Here is an intriguing question I received last month. Perhaps the answers can help you in your practice.
Dear Andrea: My current struggle is finding ways to obtain appropriate referrals from our primary land-based therapists. How can I get them to send me patients at the beginning of their treatment instead of when it is too late or when they are tired of seeing them? They also have a nasty habit of sending them back to me when it is time for them to transition back to land? HELP!
Curious in Columbus
Dear Curious: Your woes are common. Therapy pools are often seen as dumping grounds (when all else fails and then they wonder why the patient isn't immediately better). Take for example treating TKR patients in the water. Once the patient is 6-8 weeks s/p surgery, they are probably past the optimum period for aquatics (unless they had complications, underwent manipulation, had ROM issues, etc). I always tell my students to ask themselves 5 questions before choosing aquatics. Perhaps these will help?
1. Does the patient have "fixable" impairments or functional limitations? If not, should not be receiving skilled care (land or water) for anything but short term instruction.
2. Does the patient require the skilled aquatic care of a therapist? If not, refer the patient to aquatic post-rehab specialists, personal trainers or group classes.
3. Does the patient require the special properties of water in order to address their impairments and limitations? If not, or if all things are "equal", the patient should be treated on land. Why? Aquatic therapy is more expensive (both to provide and to the payer) and aquatic intervention is less functional as people do not live in water. Additionally, the ability for people to continue their exercise program is limited in most cases, in contrast to a home exercise program. (To have a huge evidence-based argument about the benefits of these properties, attend the Aquatic Therapy Boot Camp at ATU).
4. Is aquatic-based intervention for this diagnosis supported by the literature? (To have a huge evidence-based argument about the benefits of these properties, attend any of our 2012 classes).
5. Does the patient show carryover of any improvements to land? Patients should be reassessed every week on land (can be short 5 minute tests, but should happen on land) for functional improvement. If they improve in water, that is great, but it won't fly in the world of insurance. They need to show carryover.
As far as returning them to water time and again... I usually tell the patient I am delighted that they love the water and promptly refer them to a (private pay) post-aquatic professional or group class. Those who really want to continue will pursue it. Those who are looking for a free ride in a warm water pool with no effort towards independent work... disappear.
Warm (water) regards,
Andrea Salzman, MS, PT
Director of Programming, ATU
(If you have a question for Ask Andrea and would like to see her answer in The Aquatic Therapist blog, feel free to email her at info@swimatu.com)
Recent Comments