Effects of Diaphragmatic Kinesio Taping Combined With Pulmonary Rehabilitation on Diaphragm Muscle Thickness in Intensive Care Patients

Patients admitted to intensive care units are at risk of respiratory muscle weakness and diaphragm dysfunction due to prolonged immobilization, critical illness, and reduced physical activity. These complications may adversely affect respiratory function, exercise tolerance, mobility, and recovery. Pulmonary rehabilitation is an important component of intensive care management and may help reduce the consequences of immobilization and respiratory muscle dysfunction.

Diaphragmatic Kinesio taping is a noninvasive therapeutic approach that may provide additional support to respiratory muscle function when combined with conventional rehabilitation. However, evidence regarding its effects on diaphragm muscle thickness and function in ICU patients remains limited.

This prospective, three-arm, randomized controlled trial will be conducted in the intensive care unit of Istinye University Medical Park Gaziosmanpasa Hospital, Istanbul, Türkiye, between November and December 2026.

A total of 48 eligible patients will be recruited and randomly allocated in a 1:1:1 ratio to one of three groups using computer-generated block randomization. Group allocation will be concealed using sequentially numbered, opaque, sealed envelopes prepared by an independent researcher.

The first group will receive pulmonary rehabilitation combined with diaphragmatic Kinesio taping. The second group will receive pulmonary rehabilitation alone. The third group will receive routine patient education as part of standard hospital care.

The pulmonary rehabilitation program will be administered for three consecutive days and will include positioning, active-assisted range-of-motion exercises, breathing exercises, thoracic expansion exercises, incentive spirometry, and controlled coughing techniques. In the combined intervention group, Kinesio tape will be applied to the anterior and posterior aspects of the trunk along the diaphragmatic region and will remain in place for three days.

Diaphragm muscle thickness at end-inspiration and end-expiration, diaphragm excursion, and diaphragm thickening fraction will be measured by an intensive care physician using ultrasonography. Measurements will be obtained at baseline and after three days. Each ultrasonographic measurement will be repeated three times, and the mean value will be recorded.

Additional assessments will include cough-related quality of life using the Leicester Cough Questionnaire and anxiety and depression symptoms using the Hospital Anxiety and Depression Scale.

The study will evaluate changes in diaphragm morphology and function and compare the effects of the three interventions over the study period.

Participants allocated to this group will receive a structured pulmonary rehabilitation program combined with diaphragmatic Kinesio taping. Pulmonary rehabilitation will be administered for three consecutive days, and Kinesio tape will be applied to the anterior and posterior aspects of the trunk along the diaphragmatic region and will remain in place for three days.

Other: Pulmonary Rehabilitation · Other: Diaphragmatic Kinesio Taping · Other: Routine Patient Education

Participants allocated to this group will receive the same structured pulmonary rehabilitation program as the experimental group for three consecutive days. No diaphragmatic Kinesio taping will be applied.

Other: Pulmonary Rehabilitation · Other: Routine Patient Education

Participants allocated to the control group will receive routine patient education as part of standard hospital care. Education will include information about their medical condition, smoking cessation when applicable, preventive health measures, adequate nutrition, avoidance of physical inactivity, vaccination, and the importance of respiratory exercises. Participants' understanding of the educational content will be evaluated through verbal questions.

Other: Routine Patient Education

Participants will receive a structured pulmonary rehabilitation program three times daily for three consecutive days. Each session will last approximately 30-45 minutes and will include in-bed positioning, active-assisted range-of-motion exercises, pursed-lip breathing, chest breathing, diaphragmatic breathing, thoracic expansion exercises, maximal inspiratory breath-holding, breathing control, incentive spirometry, and controlled coughing and huffing techniques. Exercises will be performed for 10 repetitions. Heart rate, respiratory rate, blood pressure, and oxygen saturation will be monitored throughout the sessions. The intervention will be discontinued if clinical instability or predefined safety concerns occur.

Diaphragmatic Kinesio taping will be performed using elastic therapeutic tape (Dr. Flexi) and a ligament correction technique. The tape will be applied to the anterior and posterior aspects of the trunk along the costal margins. Anteriorly, the central portion of the tape will be anchored approximately 2.5 cm below the xiphoid process, while posteriorly, the central portion will be anchored at the T12 vertebral level. The tape will be applied with tension along the costal arches, while the ends will remain tension-free. Participants will be instructed to perform deep inspiration during application. The tape will remain in place for three consecutive days. Skin sensitivity will be assessed before application.

Participants allocated to the control group will receive routine patient education as part of standard hospital care. Education will include information about their medical condition, smoking cessation when applicable, preventive health measures, adequate nutrition, avoidance of physical inactivity, vaccination, and the importance of respiratory exercises. Participants' understanding of the educational content will be evaluated through verbal questions.

Time frame: Baseline and Day 3

End-inspiratory diaphragm muscle thickness will be measured in millimeters using ultrasonography with a high-frequency linear transducer (4-12 MHz). Measurements will be performed with participants in the supine position. Three consecutive measurements will be obtained at each assessment, and the mean value will be calculated. The change in diaphragm muscle thickness from baseline to Day 3 will be evaluated.

Time frame: Baseline and Day 3

End-expiratory diaphragm muscle thickness will be measured in millimeters using ultrasonography. Three consecutive measurements will be obtained at each assessment, and the mean value will be calculated. Changes in end-expiratory diaphragm muscle thickness between baseline and Day 3 will be evaluated.

Time frame: Baseline and Day 3

Diaphragm thickening fraction will be calculated using the following formula: \[(end-inspiratory diaphragm thickness - end-expiratory diaphragm thickness) / end-expiratory diaphragm thickness\] × 100. The results will be expressed as percentages. Changes from baseline to Day 3 will be compared between groups.

Time frame: Baseline and Day 3

Diaphragm excursion will be assessed using M-mode ultrasonography with a low-frequency curvilinear transducer (2-5 MHz) positioned below the right costal margin. Diaphragmatic movement during respiration will be recorded, and changes between baseline and Day 3 will be evaluated.

Time frame: Baseline and Day 3

Cough-related quality of life will be evaluated using the Leicester Cough Questionnaire (LCQ), which consists of 19 items covering physical, psychological, and social domains. Total scores range from 3 to 21, with higher scores indicating better cough-related quality of life. Changes in total scores from baseline to Day 3 will be evaluated.

Time frame: Baseline and Day 3

Anxiety symptoms will be assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A). The subscale consists of seven items, with total scores ranging from 0 to 21. Higher scores indicate greater anxiety symptom severity. Changes from baseline to Day 3 will be evaluated.

Time frame: Baseline and Day 3

Depression symptoms will be assessed using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). The subscale consists of seven items, with total scores ranging from 0 to 21. Higher scores indicate greater depression symptom severity. Changes from baseline to Day 3 will be evaluated.

Investigation of the Effects of Diaphragmatic Kinesio Taping Applied in Addition to Pulmonary Rehabilitation on Diaphragm Muscle Thickness in Intensive Care Unit Patients: A Randomized Controlled Trial