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PubMed1991

Hydrotherapy pools of the future--the avoidance of health problems.

The need to minimize the threat of infection to patients and the high incidence of health problems in hydrotherapy pool workers, have led to recommendations especially tailored to the design and operation of the water and air treatment plant of hydrotherapy pools. Hitherto unpublished surveys are detailed which confirm that pathogenic species of Pseudomonas aeruginosa in pools (in which ears may be wetted) cause a high incidence of otitis externa, but rarely cause body rashes (pseudomonas folliculitis) unless there has also been prolonged skin wetting. In brominated pools contact dermatitis is common and can be distinguished clinically from pseudomonas folliculitis by the onset of a pruritic rash less than 12 hours after exposure to the pool and reactivation of the rash on re-exposure to the brominated pool.

Cross Infection↗
PubMed1977

[Immunological changes during hydrotherapy].

Immunological tests were performed in 34 patients undergoing hydrotherapy according to Kneipp. IgM, alpha2-macroglobulin and complement factor C3 concentrations were increased after this treatment, but not in ten healthy volunteers. Specific antibody activities (staphylococci, E. coli, streptococci) remained unchanged. After intracutaneous testing with different protein and bacterial antigens reactions were significantly more intense (diameter of reaction) after hydrotherapy, while total number of reacting patients remained the same. Pokeweed stimulation ratio was increased in the lymphocyte transformation test, while PHA and PPD stimulation rates remained unaltered.

Adult↗
PubMed1998

Irritant contact dermatitis due to 1-bromo-3-chloro-5,5-dimethylhydantoin in a hydrotherapy pool. Risk assessments: the need for continuous evidence-based assessments.

A physiotherapist working in hydrotherapy presented to occupational health with irritant contact dermatitis. Subsequent investigation revealed that the likely causative agent was 1-bromo 3-chloro 5,5 dimethylhydantoin which was used to disinfect the hydrotherapy pool. A COSHH risk assessment had been performed which failed to take full account of current knowledge and this agent had been introduced into the workplace. The development of adverse health effects among staff and other pool users lead to a review of this risk assessment and eventually a return to less hazardous chlorine-based disinfection. Had an evidence-based approach been combined with an appropriate COSHH assessment prior to and following changes in the workplace then unnecessary risk to employees would not have occurred.

Dermatitis, Contact↗
PubMedDate not supplied

A survey of burn hydrotherapy in the United States.

One hundred burn care facilities in the United States were surveyed to determine the present use of hydrotherapy in burn care. It was found that 92% of the burn units that were polled practice this treatment in some form. There was no consensus as to how the procedure is carried out, how long it takes, how often it is done, or who does it. Most burn facilities that were contacted use a disinfectant solution for hydrotherapy, and the procedure is carried out once a day for 30 minutes or less. In most of these facilities, nurses perform the procedure. Although immersion therapy continues to play an important role in most burn care facilities, spray or shower techniques are also incorporated into many programs.

Burn Units↗
PubMed2002

Changes in the use of health resources by patients with chronic phlebopathies after thermal hydrotherapy. Report from the Naiade project, a nation-wide survey on thermal therapies in Italy.

BACKGROUND: Chronic venous disorders carry lifelong medical and social burdens. Within conservative approaches, spa hydrotherapy is popular among patients with venous disorders in Europe, but whether the practice is associated with health or social benefits remains controversial. METHODS: The present work is a substudy of the nation-wide Italian Naiade Project, a large multicenter observational exercise on spa treatments in different disease groups. The "Chronic Phlebopathies" substudy included 2504 patients with primary or secondary varicosis or non-varicose venous insufficiency. After a first visit and administration of a detailed questionnaire, patients underwent a "thermal cycle" of 15-20 days consisting of underwater active and passive physical therapy with mineral waters. The same procedures were repeated after 1 year on the 1352 patients (54%) who spontaneously returned to the same spa. Primary endpoints of the study were some indicators of the use of health resources related to the year after the first thermal cycle, compared with the same indicators recorded at first visit using appropriate statistical methods. RESULTS: The occurrence of acute venous episodes, working days missed, number and duration of hospital admissions, consumption of drugs and physical therapies were all significantly reduced in the year after thermal therapy, thus indicating lesser use of health resources. CONCLUSIONS: The study suggests that thermal hydrotherapy in patients with chronic venous disorders is associated with health and social benefits.

Data Collection↗
PubMedDate not supplied

Water treatment of hydrotherapy exercise pools.

The major objectives of water treatment of hydrotherapy pools are to disinfect the water and to balance the water appropriately. A variety of disinfectant systems utilizing either halogens, ozone, or metals have been implemented in hydrotherapy pools. Regardless of the disinfectant system employed, continual and appropriate monitoring of the system is mandatory to prevent infection. Water balancing refers to the control of the water mineral concentration so that the water does not damage the pool. Five major factors that influence water balance are pH, total alkalinity, calcium hardness, total dissolved solids, and temperature. The extent to which these five factors affect water balance can be computed by the Langelier saturation index.

Chlorine↗
PubMedDate not supplied

Design of hydrotherapy exercise pools.

Several hydrotherapy pools have been designed specifically for a variety of aquatic exercise. Aqua-Ark positions the exerciser in the center of the pool for deep-water exercise. Aqua-Trex is a shallow underwater treadmill system for water walking or jogging. Swim-Ex generates an adjustable laminar flow that permits swimming without turning. Musculoskeletal conditioning can be accomplished in the above-ground Arjo shallow-water exercise pool. A hydrotherapy pool also can be custom designed for musculoskeletal conditioning in its shallow part and cardiovascular conditioning in a deeper portion of the pool. Regardless of the type of exercise, there is general agreement that the specific exercise conducted in water requires significantly more energy expenditure than when the same exercise is performed on land.

Equipment Design↗
PubMed1979

[Hydrotherapy pools, microbiological and chemical results (author's transl)].

The results of microbiological and chemical examinations of water samples collected from hydrotherapy pools for non incontinent patients proved that the officially agreed parameters for the surveillance of public swimming pools (Osterr. Bäderhygiene-Gesetz and Verordnung) have to be extended to meet the requirements of epidemiology. Similarly the requirements for treatment and operating conditions of those waters should be more rigorous. Minimal requirements for the treatment of water in hydrotherapy pools are recommended. The results of the study indicated also that the microbicide action of chlorine (chlorine gas, hypochlorite solution) was superior to those of DIHALO (chlorine-bromine-hydantoine). Suggestions are made for proper handling of waters which would lose their therapeutical potencies by any kind of treatment.

Baths↗
PubMed1995

Physical modalities in wound management: ultrasound, vasopneumatic devices and hydrotherapy.

The modalities discussed in this manuscript have proven effective in augmenting repair in venous, arterial, pressure and insensitivity ulcers. However, if used inappropriately, these same physical modalities can have significant negative effects on healing. This article will review three commonly used modalities, ultrasound, vasopneumatic devices and hydrotherapy, in an effort to promote proper use of these modalities and to prevent their misuse. The treatment goals for ultrasound are stimulation of fibroblasts and macrophages, degranulation of mast cells, promotion of angiogenesis, reduction of the inflammatory phase of repair and acceleration of healing. The treatment goal of vasopneumatic devices, such as intermittent compression therapy, is to reduce venous hypertension and edema by assisting venous blood flow back toward the heart. The treatment goals of hydrotherapy are to debride loosely attached devitalized tissue, remove surface contaminants, oils and cellular debris, and promote circulation in ischemic limbs. The use of inappropriate modalities or selection of excessive treatment parameters not only can delay healing but also can cause significant harm. Each agent needs to be used judiciously with attention given to potential adverse reactions.

Bandages↗
PubMed2006

[Hydrotherapy and thermotherapy in the treatment of functional disorders].

The modern interpretation of functional disorders classifies them as somatoform autonomic functional disorders that are associated with the vegetative nervous system. This places them within the responsibility of psychosomatic, psychotherapeutic medicine or psychiatry. In consequence, other forms of treatment with an impact on the vegetative system are being underestimated, such as hydrotherapy and thermotherapy, the efficacy of which depends on the fact that thermoregulation predominates over the regulation of numerous other organ systems. In the present article, the effectiveness of this therapeutic approach is discussed.

Acclimatization↗
PubMed2004

Hydrotherapy, balneotherapy, and spa treatment in pain management.

The use of water for medical treatment is probably as old as mankind. Until the middle of the last century, spa treatment, including hydrotherapy and balneotherapy, remained popular but went into decline especially in the Anglo-Saxon world with the development of effective analgesics. However, no analgesic, regardless of its potency, is capable of eliminating pain, and reports of life-threatening adverse reactions to the use of these drugs led to renewed interest in spa therapy. Because of methodologic difficulties and lack of research funding, the effects of 'water treatments' in the relief of pain have rarely been subjected to rigorous assessment by randomised, controlled trials. It is our opinion that the three therapeutic modalities must be considered separately, and this was done in the present paper. In addition, we review the research on the mechanism of action and cost effectiveness of such treatments and examine what research might be useful in the future.

Balneology↗
PubMed1989

Two sources of contamination of a hydrotherapy pool by environmental organisms.

As a result of occasional water discolouration, the hydrotherapy pool of a large teaching hospital was monitored for free and combined chlorine, alkalinity, calcium hardness, total dissolved solids and cyanuric acid levels together with bacteriological analysis. The hose pipe supplying the pool and the dual water pumps were also examined as potential sources of bacterial contamination. The pool water yielded high counts of Pseudomonas vesicularis, Pseudomonas aeruginosa, and CDC Group IV C2, even in the presence of adequate levels of free chlorine. This was found to be due to high concentrations of cyanuric acid which resulted in a 'chlorine lock'. The source of the P. vesicularis and CDC Group IV C2 was found to be the pool hose and this problem was alleviated by flushing it with water each day before use. The source of the P. aeruginosa was the pool pumps, and was eradicated by regularly shock dosing them with 6-8 ppm of free chlorine.

Bacterial Typing Techniques↗
PubMed2006

Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial.

OBJECTIVE: To compare hydrotherapy (HT) and conventional physiotherapy (CP) in the treatment of fibromyalgia (FM), regarding quality of life (QOL), total sleep time (TST), and total nap time (TNT). METHODS: Fifty outpatients, all female, 30-60 years old, diagnosed with FM, were randomly assigned to two groups to carry out 3 weeks of treatment with HT or CP. In the beginning and in the end of treatment, patients were evaluated with the SF-36 questionnaire to measure QOL and the sleep diary for TST and TNT. Data analyses were blind. RESULTS: All 24 HT patients increased 1h in TST compared to 19 CP patients. TNT decreased in the HT group. QOL improved for the two groups in all domains when pre- and post-intervention were compared, but there was no difference between groups. CONCLUSION: HT is more effective than CP to improve TST and to decrease TNT in FM patients.

Adult↗
PubMed2001

An outbreak of methicillin resistant Staphylococcus aureus on a burn unit: potential role of contaminated hydrotherapy equipment.

OBJECTIVE: To report a multi-institution outbreak caused by a single strain of methicillin-resistant Staphylococcus aureus (MRSA). OUTBREAK: Between September 19 and November 20, 1996 an index case and five secondary cases of nosocomial MRSA occurred on a 26 bed adult plastic surgery/burn unit (PSBU) at a tertiary care teaching hospital. Between November 11 and December 23, 1996, six additional cases were identified at a community hospital. One of the community hospital cases was transferred from the PSBU. All strains were identical by pulsed-field gel electrophoresis. MRSA may have contributed to skin graft breakdown in one case, and delayed wound healing in others. Patients required 2 to 226 isolation days. CONTROL MEASURES: A hand held shower and stretcher for showering in the hydrotherapy room of the PSBU were culture positive for the outbreak strain, and the presumed means of transmission. Replacement of stretcher showering with bedside sterile burn wound compresses terminated the outbreak. The PSBU was closed to new admissions and transfers out for 11 days during the investigation. Seven of 12 patients had effective decolonization therapy. CONCLUSION: Environmental contamination is a potential source of nosocomial MRSA transmission on a burn unit. Notification among institutions and community care providers of shared patients infected or colonized with an antimicrobial resistant microorganism is necessary.

Adult↗
PubMed2006

Control of Legionella pneumophila contamination in a respiratory hydrotherapy system with sulfurous spa water.

OBJECTIVE: To evaluate the effectiveness of different disinfection treatments in a spa water system contaminated by Legionella pneumophila and associated with a case of Legionella pneumonia. DESIGN: During an 18-month period, the spa water was analyzed by taking samples from the well, the recirculation line, and the final distribution devices (nebulizers and nasal irrigators). Various attempts were made to eradicate Legionella organisms by chemical and thermal shock. The final protocol consisted of heat shock treatment at 70 degrees C-75 degrees C for 3 hours, 2 nights per week, followed by a lowering of the water temperature to 30 deg C+/-1 deg C for use in the plant. In addition, 3 times a week superheated steam (at a pressure of 1 atmosphere) was introduced for 1 hour into the nebulization machines. SETTING: A spa at which sulfurous water was used for hydrotherapy by means of aerosol and nasal irrigation. PATIENT: A 74-year-old woman with legionnaires disease. RESULTS: After the case of infection occurred, L. pneumophila was isolated from the recirculation line at a concentration of 400,000 cfu/L and from the nebulizers and nasal irrigators at levels ranging from 3,300 to 1,800,000 cfu/L. The colonizing organisms consisted of a mixture of L. pneumophila serogroup 1 (12%) and serogroup 5 (88%). The shock treatment with chlorine dioxide and peracetic acid resulted in the eradication of Legionella organisms from the recirculation line but not from the water generated from the final distribution devices. After the restructuring of the plant and the application of thermal shock protocol, an evaluation after 12 months revealed no evidence of Legionella contamination. CONCLUSION: To prevent Legionella colonization, disinfection treatment is effective if associated with carefully selected materials, good circuit design, and good maintenance practices.

Aged↗
PubMed2006

Estimation of the radiological risk related to the presence of radon 222 in a hydrotherapy centre in Tunisia.

The (222)Rn concentration in air was measured in a thermal water spa used as a hydrotherapy centre in Tunisia. The associated health risk for employees and patients due to the inhalation of (222)Rn and its progeny was estimated. A protection scheme for the employees of the spas has been designed. Results show that the (222)Rn concentration varies in the range 33-589 Bq m(-3). The (222)Rn concentrations measured in the present study show lower values in comparison to those reported for thermal spas in other countries. The (222)Rn concentration in different rooms of the spa depends mainly on the ventilation rate. A model based on a dosimetric approach was adopted to estimate the radon risk considering the (222)Rn concentration, the time spent in the spa, and the radioactive equilibrium factor F. The annual effective dose was found to vary between 0.2 and 1.7 mSv for workers while the range for patients was from 2.8 x 10(-4) to 1.1 x 10(-4) mSv. These values are within the ICRP recommended values.

Air Pollutants, Radioactive↗
PubMed1980

Comparison of in vivo temperatures produced by hydrotherapy, paraffin wax treatment, and Fluidotherapy.

The effectiveness of a new heat modality, Fluidotherapy, was compared with other superficial heat modalities by in vivo temperature measurements. The joint capsule and muscle temperatures in the hands and feet were measured in subjects treated with hydrotherapy, paraffin wax, and Fluidotherapy. Fluidotherapy is a dry heat modality consisting of finely divided solids suspended in an air stream. The dry heat modality, applied at 118 degrees F (47.78 degrees C), resulted in maximum joint capsule and muscle temperature rises of 16.2 degrees F (9 degrees C) and 9.5 degrees F (5.27 degrees C), respectively, compared to 13.5 degrees F (7.5 degrees C) and 8.1 degrees F (4.5 degrees C) for paraffin wax treatment and 10.8 degrees F (6.0 degrees C) and 7.7 degrees F (4.3 degrees C) for a 102 degrees F (38.89 degrees C) water bath, at a depth of about 0.5 cm beneath the skin. At depths down to 1.2 cm, superficial heat modalities are more effective than diathermy and much more effective than ultrasound in elevating temperature.

Calorimetry↗
PubMedDate not supplied

Automated hydrotherapy pool water treatment system.

An automated hydrotherapy water treatment system was described that controls chemical pumps that maintain the pool's water pH and chlorine levels at the designated set points, regardless of the bather load. This system consists of sensing electrodes, a controller, and positive displacement pumps. Because outbreaks of waterborne infections have never been reported in facilities in which the pool water has been continuously maintained at pH 7.2 to 7.8 with a free available chlorine level of at least 1.0 ppm, we recommend that this type of water treatment system be installed in all public pools.

Automation↗