OVERVIEW.

Hydrotherapy is water treatment used for exercises, pain management, and wound care¹ and includes whirlpool, pool therapy, and contrast baths. Hydrotherapy benefits are derived from its cleansing action, buoyancy properties (reduced weight bearing), hydrostatic pressure effects (improved venous return), and psychological effects.

Sources generally recommend monitoring patient vital signs (because of patients’ inability to lose heat while in water if fully immersed), check temperature levels, clean tanks, and caution to never leave patient unattended during or after hydrotherapy.^2,3 Note: (1) Because of the potential for cross-contamination, aspiration, drowning, cardiovascular stress, and burns (in heated water), patient screening is required. (2) If hydrotherapy is used in conjunction with hot or cold water, then superficial heat and cryotherapy concerns also apply, respectively.^3–5

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Five sources cited a total of 48 concerns for hydrotherapy. Several of these concerns were temperature related. Concerns ranged from 19 to 28 per source, with physical therapists citing the greatest number. The largest proportion of concerns fell within the ICD categories of circulatory, skin, mental/behavioral, or nervous system. The most frequently cited concerns in this sample were malignancy and sensory impairments. In addition, 10 other frequently cited concerns included bowel incontinence, urinary incontinence, pulmonary disease, cardiac insufficiency, impaired circulation, skin infection, mental impairment, epilepsy, and fever (mentioned by 80% of sources). The concerns below include both full body and local immersion (for local concerns, also see Debridement section in Wound Care).

OTHER ISSUES: ELECTROLYTE IMBALANCES IN BURNS, SLIPS, AND FALLS, AND HAIR ENTANGLEMENT.

(1) Said and Hussein,⁶ in a 1987 case series, reported on two brothers who sustained partial-thickness burns and subsequently developed hyponatremia while immersed in a whirlpool filled with tap water. (2) In a 1994 Missouri lawsuit,⁷ a man with arthritis was awarded $47,773.90 after he slipped and fractured his patella while being assisted out of a whirlpool bath. (3) The CPSC⁸ reported 43 incidences of hair getting sucked into suction fittings of spas, whirlpools, or hot tubs, including 12 deaths (the head of victim was trapped underwater).