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The Holy Grail of Aquatic Therapy Literature: No Increased Risk of Infection after Surgery

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b2ap3_thumbnail_6a00d83453c2c669e2017ee9963bc4970d-320wi.jpgYou've heard every rationale in the book from payers who want to discontinueaquatic therapy.

  • "It's not functional; people don't live in the water"
  • "6-8 visits to teach the exercises, then an immediate transition to land"
  • "You don't need a skilled therapist to teach water aerobics." (my personal favorite)

So, when the day comes when a gorgeous piece of literature comes out which makes the case for aquatic therapy -- and that case is not just (unequivocally) pro-aquatic therapy, but pro-starting-as-early-as-4-days-post-op, well, it's time to celebrate.

This systematic review/meta-analysis is equivalent to the Holy Grail... desired by all, long sought, yet always elusive.

Attend March 26th webinar for a much more extensive look at the ramifications of this study and many others. We will be incorporating this study into a free brochure you can use to give to refering physicians after the webinar.

REVIEW ARTICLE (META-ANALYSIS): Early Aquatic Physical Therapy Improves Function and Does Not Increase Risk of Wound-Related Adverse Events for Adults After Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Even the title makes me shiver. Let's look at the good news:

1. It was published in 2013. It is the latest word.

2. It is a systematic review and a meta-analysis. You can't find a stronger look at the evidence. Systematic reviews (and more importantly, meta-analyses) aren't just some physician's best quess at the state of the evidence. They are a statistics-driven investigation of existing literature. They examine what other people have done, throw out the weak, unreliable and invalid, and bring a "big picture" answer to the question: Does it work?

3. It states a finding. Systematic reviews for physical medicine are often a disappointment. Typically, at the end of these reviews, a finding is stated... and that finding is that there is not enough good quality research in existance to make a finding. That is not the case for this review.

4. It's first finding is a big hairy deal. Forget for a moment about aquatic therapy's effectiveness. This study also examines aquatic therapy's safety.

The #1 reason physicians resist post-operative aquatic therapy is the fear of infection. Right? Yet, the primo time for pool therapy is immediately after surgery, when the effects of immersion on pain, gait, ROM, confidence, and swelling are the most powerful.

Finding: The results from this systematic review provide evidence from 8 controlled trials, with 287 participants, that there was no increased risk of wound-related adverse events for subjects undertaking aquatic physical therapy in the early postoperative period after orthopedic surgery compared with land-based therapy.

5. It's second finding is nothing to sneeze at. In addition to showing that aquatic therapy is safe as early as 4 days post-op, the study shows that aquatic therapy does a superior job to traditional land-based treatments on improving function. And isn't function the "most important" result to payers?

Finding: When compared with standard land-based physical therapy, aquatic therapy resulted in a significant improvement on measures of ADL. Improvement in ADL has also been noted after participation in an aquatic therapy program in older adults with arthritis. This is a clinically significant finding because the ability to perform ADL with less pain and difficulty is a major priority for the older population with arthritis.

6. It's remaining findings are great news as well. The study states that aquatic therapy is just as effective as its land-based counterpart on tackling the other problems associated with orthopedic complaints (swelling, weakness, ROM, etc). Although it is a surprise that aquatic therapy wasn't demonstrably superior, especially in edema control, it was at least as effective.

Finding: There was no significant difference between the aquatic group and the land-based group in terms of swelling or edema; however, both groups demonstrated an improvement in swelling over time, suggesting that early mobilization in either an aquatic environment or a land environment will result in reduced swelling via the pumping action of the involved muscles and that the possible expected hydrostatic effects of immersion may be counteracted by the dilation of vessels due to the water’s warm temperature.

In 1 trial, circumferential measurements were taken at 4 locations and averaged to obtain the edema measurement while the other 3 trials used 1 measurement closer to the knee joint. When this trial was removed from the analysis, aquatic physical therapy [did result] in significantly reduced edema.

Now, if this finding stood alone, it would not be enough to compel payers to support aquatic therapy. Why? The reimbursement rate for aquatic therapy is higher than the reimbursement rate for therex and most other "land-based" codes. This means that -- all things equal -- payers have the right to choose the cheaper route.

But all things are not equal. Aquatic therapy has been shown to improve function more than the alternative. This, coupled with the fact that immersion has been shown to be SAFE immediately after surgery, is wonderful news.

Conclusion: The ranks of evidence supporting aquatic therapy for the orthopedic client just grew. Again.

Next step? Attend a March 26th webinar (12 Eastern) for a much more extensive look at the ramifications of this study plus additional justification/treatment options for the Total Knee Replacement client. If you miss the live webinar, a taped version will be available.

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