the aquatic therapist

Another study telling us what we already knew... that aquatic therapy works for the fibromyalgia patient

Fun, fun, fun! More fibro research!
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OBJECTIVES: To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia (FM) and to determine exercise adherence levels.

DESIGN: A randomized controlled trial.

SETTING: Testing and were completed at the university.

PARTICIPANTS: Middle-aged women with FM (n=60) and healthy women (n=25).

INTERVENTION: A 16-week aquatic training program, including strength training, aerobic training, and relaxation exercises.

MAIN OUTCOME MEASURES: Tender point count (syringe calibrated), health status (Fibromyalgia Impact Questionnaire); sleep quality (Pittsburgh Sleep Quality Index); physical (endurance strength to low loads tests), psychologic (State Anxiety Inventory), and cognitive function (Paced Auditory Serial Addition Task); and adherence 12 months after the completion of the study.

RESULTS: For all the measurements, the patients showed significant deficiencies compared with the healthy subjects. Efficacy analysis (n=29) and intent-to-treat analysis (n=34) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality, cognitive function, and physical function. Anxiety remained unchanged during the follow-up. The exercise group had a significant improvement of health status, not associated exclusively with the exercise intervention. There were no changes in the control group. Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program.

CONCLUSIONS: An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology. The therapeutic intervention's effects can be assessed through applicable tests in the clinical practice.

SOURCE: Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008 Dec;89(12):2250-7.

Section of Physical Education and Sports, University Pablo de Olavide, Seville, Spain. dmunizq@upo.es

Aquatic therapy billing questions answered...

Advance Magazine columnist Rick Gawenda, PT answers tough aquatic therapy questions like these for breakfast.

Question #1: We're an outpatient hospital billing on a UB92. A patient is attending one of our satellites for land physical therapy 3 days a week and requested to come to another satellite facility the other 2 days for aquatic therapy. Even though both satellite facilities show 1 tax identification number and the UB92 reflects the same HCPC codes, the charges are from two different services lines. Will Medicare pay to treat this patient 3 times a week on land at one satellite and 2 times at another for aquatic therapy?

Question #2: Are land and pool services that are delivered on the same day billable to Medicare? The ICD-9 codes are the same for both therapies.

Read his answers here (tab down to find question):

Rick Gawenda, PT, is president of the American Physical Therapy Association section on health policy and administration. He's also the director of physical medicine and rehabilitation at Detroit Receiving Hospital in Michigan. He conducts national seminars on coding and reimbursement, along with other topics. If you have a tough coding issue you can't crack, e-mail shuelskamp@merion.com. To read more coding suggestions, go to www.advanceweb.com/rehab and click on the Coding Clues tool bar.

Aquatic respiratory exercises improves inspiratory muscle strength in healthy persons

Does immersion plus exercise improve your respiratory capacity? Read more here.

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PURPOSE: To assess the effect of a program of aquatic versus non-aquatic respiratory exercises on respiratory muscle strength in healthy aged persons.

METHODS: The respiratory muscle strength was measured in 81 subjects between 60 and 65 years, 59 of which completed the program. Subjects were randomized into 3 groups. Gaquatic undertook a program of respiratory exercise in an aquatic environment. Gnon-aquatic undertook the same program in a non-aquatic environment. Gcontrol acted as the negative control. Programs were applied three times a week for 10 consecutive weeks. Subsequently, subjects were reevaluated, and results compared to each individual’s pre-treatment own result and between the groups. The data were statistically analyzed using the paired t test and the Sign test. Comparisons between the groups were performed through parametric and nonparametric variance. A comparison of Gaquatic and Gnon-aquatic versus Gcontrol was performed using the Dunnett test.

RESULTS: A significant improvement in the inspiratory muscle strength in the Gaquatic group compared to the Gcontrol, group was found, suggesting beneficial effects mediated by the aquatic exercise. The expiratory muscles did not show significant alterations.

CONCLUSION: Aquatic respiratory exercise improves the inspiratory muscle strength of healthy aged persons. However, neither aquatic nor non-aquatic respiratory exercise influences the expiratory muscle strength.

SOURCE: IDE MR et al. Effects of an aquatic versus non-aquatic respiratory exercise program on the respiratory muscle strength in healthy aged persons. CLINICS. 60(2):151-158, 2005.

OMF: What's Your Favorite Technique

For this week's Open Meme Friday, we want to know what your magical elixir is in the pool. What Rosetta-Stone-Pot-of-Gold technique is it that brings you the most patients and gives them the most smiles. Is it Ai Chi, Halliwick or Watsu® that works the best for shoulder rehab? Or is Bad Ragaz, Jahara or Healing Dance your best bet for pain mediation?

Join the thread this weekend. We've turned on the comments and left the lights on. With the dozens of techniques out there and thousands of therapists experimenting, we can't help but think someone is coming up with their own secret brew this very minute. Don't be shy. Let us know. We won't tell anyone.

The Lightning Controversy: A Rebuttal

In November, we reported in our eSplash newsletter that Aquatics International was questioning the policy of closing indoor pools during an electrical storm. Turns out that article has touched off a, err, firestorm with the National Lightning Safety Institute (NLSI) who have sent us a letter rebutting AI's claims. With all the experts in a tumult, what's a pool director to do?

Read the Aquatic International article here then the NLSI retort below before making up your own mind.

Lightning and Indoor Pools:  A Reply to Aquatics Resources eSplash Newsletter 17 Nov 2008*

By Richard Kithil, President & CEO, NLSI

Background: In May 2003, NLSI co-authored Lightning and Aquatics Safety: A Cautionary Perspective for Indoor Pools. Before and since that time, many national aquatics groups have followed our recommendations. We suggest, in brief, that safety is the prevailing directive and that pool activities should be suspended at the first signs of thunder or lightning. A contrary opinion has appeared in Aquatics Resources eSplash newsletter dated 17 Nov. 2008. The purpose of our reply is to discuss the topic with regard to comments made by the authors of the above newsletter article.

It is correct that national statistics omit reports of deaths from lightning to people in indoor pools. That’s good news. However, there are many reports of lightning deaths in bathtubs as well as reports of injuries to people indoors in direct and indirect contact with water (kitchen sink, laundry room, bathroom, etc.). The agencies that cause these incidents can be traced to energized circuits. This means copper water pipes, electrical service lines, and other conductors that carry some component of lightning’s energy. It seems reasonable to NLSI that the potential for lightning incidents to people in indoor pools does exist.

The eSpalsh [sic] article contains several errors that should be discussed. The National Electrical Code (NEC) does NOT refer in any way to pool closures or any type of enforcement or any legal consequences. The presence of a lightning protection system does not bring with it any certainty of immunity from death, injury, fire, or other consequences. People in contact with, or adjacent to, conductive circuits may become lightning victims regardless of grounding, bonding, shielding, surge protection, air terminals, etc. The National Collegiate Athletic Association (NCAA) does not refer to pools specifically. However, it does contain the warning: “avoid using the shower or plumbing facilities and contact with electrical appliances during thunderstorms.”

The bottom line: liability issues. There are nationally published recommendations for evacuating pools during thunderstorms. Those guidelines are based upon very conservative "safety first" principles. These admonitions do not have the force of law. However, they address a well-known duty-to-warn concept. Failure to provide safe activities and failure to comply with recognized national safety measures may bring with it liability issues. The choice is yours.

*Aquatic Resources Network (eSplash) Editor's Note: Dear reader. As you may realize, the article referenced by the NLSI was published by Aquatics International magazine and not by us. We merely linked readers to their online article. So, as much as we appreciate being at the middle of the storm, we can't take credit for the controversy! We've pointed this out to the NLSI, but so far, the website retort remains as is.

Open Meme Friday #1: Tell us how you generate referrals (comment at end of posting)

Aquatic Therapy Referrals. Tell us. How are you getting the word out to your community?

Not just to the public, but also to the doctors in town.

Are they up to speed on the benefits of aquatherapy? Are they evangelistic about AT or humbug on it? Do they even know you exist?!?

We get calls all the time from physicians who are fervent believers in the curative power of water but have been unable to refer patients because they did not know a therapist or facility was nearby (until we told them they were there under their nose).

Whether your patient load is bulimic or you have a thriving relationship with the neighborhood pain clinic, now is the time to share your horror-stories, your discoveries, your knowledge and your best-practices. So have at it.

Click "Comments" at the bottom of this posting and tell us what you think! You do NOT need to be a Typepad member to post. Just put your name and comment away...

Bumping and pushing in the therapy pool... a new way to find balance?

A research team out of Israel is examining whether a novel water-based balance training program that includes perturbation (pushing, for you laymen!) can improve improve balance control.

Read more here...  (this includes a lot of great background and references).