether the patient’s functional status had changed, possibly further supporting the benefit of K-tape. However, the OT documentation noted that the patients’ levels of assist improved daily with respect to mobility or ADL assessment. Further research should consider using the same standardized assessments on milestone days to track progress.

Depending on the timing of OT orders from residents or staff physicians, they could not always be implemented on the first or second POD, which limited the OT’s ability to intervene. The length of stay of patients also varied widely (range, 2–22 days) because of variable rates of healing and pain control. Furthermore, selection bias existed because the OTs determined which patients would be good candidates for study consideration and informed the PI or CI at different times. Observation bias was also a limitation because all patients were educated on the importance of following the standard of care (use of cryotherapy and head-of-bed elevation) from the onset of OT or no later than administration of the first survey (Appendices B and C).

CONCLUSION

Although several researchers have speculated about the benefits of K-tape application after different acute facial surgeries^5,11, none have attempted to implement it to reduce postoperative ocular edema. Previous researchers have highlighted the benefits and applicability of using K-tape for edema in various parts of the body^4,5,10,11,24, but there is limited research on its use for the specific postoperative ocular edema examined in this study.

Researchers have highlighted the practicality of implementing the use of K-tape as an adjunct modality to help alleviate postoperative edema. Patients who received K-tape consistently reported less pain, pressure, and swelling around the operative eye. Our results indicate that the application of K-tape is a viable and affordable modality that can serve as an additional tool for acute care OTs to help patients improve their speed of eye-opening for binocular vision, which in turn improves patient satisfaction and safety, reduces pain, and can potentially assist with improving patient ability to complete ADL, instrumental ADL, and functional mobility tasks. Practitioners at our institution now specifically request this modality for assistance with edema and hematoma management in the above-mentioned postoperative populations. There is a great opportunity to expand on this pilot study for future research.

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Appendix A. Brochure given to patients and family members providing information on kinesiology tape background, purpose, removal, and general care

Appendix B. Patient Satisfaction Survey: Standard of Care for Patients Experiencing Ocular Edema

Question 1: I understand that using ice and elevating my head can assist in decreasing the swelling around my eye.

Strongly Agree	Agree	Neither or N/A	Disagree	Strongly Disagree
5	4	3	2	1

• How frequently during the day do you complete icing?
• How frequently during the day do you elevate your head in bed?

Question 2: How much pain are you currently experiencing?

0	1		2	3		4	5		6	7		8	9		10
No pain		Mild, annoying pain			Nagging, uncomfortable, troublesome pain			Distressing, miserable pain			Intense, dreadful, horrible pain			Worst possible, unbearable, excruciating pain

Question 3: I was up out of bed at least 3 times today (could include sitting in chair, using bathroom, or walking).

Strongly Agree	Agree	Neither or N/A	Disagree	Strongly Disagree
5	4	3	2	1

Abbreviation: N/A, not applicable.

Appendix C. Patient Satisfaction Survey: Ocular Kinesiology Taping for Patients Experiencing Ocular Edema

Question 1: I understand that using ice and elevating my head can assist in decreasing the swelling around my eye.

Strongly Agree	Agree	Neither or N/A	Disagree	Strongly Disagree
5	4	3	2	1

• How frequently during the day do you complete icing?
• How frequently during the day do you elevate your head in bed?

Question 2: I had less pain around my eye after the Kinesio tape was applied.

Strongly Agree	Agree	Neither or N/A	Disagree	Strongly Disagree
5	4	3	2	1

 

Question 3: I had less pressure around my eye after the Kinesio tape was applied.

 

Strongly Agree	Agree	Neither or N/A	Disagree	Strongly Disagree
5	4	3	2	1

 

Question 4: How much pain are you currently experiencing?

 

0	1		2	3		4	5		6	7		8	9		10
No pain		Mild, annoying pain			Nagging, uncomfortable, troublesome pain			Distressing, miserable pain			Intense, dreadful, horrible pain			Worst possible, unbearable, excruciating pain

 

Question 5: I believe the Kinesio taping around my eye assisted with reducing swelling.

 

Strongly Agree	Agree	Neither or N/A	Disagree	Strongly Disagree
5	4	3	2	1

 

• How long did it take you to notice this change in swelling?

 

Question 6: I was up out of bed at least 3 times today (could include sitting in chair, using bathroom, or walking).

 

Strongly Agree	Agree	Neither or N/A	Disagree	Strongly Disagree
5	4	3	2	1

 

Abbreviation: N/A, not applicable.

SUPPLEMENTAL MATERIALS

Supplemental Material 1. Signage posted in the hospital rooms of patients who had K-tape applied to their face

The OT implemented the application of Kinesiotape to the patient's face on the operative side. Our department has found this technique to be very effective. It is part of our scope of practice to apply this technique as deemed necessary.

1. It assists with edema and bruising reduction along with ice and HOB elevation.
2. There may be a piece of tape placed over upper eyelid with this approach. This does NOT tape the eyelid closed nor does it impede eyelid opening.
3. Please do not remove it and encourage patient not to remove it unless absolutely necessary.

If you have any questions, please call the acute therapy department at 602-406-3222

 

Thank you!

 

Occupational Therapist: ____________________________

Supplemental Material 2. Ocular taping competency used in the Acute Care Therapy Department

The aforementioned person has demonstrated knowledge and ability to apply kinesiotape to post-operative patient utilizing the following provided documents and clinical skills.

CRITICAL ELEMENTS	Paperwork Provided	Activity Observed	Date
Documents Provided:
Acute Therapy Department: Brochure for home and signage to place in patient room
Background: Therapist has taken at least one kinesiotaping course for basic knowledge of tape application
Skills Performed:
Chart review performed using medical and therapy considerations for taping including contraindications (i.e. not taping if central line in place, facial hair)
Received verbal consent from patient and/or caregiver meaning at least one is competent and able to make decisions
Explains purpose, role, possible contraindications and necessary information to patient/caregiver with permission given
Measures face prior to cutting tape
Removes oils with alcohol wipe on skin prior to application
·       Cuts K-tape appropriately in fanned pattern up to 5 strips, rounding the edges ·       Applies anchor at supraclavicular or subclavicular space at 0% tension applied ·       Turns/has patient turn to the contralateral side post anchor placement prior to applying fanned pieces ·       Starts from the top/down for fanned piece application ·       Does not apply extra stretch to tape when applying fanned pieces to patient ·       Does not impede eye opening with eyelid tape ·       Does not cross nasal passage when applying tape ·       Shows definite recoil in tape when patient returns head to neutral
Documented session appropriately including ·       K-tape dot phrase or something similar explaining purpose, application, appearance of edema or bruising, patient response, education, etc. ·       A goal written regarding improved ADL/functional mobility performance in regards to binocular vision with improved eyelid opening

Observer Signature: _____________________________________ Date: ___________ 

Employee Signature: ____________________________________ Date: ___________