Hydrotherapy within expert physiotherapy reports – is it a justifiable cost?

By Tanya Owen

[HYDROTHERAPY can be a contentious issue within specialist neurological physiotherapy expert reports, because of the significant costs associated with installation and maintenance of a pool.

There are key differences between aqua therapy, hydrotherapy and water-based exercise: •Aqua therapy is used by suitably qualified physiotherapists employing the therapeutic properties of water in treatment programmes to help maximise a person’s function. The term has now been adopted by the Aquatic Therapy Association of Chartered Physiotherapists to highlight the distinction from hydrotherapy. • Hydrotherapy is water-based therapy carried out by non-specialist therapists such as support workers, carers and family members, who may not have extensive knowledge about the therapeutic properties of water. • Water-based exercise includes swimming, aqua aerobics or following an exercise programme in the pool – with or without care support – for cardiovascular, mental health and a myriad of other exercise-related benefits.

It is rare that any of the above will replace land-based exercise, but for some claimants they can be an important part of therapy, rehabilitation and long-term health and wellbeing, including promoting confidence in water following injury.

While aqua therapy requires warmer pools, and some claimants need warmer water in the longer term, it does not automatically follow that a claimant will need a swimming pool at home. Alternative options for the expert witness to consider include local hydrotherapy centres, warmer pools at private health clubs and spa/plunge pools.

Not every pool has fully-accessible changing rooms, hoist facilities, chair or step entry to the pool. However, that is changing, with many local pools expanding their facilities.

In addition to considerations of access, the physiotherapy expert witness will consider how the claimant presents, their symptoms, their requirement for support, suitable alternatives, their subjective account of the benefits, frequency of use and any track record of engagement with hydrotherapy provision, as evidenced in the records available. The admissibility is ultimately a matter for the court and there remains a mix of case law regarding recoverability.

Sometimes what a claimant needs or wants in the longer term is access to water sports and leisure activities. Formal therapy goes on the back burner in favour of disabled surfing, scuba diving and sailing – and rightly so; life is to be lived. Unfortunately, those are rarely represented within expert physiotherapy reports, but they really should be, as they are integral to the principle of reasonable restitution. q • Tanya Owen MSc Global Health and Development BSc (Hons) Physiotherapy is a private neurological physiotherapist with Neuro Physio Works Ltd and an expert witness with Somek and Associates. She qualified as a physiotherapist in 1999 and specialises in neurology, spinal cord injury, cauda equina syndrome, brain injury, cerebral palsy and stroke.