Mechanical Stretch Devices for the Treatment of Joint Stiffness
Mechanical stretch devices are rented durable medical equipment used for joint stiffness due to limited range of motion (ROM) or immobilization. They are intended to elongate the connective tissue surrounding the joint and restore range of motion from prolonged stiffness or contracture due to illness, surgery, or trauma. These devices are controlled by the individual and used in the home as an adjunct to physical therapy.
There are three classifications of mechanical stretch devices currently available:
Dynamic low-load prolonged-duration stretch (LLPS) devices are set at a fixed joint angle and worn for extended periods each day (e.g., Dynasplint System® and Pro-Glide™)
Static progressive (SP) stretch devices are used for multiple short term sessions per day with the joint angle progressively increased at each session (e.g., Joint Active Systems splints and Air Cast®)
Patient-actuated serial stretch (PASS) devices supply a low to high-level load to the joint, using pneumatic or hydraulic systems that can be adjusted by the individual and used for multiple short sessions each day (e.g., ERMI Elbow Extensionator® and ERMI Knee/Ankle Flexionator®)
Mechanical stretch devices for the treatment of joint stiffness in the hand (i.e., wrist or fingers) or elbow due to limited range of motion (ROM) or immobilization are considered medically necessary.
Mechanical stretch devices for the treatment of stiffness in all other joints are considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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.
The lack of randomized control and poor quality of published studies provide little evidence of the efficacy of these devices over traditional therapies.
BlueCross BlueShield Association. Evidence Positioning System. (3:2018). Patient-actuated end of range motion stretching devices (1.03.05). Retrieved January 3, 2019 from http://www.evidencepositioningsystem.com. (18 articles and/or guidelines reviewed)
BlueCross BlueShield network physicians. November 2005.
Cantero-Téllez, R., Cuesta-Vargas, A., & Cuadros-Romero, M. (2015). Treatment of proximal interphalangeal joint flexion contracture: combined static and dynamic orthotic intervention compared with other therapy intervention: a randomized controlled trial. The Journal of Hand Surgery, 40 (5), 951-955. Abstract retrieved February 10, 2017 from PubMed database.
Furia, J.P., Willis, F.B., Shanmugam, R., & Curran, S. (2013) Systematic review of contracture reduction in the lower extremity with dynamic splinting. Advances in Therapy, 30 (8), 763-770. (Level 1 evidence)
John, M.M., Kalish, S., Perns, S.V., & Willis, F.B. (2011). Dynamic splinting for postoperative hallux limitus: a randomized, controlled trial. The Journal of American Podiatric Medical Association, 101 (4), 285-288. Abstract retrieved February 10, 2017 from PubMed database.
Schwartz, D. (2012). Static progressive orthoses for the upper extremity: a comprehensive literature review. Hand, 7, 10-17. (Level 2 evidence)
Veltman, E.S., Doornberg, J.N., Eygendaal, D., & van den Bekerom, M.P. (2015). Static progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients. Archives of Orthopedic and Trauma Surgery, 135 (5), 613-617. Abstract retrieved February 10, 2017 from PubMed database.
Winifred S. Hayes, Inc. Medical Technology Directory. (2013, February; last update search May 2018). Mechanical stretching devices for the treatment of joint contractures of the extremities. Retrieved January 7, 2019 from www.Hayesinc.com. (174 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 2/1/2001
MOST RECENT REVIEW DATE: 3/28/2019
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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