Transcript Application of Proprioceptive Taping in Evidence

Application of Therapeutic
Taping in Evidence-Based
Practice (EBP)
Dr. Dyanna Haley-Rezac, PT, DPT, OCS, CSCS, CKTP
Dr. Scott Rezac, PT, DPT, OCS, CSCS, CKTP, CEAS
Talk the Talk
One of the key components of
Evidence Based Medicine is
communicating to your patients,
colleagues and other medical
practitioners what you are doing
and why when you perform an
intervention.
Scott & Dyanna Rezac - Evidence Based Taping
Talk the Talk
• What is OUT (not EBP)
– VMO re-education
– Joint Alignment / Patellar re-alignment
– Taping to effect nociceptors,
mechanoreceptors, thermoreceptors,
GTOs, muscle spindles, etc – things we
can’t measure
– Taping for prophylaxis (with no injury)
Scott & Dyanna Rezac - Evidence Based Taping
Talk the Talk
What is “IN”
– Taping to unload
– Taping to provide biomechanical support
– Taping for postural awareness
– Taping to decrease over-extension of
injured tissue
– Decrease pain
– Improve Function
Scott & Dyanna Rezac - Evidence Based Taping
Research
Keep in mind when discussing the
research out there the weight it holds:
– Small subject number – many <20
– Lots of case studies
– Few randomized control trial double blind
– Very few comparisons between specific
types of tape application
– Clinical Objective Measures are still best
evidence available
Scott & Dyanna Rezac - Evidence Based Taping
Research
What it does consistently support:
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Decrease in pain rating scales
Improvement in disability scores
Improvement in functional tasks
Decreased incidence of re-injury
Prevention of over-extension on soft tissues
Decreased inflammation / edema
Potential psychological benefits
Does not make them worse
Scott & Dyanna Rezac - Evidence Based Taping
Asterisk / Comparable Sign
This is your best measure of efficacy of your
intervention.
– It addresses the patient’s functional goal (their
complaint, limitation, etc.)
• For example “Pt. reports unable to ascend/descend 1
flight of stairs in their home carrying a basket of
laundry”
– It is objective and measureable
• 8” Step Up/Down Test would be appropriate
– Pre-tape: Pt. able to perform 2-3 reps with pain
– Post-tape: Pt. able to perform 10 reps with 75%
improvement in pain.
Scott & Dyanna Rezac - Evidence Based Taping
Asterisk / Comparable Sign
You may choose to evaluate your
efficacy of taping from one treatment to
the next.
– Day 1 (Taping) – “Pt. reports has pain 46/10 after typing on computer 30-45 min at
work.”
– Day 2 (next treatment following taping) –
“Pt. reports pain 2-3/10 after typing on
computer at work 3 hours.”
Scott & Dyanna Rezac - Evidence Based Taping
Asterisk / Comparable Sign
How do you decide if the tape worked?
– Objective
• Is it measureable?
• Could another clinician repeat the same
measure with good reliability and validity?
– Functional
• Does it allow the person to accomplish a
functional task better – ADL, work, sport, etc.
Scott & Dyanna Rezac - Evidence Based Taping
Taping Guidelines
• Tape for function, then pain
• Use least amount of tape to
accomplish goal
• One technique at a time, test for
efficacy
• Use objective measures
• Be creative, have fun!
Dyanna
Scott & Haley-Rezac,
Dyanna Rezac
PT,
- Evidence
DPT, OCS,Based
CSCS,
Taping
CKTP
10
Documentation
• Ok, you have this great objective,
measureable goal and the tape worked.
How do you document WHAT tape you
did?
• This is the same dilemma we have with
spine mobilizations (PVM, PAVM,
FRSB, ERSB, etc.)
• It makes it difficult to reproduce
between clinicians.
Scott & Dyanna Rezac - Evidence Based Taping
Documentation
If it is a technique presented by
someone, use that:
– Kinesio® Tape – supraspinatus
faciliatation
– McConnell Medial Glide x2 (two strips)
with elastic tape
– McConnell Navicular Lift and low-dye arch
support with elastic tape
Scott & Dyanna Rezac - Evidence Based Taping
Documentation
• What if you invented that tape job for
that patient’s problem?
• Document what you were trying to
accomplish.
– Elastic Tape – R abdominal oblique
faciliation x2 and R quadratus lumborum
faciliation x2.
– Elastic Tape – space correction over L
scalenes x3.
Scott & Dyanna Rezac - Evidence Based Taping
Billing
• Follow your state’s regulations first and
foremost!
• Taping – not well reimbursed for this code
• Bill for goal of taping
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Manual Therapy Codes
Edema/Lymphedema
Neuromuscular Re-education
Patient Education
• Can’t bill for tape used in procedure, can
have patients purchase their tape and teach
them the technique
Scott & Dyanna Rezac - Evidence Based Taping
Questions / Comments /
Discussion
[email protected]
[email protected]
www.rezacpt.com
Scott & Dyanna Rezac - Evidence Based Taping