Mechanical Stretch Devices for the Treatment of Joint Stiffness
DESCRIPTION
Mechanical stretch devices for joint stiffness due to limited range of motion (ROM) or immobilization are intended to elongate the connective tissue surrounding the joint. This may restore motion from prolonged stiffness or contracture due to illness, surgery, or trauma. These devices are controlled by the individual and may be used as an adjunct to therapy.
There are several types of mechanical stretch devices. Dynamic splinting systems provide low-load prolonged duration stretch (e.g., Dynasplint®) to the affected joint and are used from six to twelve hours per session. Static progressive stretch devices increase the angle of stretch slowly (e.g., JAS™ device) and are used for 30 minutes several times daily. Flexionaters and extensionaters (e.g., ERMI Flexionater® and Extensionater®) use a serial stretch load application and quick release mechanism. These devices are used in 15-minute increments, four to eight times daily.
POLICY
Mechanical stretch devices for the treatment of joint stiffness in the hand or elbow due to limited range of motion (ROM) or immobilization are considered medically necessary.
Mechanical stretch devices for the treatment of stiffness in other joints are considered investigational.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The lack of randomized controlled studies and poor quality of published studies provide little evidence of the efficacy of these devices for use in joints other than of the hand or elbow over traditional therapies.
SOURCES
BlueCross BlueShield network physicians. November 2005.
Cincinnati Children’s Hospital Medical Center. (2007). Evidence-based care guideline of loss of elbow motion. Retrieved from http://www.cincinnatichildrens.org/assets/0/78/1067/2709/2777/2793/9199/2dd2aa87-1155-4659-8652-4f53f9f51ee0.pdf.
Farmer, S. E., Woollam, P. J., Patrick, J. H., Roberts, A. P., & Bromwich, W. (2005). Dynamic orthoses in the management of joint contracture. Journal of Bone and Joint Surgery, 87-B (3), 291-295.
National Institute of Advanced Industrial Science and Technology (AIST). (2007). IEEE 10th International Conference on Rehabilitation Robotics. (2007). Development of ankle dorsiflexion/plantar flexion exercise device with passive mechanical joint. Retrieved October 16, 2009 from http://unit.aist.go.jp/is/sirg/output/pdf/Homma's_paper_for_IEEE_with_copyright.pdf.
U. S. Food and Drug Administration. (2001, July). Center for Devices and Radiological Health. Physical Medicine Therapeutic Devices. Retrieved October 15, 2009 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=890.5380.
Winifred S. Hayes, Inc. Medical Technology Directory. (2011, August). Mechanical stretching devices for the treatment of join contractures of the extremities. Retrieved September 23, 2011 from www.Hayesinc.com/subscribers (51 articles and/or guidelines reviewed)
Work Loss Data Institute. (2011). Elbow (acute & chronic). Retrieved September 23, 2011 from http://www.guideline.gov/content.aspx?id=33179&search=join+contracture+stretch.
ORIGINAL EFFECTIVE DATE: 2/1/2001
MOST RECENT REVIEW DATE: 12/8/2011
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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