Introduction

Ta** has gained widespread attention in rehabilitation and performance science [1]. The earliest use of ta** in rehabilitation dates back to as early as 1969, as documented in the literature [2]. Its integration in modern practice was prominently observed during the 2012 London Olympics, where Kinesiota** was identified as one of the most frequently used treatment modalities by the Olympians [3]. The intervention entails the application of specialized adhesive tape to the body to achieve various therapeutic and performance-related outcomes [4]. The growing use of this intervention is largely due to its viability [5], ease of application [6], availability [7], and cost-effectiveness [8, 9]. Owing to these factors, the application of ta** in the existing literature extends across a range of medical conditions including chronic ankle instability [10], patellofemoral pain syndrome [11], low back pain [12], lymphedema [13], Parkinson’s disease [14], and stroke [15]. Likewise, the application of ta** also extends across a range of sports including, Judo [16], athletics [17], Taekwondo [18], soccer [19], and Karate [20].

Researchers have put forth various explanations concerning the effects of ta** in the literature [10, 21,22,23,24,25]. For instance, adhesive patellar ta** has been reported to alternate muscle function by facilitating muscle kinematics such as, torque, moment, and power [21]. Similarly, in individuals with patellofemoral pain syndrome [26], the application of adhesive patellar ta** has been reported to allocate knee extensor moment arm in an advantageous position which results in facilitated muscle activity. Additionally, facilitating ergonomic movement strategies including trunk engagement, and improvement of vastus medialis obliques and vastus lateralis ratio have been reported with rigid Leuko ta** to be supplementary mechanisms that could facilitate muscle function [27]. Likewise, “microcirculatory” effects of Kinesiota** interventions have also been proposed as a mechanism in the literature that could facilitate recovery. Studies have suggested that the “skin lifting” associated with ta** interventions could facilitate local circulation [28], augment lymphatic and venous drainage [29, 30] which might result in enhanced recovery and performance. Moreover, ta** has also been reported to pertain with psychological effects, primarily centered around boosting the wearer’s confidence and perception of stability [10, 31, 32]. Researchers have indicated that heightened confidence and a sense of stability through rigid sports ta** could enable individuals with joint instability to perform challenging tasks more effectively than without the tape [10, 31].

Furthermore, an additional advantage attributed to ta** is the enhancement of joint proprioception. This aspect has been linked to ta**’s potential to improve recovery and performance [33,34,35]. Research has suggested that the tactile feedback provided by ta** activates mechanoreceptors, which can enhance proprioception through increased input to the central pathways [34, 36]. Eventually, this amplified afferent input consequently aids in bolstering the efferent neuromuscular response, which increases both the speed and the quality of the muscle reaction (i.e., reduced reaction time) [37, 38]. Konishi [36] suggested that reduced proprioceptive activity due to injury or weakness might impede the ability of mechanoreceptors to provide regular afferent feedback to gamma motor neurons. This deficiency in afferent feedback could disrupt the modulation of primary afferents and hinder the recruitment of high-threshold motor units [39]. The author suggested that ta**’s tactile stimulation might offer a potential solution by bypassing this deficit and rescuing alpha motor activity [36].

Additionally, elastic tapes such as Kinesiotape have been reported to induce a phenomenon known as “skin stretch”, which alters underlying tissue and improves proprioception [40, 41]. This ability of the ta** to influence underlying tissue is believed to modify the musculoskeletal kinetics, ultimately leading to improved muscular activation [42,43,44], and increased comfort [45]. For instance, Franettovich Smith, Coates [46] proposed that the elastic tape’s recoil properties could potentially offer mechanical support or opposition (such as deceleration or acceleration) to movement. This, in turn, could alleviate the strain on musculotendinous units by decreasing the load demands, while simultaneously allowing for the execution of a complete range of motion. Also, proprioceptive enhancement due to ta** is identified as an effective means of prophylaxis to prevent injury [47, 48]. In this context, the improved proprioception and the resistive properties of athletic and Kinesiotape, may also help prevent movement into potentially injury-prone ranges ultimately reducing further risk of injury [32, 47, 49, 50]. Moreover, patellar ta** has demonstrated non-biomechanical neurological effects that enhance motor performance [10, 51, 52]. An fMRI study revealed heightened activity in the cerebellum, primary somatosensory cortex, supplementary motor area, primary sensory cortex, and cingulate motor area due to ta** [51]. The authors posited that the increased activation observed was indicative of improvements in coordination, sensation, decision-making, and coordination of non-conscious aspects of proprioception [51]. Similarly, recent electrophysiological data indicated that ta** might facilitate proprioception by desynchronizing waves in the β-band in the motor cortex, aiding in precise force control during movement execution [52].

Conventionally, clinical assessment of proprioceptive acuity is conducted by tests evaluating kinematic and kinetic aspects of movement [53, 54]. The kinematic assessment by means of joint re-positioning accuracy measurement, the threshold to detection of passive motion, and active movement extent discrimination accuracy are widely evaluated in the existing literature [54]. However, the kinetic assessment of proprioception through force sense accuracy measurement has received less attention [55,56,57]. Force sense accuracy refers to a person’s active ability to sense and reproduce muscle tension or force [57, 58]. The assessment of force sense accuracy involves selecting a specific target force level, such as 50% of maximum voluntary isometric contraction and instructing the participant to reproduce this level of force during a muscle contraction at a specific joint angle [59, 60]. The discrepancy between the force produced by the participant and the target force level is then calculated and reported as the error in the sense of force. In the existing literature, the control of force sense has been hypothesized to exist due to an interplay between central feed-forward and peripheral feedback mechanisms [57]. Simon, Garcia [57] suggested that peripheral feedback mechanisms dominate during the initial phases of learning, whereas this dominance switches to feed-forward pathways upon gaining task-specific expertise [61]. In injuries when inherent proprioceptive accuracy is low, a larger dependence on peripheral feedback mechanisms is expected [62, 63]. Under such circumstances, the use of ta** to facilitate force reproduction via peripheral feedback mechanisms makes sense. Docherty and Arnold [58] suggested that any improvement in force reproduction might signify an enhanced ability of a muscle to support the joint during movement, thereby reducing its predisposition towards injury [64].

Despite mounting evidence suggesting the beneficial influence of ta** on proprioception and its gaining popularity, a lack of consensus exists in the literature regarding its efficacy, specifically concerning force sense accuracy. This lack of consensus exists primarily at the level of individual clinical trials. For instance, some individual trials have suggested the beneficial influence of ta** on improving force sense accuracy [49, 65,66,67], whereas others have indicated that ta** does not affect force sense accuracy [52, 57, 68]. Besides, several other outcomes need to be evaluated to determine the overall influence of ta** on force sense accuracy outcomes. For instance, there is a need to evaluate the impact of ta** on force sense from both between- and within-group perspectives. These findings could be significant because the analyses between the groups can provide insights into the contrasting results observed between ta** and both the absence of a comparator and placebo ta**. In contrast, the within-group analyses could explain the magnitude of change in proprioceptive parameters before and after the ta**. Moreover, it is also important to classify the influence of ta** in different population groups (i.e., healthy individuals and individuals with musculoskeletal/ neurological disorders). Evaluating this outcome is essential to understand the effectiveness of ta** in various health conditions and could be helpful for both clinicians and patient population groups. Likewise, it is also crucial to assess separately the influence of different tapes on force sense accuracy. Ta** interventions (i.e., Leuko, Kinesio, athletic, Zinc oxide tape) reported in the literature have been found to exhibit different elastic properties [69]. The literature suggests that different mechanisms are involved in modulating movement kinematics due to a change in the tape’s elasticity [46, 70]. Therefore, it makes sense that the influence of tapes is separately evaluated.

Research aims and questions

  1. 1.

    To investigate the effects of ta** on force sense accuracy in terms of absolute and relative accuracy from between- and within-group analyses.

  2. 2.

    To conduct exploratory subgroup meta-analyses of individual studies to investigate the potential impact of various factors such as study design, health status, ta** elasticity on force sense accuracy.

Material and methods

We followed PRISMA 2020 guidelines to conduct this systematic review and meta-analysis [71]. The checklist is presented in Supplementary Table S1. This systematic review was pre-registered at PROSPERO (CRD42022383616).

Sources of data and search strategy

The systematic literature search was carried out across seven databases (Web of Science, PEDro, Pubmed, EBSCO, Scopus, EMBASE, Psychinfo) and one registry (Cochrane Central Register of Controlled Trials) from January 1946 until December 2022. These databases were chosen based on access provided by the academic organization. The search strategies according to each database have been provided in the Supplementary file. Furthermore, the authors conducted an extra search through the bibliography section of the relevant studies.

Inclusion criteria

The inclusion criteria for the studies to be included in the review were developed according to the PICOS approach (Population, intervention, comparator, outcome of interest, and study design). The inclusion criteria were determined by two researchers (S.G, I.G). The inclusion criteria were as follows:

  1. 1)

    Incorporation of studies involving healthy individuals.

  2. 2)

    Inclusion of studies involving population groups affected by musculoskeletal disorders (such as a sprain, strain, tendinitis, repeated stress injuries, degenerative joint diseases, and traumatic injuries).

  3. 3)

    Inclusion of studies involving population groups affected by neurological disorders (such as stroke, Parkinson’s disease, cerebral palsy, multiple sclerosis, traumatic injuries, degenerative neurological disorders).

  4. 4)

    Inclusion of studies that evaluated the influence of ta** on force sense accuracy. This encompassed various forms of ta**, including tape, Kinesiotape, leuko tape, orthotic tape, adhesive tape, and others.

  5. 5)

    Inclusion of studies that assessed proprioception acuity through the analysis of active and relative force sense accuracy.

  6. 6)

    Inclusion of studies that compared ta** intervention outcomes with a control group utilizing placebo tape and/or no tape.

  7. 7)

    Inclusion of all types of quantitative clinical study designs such as, randomized controlled trials, controlled clinical trials, crossover trials, longitudinal studies, cohort analyses, feasibility studies.

  8. 8)

    Inclusion of studies that achieved more than or equal to 4 on the PEDro quality appraisal scale [72].

  9. 9)

    Inclusion of studies published in peer-reviewed academic journals, theses, and conference proceedings.

  10. 10)

    Inclusion of studies published in English, French, German, or Hindi languages.

The intent behind maintaining a broad scope for the inclusion criteria was to ensure a comprehensive exploration of the subject matter. For example, the decision to encompass individuals with and without medical conditions stemmed from the goal of thoroughly investigating the potential variations in the effects of ta** based on differing health statuses. Similarly, in acknowledging the diversity of study designs in existing research, we recognized the absence of a singular dominant design. By incorporating various study designs, our aim was to encompass a wider array of evidence and insights. Finally, the inclusion of diverse types of tapes was intended to scrutinize the potential distinct effects of these interventions based on their inherent elastic properties.

Selection and extraction of data

The screening of the titles, abstracts, and full texts of the articles were conducted independently by two authors (S.G, I.G). During the screening process, both the authors were blinded from each other. In cases where there were disagreements about the inclusion of pertinent articles, the third author (S.N) participated in discussions to facilitate consensus. The following information was extracted from the articles: author names, country of research, participant information (age, sample size, gender distribution, health status), assessed joint, ta** method, ta** technique, application by physiotherapist, assessment periods, ta** frequency, and results.

Evaluation of the methodological quality

The PEDro quality appraisal scale was used to assess the quality of the studies included in our review [73]. The appraisal by the PEDro scale can be interpreted as follows: studies scoring between 9 to 11 are categorized as “excellent quality”, those with scores between 6 to 8 are considered “good quality”, scores between 4 to 5 indicate “fair quality”, and scores equal to or less than 3 signify “poor quality”. The appraisal of the studies was carried out by two researchers (S.G, I.G) independently. In instances of discrepancies, the researchers engaged in discussions, and if a unanimous decision couldn’t be reached, a third researcher (S.N) was consulted to achieve a consensus.

Data analysis

In the present review, a between-group (ta** vs. no comparator, ta** vs. placebo ta**) and a within-group (pre- vs. post-ta**) random effect meta-analysis was conducted with Comprehensive meta-analysis (V 4.0) [74]. For the between-group analysis, we utilized mean change scores (i.e., post–pre performance outcomes) extracted from the respective studies. The data extracted from the studies were separately distributed and analyzed for force sense, encompassing active and relative accuracy. The meta-analysis outcomes reported comprise weighted and adjusted effect sizes (Hedge’s g), 95% confidence intervals (C.I.), and significance levels. The threshold for the interpretation of effect size were as follows: 0.16 denoted a small effect, 0.38 indicated a medium effect, and 0.76 signified a large effect [75]. Forest plots were generated to illustrate the results. Besides, the included studies’ heterogeneity was quantified using I2 statistics. The threshold for interpreting the heterogeneity with I2 statistics were defined as follows: between 0 and 40% indicated negligible heterogeneity, 30% to 60% denoted moderate heterogeneity, 50% to 90% represented substantial heterogeneity, and 75% to 100% indicated considerable heterogeneity [76]. In the present study, subgroup analyses were conducted based on study design (i.e., repeated measures design, quasi experimental studies), health status (i.e., healthy individuals, individuals with chronic ankle instability), and elasticity of ta** (i.e., elastic, rigid tapes). An assessment of publication bias for the primary outcome was carried out according to the trim and fill procedure by Duval and Tweedie [77]. Additionally, we also conducted “leave-one-out” sensitivity analyses to test the robustness of our findings. The leave-one-out method systematically removes each study from the meta-analysis and re-analyzes the data to assess the influence of individual studies on the overall results [78]. This helps to identify studies that may be driving the results and assess the robustness of the findings. The significance level for the study was set at 0.05.

Included studies

The initial search across seven databases and one registry yielded a total of 7362 articles, which after implementing the PICOS inclusion criteria, were reduced to 11 articles (Fig. 1). Thereafter, qualitative, and quantitative data were extracted from all included studies.

Fig. 1
figure 1

PRISMA flowchart of study selection (made from [79])

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Study design

Of the 11 included studies, five studies reported a repeated measures design [49, 52, 65, 80, 81], while four studies reported that they adhered to a case control format within a repeated measures design [57, 66, 82, 83]. Moreover, one study each reported to adhere to a pretest–posttest cross sectional design [68], and a pretest–posttest quasi-experimental design [67].

Methodological quality

The individual PEDro scoring for each included study has been tabulated in Table 1. The average PEDro quality score of the 11 included studies was (5.8 ± 0.9), suggesting the overall quality of the included studies to be “fair”. The two researchers (S.G, I.G) appraised the articles with a 97.3% agreement. In terms of individual scores, one study scored eight [68], seven studies received a score of 6 [49, 52, 57, 65, 66, 80, 82], two studies achieved a score of 5 [81, 83], and one studies attained a score of 4 [67]. The methodological quality across the studies has also been illustrated in Fig. 2.

Table 1 PEDro methodological quality for the included studies
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Fig. 2
figure 2

Illustrating the methodological quality according to the PEDro scale

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Publication bias

The incidence of publication bias according to Duval and Tweedie’s trim and fill procedure is shown in Fig. 3. The method identified two missing studies on the right side of the mean effect, whereas no study was missing on the left side. In the analysis, under the random effect model, the point estimate and the 95% C.I. for the combined studies was -0.79, -1.27 to -0.31. Based on the trim and fill procedure, the imputed point estimates are -0.54 (-1.04 to -0.05).

Fig. 3
figure 3

A trim and fill funnel plot illustrating the publication bias. Blue circle: individual studies, red circle: imputed studies, funnel plot: 95% area of the pseudo-confidence intervals, vertical midline: estimated overall effect size (i.e., empirical studies + imputed studies)

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Results

Systematic review report

Participants

Among the 11 included studies, data from a total of 279 (128F, 94M) people was reported. The difference in sex distribution was because two studies had not reported these values for their sample [82, 83]. The average age of the entire sample was 24.5 ± 11.7 years. A comprehensive depiction of the health status of the participants featured in this review is provided in Table 2.

Table 2 Details of cohorts with different health statuses included in this review
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Countries

Four of the 11 studies were conducted in Taiwan [52, 65, 66, 82], two in South Korea [49, 83], two in Iran [67, 68], one in Australia [80], one in China [84], and one in USA [57].

Tape

There are three different types of tapes evaluated in the included studies. A total of nine studies used Kinesiotape [49, 52, 57, 65,66,67,68, 82, 84], one used Zinc oxide tape [83], and one used rigid sports tape [80]. As per established literature, Kinesiotape is categorized as an elastic tape [85], whereas zinc oxide and rigid sports tape are classified as rigid tapes [86].

Force sense accuracy assessment

The included studies reported absolute and relative force sense accuracy outcomes. All 11 included studies reported the absolute force sense accuracy values [49, 52, 57, 65,66,67,68, 80, 82,83,84], with an additional subset of five studies also offering insights into relative force sense accuracy values [65, 66, 68, 82, 84].

Joints assessed

Six of the included studies evaluated the efficacy of ta** on the wrist joint [52, 65, 66, 68, 82, 83]. In contrast, only five studies reported the influence of ta** on the ankle joint [49, 57, 67, 80, 84].

Ta** application

Five of the included studies did not report the person who applied the tape [52, 65,66,67,68], and five reported that a physiotherapist applied the ta** [49, 80, 82,83,84]. Furthermore, one study reported that a healthcare practitioner applied the tape [57].

Outcome

The details of the included studies and their respective outcomes are mentioned in Table 3.

Table 3 Details of the included studies
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Outcomes based on type of comparator

Ta** vs. no comparator

Absolute accuracy: Nine studies compared the efficacy of ta** intervention with no ta** [49, 52, 65, 66, 68, 80,81,82,83]. Two studies reported significant improvement in force sense accuracy outcomes with ta** compared to the absence of a comparator [49, 65]. Additionally, one study reported a significant improvement in force sense accuracy outcomes within their sample of healthy individuals, but not among individuals with medial epicondylitis [82]. Conversely, another study reported a significant improvement in force sense accuracy outcomes within their sample of individuals with medial epicondylitis, but not among healthy individuals [66]. Moreover, five studies did not report any significant differences between the ta** intervention and the absence of a comparator [52, 68, 80, 81, 83].

Relative accuracy: Three studies had compared the efficacy of ta** intervention with no ta** [66, 68, 82]. Two studies reported no significant difference between the ta** and the no ta** group [66, 82]. One study reported a significant improvement in force sense accuracy between their origin to insertion ta** subgroup as compared to the no ta** group [68]. However, no significant differences were observed between insertion to origin ta** and no ta** comparator [68].

Ta** vs. placebo ta**

Absolute accuracy: Five studies had compared the efficacy of ta** intervention with placebo ta** [49, 65, 66, 81, 82]. Among these, two studies reported a significant improvement in force sense accuracy outcomes with ta** compared to the placebo comparator [49, 65]. One study indicated a significant improvement in force sense accuracy outcomes within their sample of healthy individuals but not among those with medial epicondylitis [82]. Furthermore, two studies did not report any significant difference between ta** and the placebo comparator [66, 81].

Relative accuracy: Two studies compared the efficacy of ta** intervention with a placebo comparator [66, 82]. Neither of these studies found a significant difference between the ta** intervention and the placebo comparator.

Pre vs. post differences

Three studies evaluated the within group differences after the application of the ta** intervention [57, 67, 83]. Among these, two studies reported no significant differences in force sense accuracy after the application of ta** [57, 83], while one study reported a significant improvement in force sense accuracy after the ta** application [67].

Meta-analysis report

The meta-analysis findings are detailed in Table 4, Figs. 4 and 5, offering an extensive perspective on the between-group analysis. Similarly, Table 5 and Fig. 6 visually depict the within-group meta-analysis outcomes. Additionally, Table 6 provides an in-depth report on the leave one out sensitivity analysis.

Table 4 Between-group meta-analysis outcomes
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Fig. 4
figure 4

Forest plot in this study illustrates the effect of ta** on absolute force sense improvement in accuracy. Black boxes: individual weighted effect sizes, whiskers: 95% confidence intervals, red diamond: pooled weighted effect size and 95% confidence interval, positive effect size: improvement in force sense accuracy for the no-ta** group, negative effect size: improvement in force sense accuracy for the ta** group

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Fig. 5 
figure 5

Forest plot illustrating the effect of ta** on relative force sense accuracy. Black boxes: individual weighted effect sizes, whiskers: 95% confidence intervals, red diamond: pooled weighted effect size and 95% confidence interval, positive effect size: improvement in force sense accuracy for the no-ta** group, negative effect size: improvement in force sense accuracy for the ta** group

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Table 5 Within-group meta-analysis outcomes
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Fig. 6
figure 6

Forest plot illustrating the within-group effect of ta** on force sense improvement in accuracy. Black boxes: individual weighted effect sizes, whiskers: 95% confidence intervals, red diamond: pooled weighted effect size and 95% confidence interval, positive effect size: deterioration in force sense accuracy, negative effect size: improvement in force sense accuracy. (FAI: Functional ankle instability)

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Table 6 Leave one out sensitivity analysis
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Sensitivity analysis

A summary of the leave-one-out sensitivity analysis has been provided in Table 6. Specifically, studies were reported if the overall analysis yielded a p-value less than 0.05, and the removal of a specific study increased the p-value above this threshold. Conversely, studies were also reported if the overall analysis yielded a p-value greater than 0.05 and the removal of any study decreased the p-value below this threshold.

Discussion

The current systematic review and meta-analysis aimed to comprehensively evaluate the effect of ta** on force sense accuracy in healthy and patient population groups. Our meta-analysis confirms these findings, as we observed a significant effect improvement in both absolute (Hedge’s g: -0.77) and relative (g: -0.59) force sense accuracy with ta** as compared to no comparator in the between-group analysis. Moreover, we also observed a significant improvement in absolute (g: -0.51) force sense accuracy with ta** as compared to placebo ta**. However, the within-group analysis revealed a non-significant small effect improvement in absolute force sense accuracy. The sub-sections below have discussed our further subgroup analyses concerning various population groups and tape types.

Influence of ta** on different population groups

Our findings suggest that augmentation of proprioceptive afferent by ta** is more beneficial for individuals with poorer inherent proprioception than individuals with good proprioception. The reason being that ta** augmented proprioceptive afferent information might overload the “inherently good” proprioceptive pathways in healthy individuals [33]. In contrast, individuals with poorer proprioception (i.e., medial epicondylitis) might benefit from augmented afferent information [90, 91]. We believe two main reasons might explain this differential result in our study. First, there was a large difference in the number of studies in our meta-analysis that included different population groups. For instance, in the between-group analysis, the influence of ta** was evaluated on healthy individuals within eight studies. In comparison, only two studies evaluated ta**’s impact on individuals with medial epicondylitis. Second, in the analyses of healthy population groups, we did not conduct separate sub-group analyses to assess the differential influence on individuals with excellent and poor inherent proprioception (i.e., inherent force sense accuracy). The analysis was not performed because only one included study had classified their healthy cohort based on their innate proprioceptive levels [52]. Future studies are strongly recommended to organize the proprioceptive level of their population groups to help understand the actual influence of ta** on force sense accuracy among healthy individuals.

Furthermore, ta** improved force sense accuracy in population groups with injuries, such as individuals with medial epicondylitis, lateral epicondylitis, and functional ankle instability. One potential explanation for the improved force sense accuracy in this sample is that ta** may have restricted the injured musculoskeletal tissue to its anatomical limits, leading to an enhanced sense of force at the joint [32]. The work of Seo also supports this hypothesis, who suggested that ta** allows injured ligaments to heal in their proper position, reducing the risk of chronic instability, while non-taped injuries may heal in a stretched, weakened state [92]. Simon, Garcia [57] demonstrated that Kinesiota** compensated for deficits in force sense accuracy in individuals with functional ankle instability (pre-tape: 2.6N, post-tape: 2.2N, 72 h: 1.8N). The authors hypothesized that the Kinesiotape could have allowed their sample to establish a new perceptual trace that allowed them to process the afferent information more efficiently, thereby improving their ability to sense force [57]. Chang, Wang [82] too reported the beneficial influence of ta** among individuals with medial epicondylitis. The authors hypothesized that Kinesiotape could have alleviated deficits in force sense reproduction by stimulating the mechanoreceptors in the skin and fascia to perceive better changes in shear forces, stretch, pressure, and load [82, 93]. In this context, the central nervous system could have utilized this improved perception facilitated by ta** to fine-tune the feed-forward models. This, in turn, contributed to an augmentation in the accuracy of force sensation [57, 82]. Besides, one of our included studies also suggested that perhaps the increments in force sense resulted from the pain-relieving properties of ta** [83]. Studies have indicated that because of noxious muscle input, the excitability at the motor cortex level is reduced together with the inhibition of spinal motor neurons [94, 95]. Under such circumstances, ta** could have modulated the pain through the pain gait control mechanism [96]. This could involve an increased flow of sensory signals from low-threshold peripheral mechanoreceptors, which might have countered the transmission of pain signals to central nociceptive cells, ultimately leading to a reduction in pain perception [97, 98]. Additionally, the observation of significant improvement in force sense accuracy with actual ta** as compared to no ta**, as well as ta** as compared to placebo ta**, suggests that the effects of ta** might go beyond the realm of a simple placebo effect. While the placebo effect of ta** can indeed influence an individual’s perception and performance [99], the fact that actual ta** shows a more pronounced improvement indicates that there might be additional physiological mechanisms at play. Nevertheless, the conclusive determination of ta**’s true effects, potentially extending beyond placebo responses, necessitates future studies.

Influence of ta** elasticity on force sense accuracy

Various tapes have been used in the existing literature to influence force sense accuracy outcomes in healthy and patient population groups. Some studies have directly compared the influence of different types of tapes on proprioceptive results [45, 100, 101]. However, uncertainty still looms regarding which tape is the most effective. The literature suggests that tapes with lower elastic modulus (i.e., high rigidity) function primarily by limiting the range of motion at a joint rather than facilitating its neuromuscular functioning [102, 103]. Rigid tapes are suggested to be beneficial for individuals who need additional stability to participate in certain activities or to protect an injured area.

Nonetheless, the restrictive nature of such rigid tapes has been suggested to predispose someone to higher risks of injury, as the tape can alter joint kinematics, such as excessive talocrural movement restriction [104]. Besides, as these tapes lack sufficient adhesive capabilities to cope with functional activities, their use is repeatedly questioned in sporting and rehabilitation contexts [101, 105]. On the contrary, tapes with high elastic modulus have been reported to support and stabilize the joints without restricting the joint’s range of motion. Due to their increased flexibility, elastic tapes can conform to the body’s contours, allowing for a greater range of motion. This elasticity can be beneficial specifically for individuals who need to perform functional activities. A study included in our review suggested that Kinesiotape differed from conventional rigid tapes in addition to the enhanced elasticity as it also embedded a specialized wave-like grain design [65]. According to the authors, this specialized design and the tape’s elasticity could have facilitated proprioception by exerting a pulling force on the skin while generating space by lifting the underlying fascia and soft tissue [25, 65].

In our between-group meta-analyses, we observed that elastic tapes (p = 0.009) led to a significantly improved absolute force sense accuracy, whereas rigid tapes did not show a significant effect (p = 0.069). Furthermore, when we performed subgroup analyses considering health status, we found a greater degree of enhancement, although not statistically significant, in the accuracy of absolute force sensing among healthy individuals who used elastic tape (effect size: -0.60) compared to those who used rigid tape (effect size: -0.38). We did not perform a comparative analysis on the effectiveness of rigid tape in reducing relative force sense accuracy due to limited available data. Nevertheless, several potential explanations for the observed variance in the degree of force sense accuracy between elastic and rigid tapes can be considered. Firstly, it is possible that healthy individuals who used elastic tape did not require the restrictive support provided by rigid tapes but benefited from the functional support offered by elastic tapes, which improved joint movement and proprioception. Secondly, the smaller number of studies included in the analysis of rigid tapes (only two) compared to elastic tape (six) may have contributed to greater variability in the data or an increased risk of a type II error. Therefore, we recommend that future studies be conducted with high-quality trials and sufficient sample sizes to further investigate and compare the efficacy of elastic and rigid tapes in more detail.

Limitations

The main goal of our study was to understand the impact of ta** on force sense accuracy. However, our analysis had some limitations. Some studies included in our review evaluated the immediate effects of ta** [49, 65,66,67, 82, 83], while others examined the impact of prolonged ta** on force sense accuracy [57, 68]. As our study did not precisely aim to explore the effect of prolonged ta** on proprioception, we did not perform separate analyses to compare the impact of prolonged ta** on force sense accuracy. Studies have shown that prolonged ta** may have a greater effect on proprioception’s kinematic and kinetic aspects than ta** applied immediately [106,107,108]. Therefore, future studies are strongly recommended to evaluate the differential influence of the prolonged application of ta** on force sense accuracy. Secondly, substantial heterogeneity was also prominent regarding the different ta** application methods. This heterogeneity could be an essential aspect the reader should consider while interpreting the results. For instance, some studies included in our review adhered to a specific technique, such as Kenzo Kase’s technique [57, 65, 66, 68, 82], whereas the majority had applied ta** without following any standardized approach [49, 52, 67, 80]. This heterogeneous approach to using tape complicates the understanding regarding which method of ta** is more influential in improving force sense accuracy. Therefore, we recommend that future studies adhere to standardized ta** applications as they can help develop practical, evidence-based guidelines. Thirdly, despite employing a broad inclusion criterion, we did not come across any high-quality, blinded, randomized controlled trials that had assessed the impact of ta** on force sense accuracy. The absence of randomized controlled trials in our analysis could potentially raise concerns about the reliability and validity of our findings. Consequently, we strongly recommend that future studies further expand upon our current findings by evaluating the effects of ta** interventions on force sense accuracy through well-designed, high-quality, blinded randomized controlled trials. Fourthly, while our primary objective was to assess how ta** affects accuracy parameters in force sensing, we did not analyze its impact on other kinetic measures of maximum voluntary contraction, such as dynamometry and surface electromyography. Exploring the effects of ta** on these measures could have provided additional insights relating to the heterogeneity of the results. We recommend that future reviews to examining the impact of ta** on other kinetic indicators as the findings from these studies will enhance our comprehension of how ta** influences proprioceptive control related to force. Another major limitation of our study was that fewer studies were included in our meta-analyses, such as between-group analyses of individuals with medial epicondylitis (i.e., two studies) and within-group analyses of individuals with functional ankle instability (two studies). Fewer studies could increase the chances of a type II error [109]. Again, the reader is advised to infer these results with caution.

Future directions

Although the number of studies incorporating ta** for improving proprioception in healthy and patient population groups has increased in the past decade, a few aspects still warrant exploration. For instance, limited research has evaluated the long-term retention of force sense reproduction after the application of ta** [57, 68]. Conventionally, ta** has been identified as a transient approach that facilitates performance transiently by guiding the movement when it is being worn. However, once its removed, the lack of guidance (see guidance hypothesis [110]) by ta** forces improved accuracy back to initial levels [111]. We presume that an effective means by which this feedback dependency of ta** could be countered by tapering the extent of tactile feedback provided over time. Here, perhaps reducing the length of ta** applied [112], or even the tension with which ta** is used, could reduce the extent of feedback being provided to the performer and allow them to form robust internal feed-forward models concerning the task at hand. Future studies should try to evaluate these outcomes to ascertain whether tapering the feedback by ta** can promote learning in terms of force sense reproduction compared to performance.

Conclusions

Our exploratory meta-analysis of a limited number of studies reports the positive influence of ta** on absolute force sense accuracy outcomes when compared to no compared to both no ta** and placebo ta**. The improvements in relative force sense accuracy was only significant with ta** when compared to no ta**. Collectively, the advancement in accuracy for both relative and absolute force sensing through ta** potentially indicates the potential for improved performance and a lowered risk of injury. Specifically, the improved accuracy in perceiving relative force might facilitate precise fine-tuning of force while engaging in various activities, while the enhanced absolute force perception could suggest accurate application of force. This heightened precision becomes particularly valuable in dynamic high-risk environments where maintaining balance and executing complex movements are necessary.

Moreover, we observed a significant improvement in force sense accuracy for elastic tapes as compared to rigid tapes for absolute force sense accuracy. Unfortunately, due to the predominance of studies with a repeated measures design within our pooled data, and the relatively fewer studies employing cross-sectional or quasi-experimental designs, a comprehensive comparative analysis based on study design could not be performed. Lastly, healthy individuals and individuals with medial epicondylitis were observed to significantly improve their absolute force sense accuracy with ta** when compared to ta**, as compared to no ta**. However, when compared to placebo ta** a significant improvement in force sense accuracy was only observed for healthy individuals.

Despite the sensitivity analyses confirming the robustness of our findings, we recommend our reader interpret these results cautiously as the studies included in our review were of “fair” methodological quality, and high levels of heterogeneity were observed in our meta-analyses. Future studies are recommended to further evaluate the efficacy of ta** on force sense accuracy outcomes in high-quality randomized controlled trials to ascertain the true effects of ta** on force sense accuracy outcomes.