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.)
Aquatic therapy as a maintenance program and general exercise program (e.g., water walking/jogging) in the absence of documentation that supports skilled intervention is considered not medically necessary.
See also: Staff Supervision Requirements for Delegated Services
MEDICAL APPROPRIATENESS
Aquatic therapy is considered medically appropriate for ALL of the following criteria:
The service is performed under the direct supervision of a licensed physical therapist with a physician's order
The therapeutic interventions rendered are directly related to a written treatment regimen that includes goals approved and signed by the physician
The individual must have impairments, functional limitations or disabilities that can be minimized or eliminated with aquatic therapy
The individual must be able to benefit from the unique properties of water (i.e., buoyancy, hydrodynamics, and hydrostatic pressure)
An individual selected for aquatic therapy must be unable to safely participate in a physical therapy program that is totally land based due to weight bearing restrictions, severe weakness or other considerations
The documentation must support the necessity of this intervention
The aquatic therapy rendered must require the skills of a physical therapist
A qualified therapist is physically present and actively involved in the treatment (Note: Refer to the medical policy Staff Supervision Requirements for Delegated Services for further information regarding BCBST's supervision requirements.)
The aquatic therapy services rendered are considered acceptable standards of medical practice for the individual's condition.
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:
An individual with arthritis who cannot ambulate on land because of the inability to use an assistive device, but who can begin walking in the pool.
An individual who recently had a total hip replacement with weight bearing restrictions who has difficulty following these precautions on land and who needs to begin progressive strengthening of the leg.
An individual with Guillain Barré or multiple sclerosis who is too weak to exercise on land but who can move in the pool with a buoyancy assist device.
SOURCES
Assis, M. R., Silva, L. E., Alves, A. M., Pessanha, A. P., Valim, V., Feldman, D., et al. (2006). A randomized controlled trial of deep water running: Clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis and Rheumatism, 55 (1), 57-65. (Level 2 Evidence - Independent study)
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2002). Physical therapy (8.03.02). Retrieved February 5, 2009 from BlueWeb.
Gusi, N., & Tomas-Carus, P. (2008). Cost-utility of an 8-month aquatic training for women with fibromyalgia: A randomized controlled trial. Arthritis Research & Therapy, 10 (1), R24. (Level 2 Evidence - Independent study)
Hinman, R. S., Heywood, S. E., & Day, A. R. (2007). Aquatic physical therapy for hip and knee osteoarthritis: Results of a single-blind randomized controlled trial. Physical Therapy, 87 (1), 32-43. (Level 2 Evidence - Independent study)
Stanos, S. P., McLean, J., & Rader, L. (2007). Physical medicine rehabilitation approach to pain. The Medical Clinics of North America, 91 (1), 57-95.
The American Physical Therapy Association, letter to BCBST dated January 14, 2002 containing recommended aquatic therapy guidelines.
Volaklis, K. A., Spassis, A., & Tokmakidis, S. P. (2007). Land versus water exercise in patients with coronary artery disease: Effects on body composition, blood lipids, and physical fitness. American Heart Journal, 154 (3), 560.e1-560.e6. (Level 3 Evidence - Independent study)
ORIGINAL EFFECTIVE DATE: 7/1/2002
MOST RECENT REVIEW DATE: 3/12/2009
ID_BT
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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