BlueCross BlueShield of Tennessee Medical Policy Manual

Aquatic Therapy

DESCRIPTION

Aquatic therapy is an active therapeutic intervention that takes place in water. The aquatic environment provides buoyancy, increased resistance (i.e., viscosity) and warmth. The advantage of buoyancy is direct: when a person enters the water, there is an immediate reduction in the effect of gravity on the body. The advantage of viscosity of water is indirect: when the person moves through the water, resistance is felt. This is also referred to as accommodating resistance because it matches the individual's applied force or effort. Because the resistance of the water equals the force exerted, the likelihood of exacerbation or re-injury is reduced dramatically. Advocates of aquatic therapy have proposed that water allows ease of active movement, trunk stabilization, relaxation of spastic muscles, improved circulation, strengthening and functional activity training.

POLICY

Aquatic therapy for the improvement or restoration of physical function following disease, injury, or loss of body part is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)

See also: Staff Supervision Requirements for Delegated Services

MEDICAL APPROPRIATENESS

Aquatic therapy is considered medically appropriate if all of the following criteria are met:

Maintenance programs and general exercise programs (e.g., water walking / jogging) in the absence of documentation that supports skilled intervention is considered not medically appropriate.

ADDITIONAL INFORMATION

An individual may receive aquatic therapy on the same date of service as land based therapy. However, there should be an evident trend away from aquatic therapy and towards a fully implemented land based program.

Clinical Examples of Skilled Aquatic Therapy:

SOURCES

Ariyoshi, M., Sonoda, K., Nagata, K., Mashima, T., Zenmyo, M., Paku, C., et al. (1999). Efficacy of aquatic exercises for patients with low-back pain. The Kurume Medical Journal, 46 (2), 91-96. Abstract retrieved December 14, 2001 from PubMed database.

Bacon, M. C., Nicholson, C., Binder, H., & White P. H. (1991). Juvenile rheumatoid arthritis. Aquatic exercise and lower-extremity function. Arthritis Care Research, 4 (2), 102-105. Abstract retrieved December 12, 2001 from PubMed database.

BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2002). Physical therapy (8.03.02). Retrieved April 17, 2006 from BlueWeb.

Dumas, H., & Francesconi, S. (2001). Aquatic therapy in pediatrics: Annotated bibliography. Physical & Occupational Therapy in Pediatrics, 20 (4), 63-78.

Kelly, B. T., Roskin, L. A., Kirkendall, D. T., & Speer, K. P. (2000). Shoulder muscle activation during aquatic and dry land exercises in nonimpaired subjects. The Journal of Orthopaedic and Sports Physical Therapy, 30 (4), 204-210. Abstract retrieved December 18, 2001 from PubMed database.

Lipow, V. (1998). Water-proofing measuring aquatic therapy effectiveness. Rehab Management,11 (4), 34-36, 39.

Patrick, D. L., Ramsey, S. D., Spencer, A. C., Kinne, S., Belza, B., & Topolski, T. D. (2001). Economic evaluation of aquatic exercise for persons with osteoarthritis. Medical Care, 39 (5), 413-424.

Prins, J., & Cutner, D. (1999). Aquatic therapy in the rehabilitation of athletic injuries. Clinics in Sports Medicine, 18 (2), 447-461.

Templeton, M. S., Booth, D. L., & O'Kelly, W. D. (1996). Effects of aquatic therapy on joint flexibility and functional ability in subjects with rheumatic disease. The Journal of Orthopaedic and Sports Physical Therapy, 23 (6), 376-381. Abstract retrieved December 18, 2001 from PubMed database.

The American Physical Therapy Association, letter to BCBST dated January 14, 2002 containing recommended aquatic therapy guidelines.

Wyatt, F. B., Milam, S., Manske, R. C., & Deere, R. (2001). The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. Journal of Strength and Conditioning Research, 15 (3), 337-340. Abstract retrieved January 7, 2002 from PubMed database.

EFFECTIVE DATE

5/25/2006

 

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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