the aquatic therapist

Free research download: A water-based training program that include perturbation exercises to improve stepping responses in older adults

REFERENCE:  Itshak Melzer, Ori Elbar, Irit Tsedek, and Lars IE Oddsson. A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-over trial. BMC Geriatr. 2008; 8: 19.

DOWNLOAD THE | Abstract | Full text/PDF |

GERIATRIC TRAINING OPTIONS:

Attend Feb. 12-13, 2010 class -  Water-Based Intervention for the Geriatric Client: An Aquatic Therapy Primer

Attend Oct. 8-19, 2010 class - Novel Aquatic Balance, Proprioception and Fall Prevention Strategies

Question: Why would aquatic therapy have to be "better" than land-based therapy?

This is Part 3 of a multi-part series.

Independent medical review is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. These physicians are contracted to provide objective, unbiased determinations on what the root cause of the treatment was, whether or not there is medical necessity, if there was a sentinel event, what was the reason for it, etc.

Eavesdrop on some of the recent decisions which addressed whether aquatic therapy is medically necessary. In the past two postings on this issue, the reviewer found that aquatic therapy was necessary.

In this posting, the reviewer found that aquatic therapy was as effective as land-based therapy... but that this should lead to its denial. These findings seem capricious and ill-informed -- the reviewer state b/c there is no literature which supports the effectiveness of aquatic therapy as better than land-based therapy, that aquatic therapy should not be considered a reimbursable service. What a strange thought.

First of all, the foundational contention is wrong. There have been dozens of studies in the last 10 years which have shown that aquatic therapy offers an advantage over land-based therapy for pain and many other facets of treatment.

Second, if 2 treatment choices are equally effective -- but both are effective -- why deny one as medically unnecessary?

Read these decisions for yourself.

The Case: A 54-year-old female enrollee has requested aquatic-based physical therapy (PT) from a non-contracted provider for the treatment of her knee status post total knee arthroplasty.

Findings: The physician reviewer found that although aquatic therapy is certainly a choice of modality for treatment, there is no proven benefit over land-based PT in the treatment of osteoarthritis of the knee/hip. The study by Wyatt and colleagues found that both aquatic and land-based exercise programs were beneficial for osteoarthritis. Bartels and colleagues review of several studies for aquatic exercise for knee and hip osteoarthritis determined that the available studies were not conclusive to recommend aquatic therapy over land-based therapy. This reviewer did not find any published randomized, controlled trials comparing the effects of land-based versus aquatic PT for patients following TKA. Ulrich and colleagues study regarding focused rehabilitation treatment of poorly functioning TKA recommends various rehabilitation techniques, but they do not include aquatic therapy. Based on the totality of the available evidence, aquatic therapy following TKA has no proven benefit over land-based PT. Here, although this patient had improvement in ROM, aquatic therapy is not proven to be superior to traditional (i.e., land-based) physical therapy. The gains may have been made had the patient continued land-based therapy.

Read full decision here...

The Case: The patient is a 48-year-old female with degenerative disc disease and myofascial neck pain. She has been receiving physical therapy (PT) and it has apparently been helpful. The patient's provider prescribed continued physical therapy and aquatic evaluation and therapy. The patient's request for authorization of continued physical therapy and aquatic evaluation and therapy was denied by the Health Plan based on a determination that the therapies are not medically necessary.

Findings: A review of the record shows that the patient was receiving physical therapy and that it was beneficial. Some instruction in a home exercise program was provided, but the PT progress notes indicate the patient had not been fully instructed. Since land-based physical therapy was helpful to the patient, aquatic therapy would not be medically necessary at this time. The patient should continue with the land-based physical therapy in order to complete all of the instruction necessary for a home-based exercise program. Three times per week for three weeks would be a reasonable time frame. Based upon the information set forth above, I have determined one of the requested therapies is medically necessary for treatment of the patient's medical condition. The Health Plan's denial should be partially overturned.

The Case: A 45-year-old female enrollee requested authorization and coverage of continued speech therapy, cognitive therapy, physical therapy, and aquatic therapy. The Health Plan denied the request indicating that the requested therapies are not medically necessary for treatment of the enrollee's traumatic brain injury.

Findings: One physician reviewer performed a medical necessity Independent Medical Review. The physician reviewer partially overturned the Health Plan's denial on the basis that the requested physical therapy is medically necessary but speech therapy, cognitive therapy, and aquatic therapy in excess of the therapy already approved by the Health Plan is not medically necessary.

Read full decision here...

Accelerated Rehab after ACL Surgery Includes Aquatic Therapy

Attend 2010 seminar - Aquatic Therapy Training Options for the Collegiate, Professional and Elite Athlete

Bridey-Lee Momberg, Quinette Louw, Lynette Crous. Accelerated hydrotherapy and land-based rehabilitation in soccer players after anterior cruciate ligament reconstruction:a series of three single subject case studies. SAJSM. 2008; 20(4): 109-114.

DOWNLOAD FULL TEXT (PDF)

Objective. To investigate the effectiveness of accelerated rehabilitation and accelerated hydrotherapy after anterior cruciate ligament (ACL) reconstruction in male athletes participating in soccer.

Design. A non-concurrent single subject, multiple baseline design (ABA design) was conducted over 10 weeks. A series of three N=1 studies was conducted to assess the effect of an accelerated hydrotherapy programme on pain, function, and range of motion.
Setting. The study was conducted at a private physiotherapy practice in Port Elizabeth, South Africa.

Interventions. The land rehabilitation programme was a homebased programme supervised every week by the physiotherapist. The accelerated hydrotherapy consisted of a 6-week programme, and participants attended two treatment sessions of accelerated  hydrotherapy per week each of 30 minutes' duration.

Main outcome measures. The knee injury and osteoarthritis outcome scale (KOOS) as a subjective measure of pain, function and quality of life; the goniometer to measure active knee ROM and the 6-minute walking test (6MWT) as an objective measure of function.

Results. All three patients demonstrated good improvement during the treatment phase for the KOOS scale and progressed well

CORESPONDENCE:
Professor Quinette Louw
Division of Physiotherapy
Department of Interdisciplinary Health Sciences
Faculty of Health Sciences
Stellenbosch University
PO Box 19063
Tygerberg 7505
Republic of South Africa
Tel: +27(021) 938 - 9301
Fax: +27(021) 931-1252
E-mail: qalouw@sun.ac.za
Bridey-Lee Momberg (BSc, MSc Physiotherapy (OMT))
Quinette Louw (BSc, MASP, PhD)
Lynette Crous (BSc, MSc)
Division of Physiotherapy, University of Stellenbosch

Frail elderly... Does water exercise improve ADLs in nursing-at-home residents?

Sato D, Kaneda K, Wakabayashi H, Nomura T. Comparison of 2-year effects of once and twice weekly water exercise on activities of daily living ability of community dwelling frail elderly. Arch Gerontol Geriatr. 2009 Jul-Aug;49(1):123-8. 

Previous research suggests that water exercise improves the activities of daily living (ADL) ability of the frail elderly, but the specific frequency and intensity of such programs is unclear.

This study aims at comparing the effects of once- and twice-weekly water exercise on the ADL ability of frail elderly receiving nursing care for 2 years. The design is a prospective randomized longitudinal study. Participants were assigned to two different exercise groups (Group 1 and Group 2). Group 1 participated in a 60-min exercise session once a week, for 2 years, while Group 2 attended the session twice a week.

Exercise sessions were divided into a 10-min warm-up on land and 50 min of exercise in water. The 50-min water exercise program consisted of 20 min walking, 10 min ADL exercise, 10 min stretching and strength exercises, and 10 min relaxation in water.

ADL ability and lower muscle strength were measured before the beginning of exercise and 6 months, 1 year, and 2 years after the program had started.

Significant group differences occurred for bathing transfer and stair climbing at the 2-year measurement. These results suggested that at least twice-weekly water exercise was necessary to maintain the ADL ability and KEX of the frail elderly during the 1-year water exercise period and for one additional year afterward.

Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City, Ibaraki 305-8574, Japan. ds5592@gmail.com