Evidence-Based Aquatic Therapy

Transcription

1 Evidence-Based Aquatic Therapy for the Total Knee Replacement Instructor: Lab demonstrations: Kim Gordon, MPT University of Alabama at Birmingham grad Awarded APTA s highest honor for aquatic PTs in 2010 Aquatic Therapy University, Director of Programming Founder and Owner, AquaticResources Network Has served as: Editor-in-Chief, Journal Therapy Pool Manager Adjunct Faculty, PT School Functional Design Consultant Instructor, over 200 conferences Aquatic Health Research Database (AHRD) Creator Author, 5 aquatic therapy-related texts Columnist, 6 magazines, over 300 articles Instructor: Contact.. asalzman@aquaticnet.com 1

2 Objectives #1. Understand, from the physician's perspective, under what circumstances it would be appropriate to begin aquatic therapy as early as 5-7 days post-operatively. Examine the literature that bolsters that argument. #2. Describe why aquatic therapy may be the treatment of choice if (a) the patient demonstrates an abnormal gait pattern or the need for an assistive device postoperatively due to pain or weakness, (b) the patient is experiencing post-operative edema limiting ROM (c) the patient is unable to exercise in a gravity-dominant environment. #3. View and discuss a 20-minute aquatic treatment plan for the post-operative treatment of a total knee replacement. #4. Document medical necessity for aquatic therapy and locate what payers (including Medicare) have to say about its use for the pre-and post-operative total joint replacement patient #5. Be able to identify and locate supportive research to bolster case. Contact.. asalzman@aquaticnet.com Understand when it s appropriate to begin #1. aquatic therapy early. A Surgeon s Fears The complication rate for total knee replacement surgery is low. Most problems are minor and easily treated. Major complications occur in less than 2% of cases. Possible surgical complications include: Blood clots Loosening of implant Stiffness Continued pain Neurovascular injury Infection 2

3 A Surgeon s Fears Peri-prosthetic infections are feared and severe complications. A Surgeon s Fears Deep infection accounts for roughly 20% of TKA revision operations. Source: Register Tska, Annual Report 2010, L. Lindgren, M. Sundberg, A. W-Dahl, O. Robertson, (Eds.), Department of Orthopedics, Lund Hospital, Lund, Sweden, A Surgeon s Fears The reported incidence lies between 0.5 and 1%. Sources: E. Jamsen, M. Varonen, H. Huhtalaet al., Incidence of prosthetic joint infections after primary knee arthroplasty, Journal of Arthroplasty, vol. 25, no. 1, pp , A. Stefansdottir, D. Johansson, K. Knutson, L. Lidgren, and O. Robertsson, Microbiology of the infected knee arthroplasty: report from the Swedish Knee ArthroplastyRegister on 426 surgically revised cases, Scandinavian Journal of Infectious Diseases, vol. 41, no , pp ,

4 Impact on Patient Devestation Impact on MD Impact on $$$ 4

5 Quiz Additionaltreatmentcosts(avg) of a single infected total joint prosthesis for medical and surgical treatment: A. $10,000 B. $20,000 C. $30,000 and more D. 100,000 Impact on Economy Additionaltreatmentcosts(avg) of a single infected total joint prosthesis for medical and surgical treatment: A. $10,000 B. $20,000 C. $30,000 D. 100,000 R. O. Darouiche, Treatment of infections associated with surgical implants, New England Journal of Medicine, vol. 350, no. 14, pp ,2004. Impact on Economy Roughly $1.8 billion per yr additional costs caused by infected joint prosthesis & fracture fixation devices in USA. R. O. Darouiche, Treatment of infections associated with surgical implants, New England Journal of Medicine, vol. 350, no. 14, pp ,

6 Impact on Economy Roughly $1.8 billion per yr additional costs caused by infected joint prosthesis & fracture fixation devices in USA. R. O. Darouiche, Treatment of infections associated with surgical implants, New England Journal of Medicine, vol. 350, no. 14, pp ,2004. The Question Is immersion safe post-operatively? Are you increasing the risk of infection? The Science 6

7 The Science Tegaderm The following site is a PDF of 3M tegaderm transparent dressing how to apply and remove, including patient handout. Fast Facts Huge, unprecedented increase in joint replacements a potential doubling of numbers between 2010 and Year % change THA 135K 238K 175% TKA 200K 498K 250% 7

8 Objectives #1. Understand, from the physician's perspective, under what circumstances it would be appropriate to begin aquatic therapy as early as 5-7 days post-operatively. Examine the literature that bolsters that argument. #2. Describe why aquatic therapy may be the treatment of choice if (a) the patient demonstrates an abnormal gait pattern or the need for an assistive device post-operatively due to pain or weakness, (b) the patient is experiencing post-operative edema limiting ROM (c) the patient is unable to exercise in a gravity-dominant environment. #3. View and discuss a 20-minute aquatic treatment plan for the post-operative treatment of a total knee replacement. #4. Document medical necessity for aquatic therapy and locate what payers (including Medicare) have to say about its use for the pre-and post-operative total joint replacement patient #5. Be able to identify and locate supportive research to bolster case. Contact.. asalzman@aquaticnet.com #2. Describe why aquatic therapy may be the treatment of choice. Why Water? S/p TKR patients are natural candidates for pool-based treatment. Why? Abnormal gait pattern Excessive use of an assistive device Post-operative edema limiting ROM Unable to exercise in a gravity-dominant environment On a weight-bearing restriction Unable to support his weight to initiate ambulation due to obesity, weakness or other factors In too much pain to treat on land 8

9 Why Water? What does water bring to the session? Buoyancy Thermal shifts Hydrostatic pressure Viscosity What does water offer that is unachievableon land? Handout (PDF) Buoyancy 9

10 . compressive forces Contact.. ease of handling & positioning. need for assistive device 10

11 Thermal shifts. muscle spasm & pain H. Pressure 11

12 . edema Slide courtesy Bruce Becker, MD.. cardiac efficiency Contact.. work of breathing Contact

13 Viscosity. strengthening. sensory input Contact

14 . safe place to fail Contact.. Objectives #1. Understand, from the physician's perspective, under what circumstances it would be appropriate to begin aquatic therapy as early as 5-7 days post-operatively. Examine the literature that bolsters that argument. #2. Describe why aquatic therapy may be the treatment of choice if (a) the patient demonstrates an abnormal gait pattern or the need for an assistive device postoperatively due to pain or weakness, (b) the patient is experiencing post-operative edema limiting ROM (c) the patient is unable to exercise in a gravity-dominant environment. #3. View and discuss a 20-minute aquatic treatment plan for the post-operative treatment of a total knee replacement. #4. Document medical necessity for aquatic therapy and locate what payers (including Medicare) have to say about its use for the pre-and post-operative total joint replacement patient #5. Be able to identify and locate supportive research to bolster case. Contact.. asalzman@aquaticnet.com View a 20-minute aquatic treatment plan for post- #3. operative TKR. 14

15 - Forwards, backwards, sideways walking- Manipulate difficulty by altering buoyancy, velocity, streamlining, levers, frontal SA, momentum - Chest opening stretch - -Trunk and hip extension stretch - - Trunk sidebending stretch

16 - Hamstring stretch - -Noodle assisted hamstring and rectus stretches - -Wall sliding (deepsquat) - -Straight plane & PNF patterns for the legs - -Monkey swing stretch

17 -Step-ups - (forward, sideways, backwards) - Lowering buttock down steps - -Stair bridging (with and without arm raises) - - Plantargrade progression - -Ladder lunges

18 -Pilates series of lunges - - Aquatic adaptations of the Berg - Courtesy Dee Ellis -Balance ball - - Polyspot shuffle

19 -Scissors - - Bicycling - Objectives #1. Understand, from the physician's perspective, under what circumstances it would be appropriate to begin aquatic therapy as early as 5-7 days post-operatively. Examine the literature that bolsters that argument. #2. Describe why aquatic therapy may be the treatment of choice if (a) the patient demonstrates an abnormal gait pattern or the need for an assistive device postoperatively due to pain or weakness, (b) the patient is experiencing post-operative edema limiting ROM (c) the patient is unable to exercise in a gravity-dominant environment. #3. View and discuss a 20-minute aquatic treatment plan for the post-operative treatment of a total knee replacement. #4. Document medical necessity for aquatic therapy and locate what payers (including Medicare) have to say about its use for the pre-and post-operative total joint replacement patient #5. Be able to identify and locate supportive research to bolster case. Contact.. asalzman@aquaticnet.com Document medical necessity for aquatic therapy. Locate what #4.payers have to say. 19

20 Medical Necessity Medical Necessity The physician reviewer found that although aquatic therapy is certainly a choice of modality for treatment, there is no proven benefit over land based PT Objectives #1. Understand, from the physician's perspective, under what circumstances it would be appropriate to begin aquatic therapy as early as 5-7 days post-operatively. Examine the literature that bolsters that argument. #2. Describe why aquatic therapy may be the treatment of choice if (a) the patient demonstrates an abnormal gait pattern or the need for an assistive device postoperatively due to pain or weakness, (b) the patient is experiencing post-operative edema limiting ROM (c) the patient is unable to exercise in a gravity-dominant environment. #3. View and discuss a 20-minute aquatic treatment plan for the post-operative treatment of a total knee replacement. #4. Document medical necessity for aquatic therapy and locate what payers (including Medicare) have to say about its use for the pre-and post-operative total joint replacement patient. #5. Be able to identify and locate supportive research to bolster case. Contact.. asalzman@aquaticnet.com

21 Be able to identify and locate supportive research #5. to bolster case. Online: Links to evidence cited 5 page Indications for AT download (PDF) Link to how to apply Tegaderm Link to order Justifiable AT for the THR/TKR manual Download at.. for 72 hrs after webinar) What next? Novel balance & fall prevention (April 23, 2013) 12 EB methods to progress any aquatic exercise Low back pain: Great ideas from the aquatic trenches Sensory and motor integration for the pediatric client Evidence-based precautions and contraindications for aquatic exercise & therapy Aquatic cardiac & respiratory rehab Register at

22 Evidence-Based Aquatic Therapy for the Total Knee Replacement Thanks for attending, Andrea QUICK LINKS: Phone: (800) Downloads at: