Hydrotherapy pools

I. Introduction

A Hydrotherapy Pool is a warm water pool designed for aquatic physiotherapy treatment and rehabilitation. They are used to treat people post injury, surgery, or for medical condition management.
Aquatic physiotherapy is a programme designed by a suitably qualified physiotherapist that utilises the properties of water and is specific to each individual in order to maximise function. This can be physical, physiological or psychological. Treatments should be carried out by appropriately trained personnel, ideally in a purpose built and suitably heated hydrotherapy pool.

Location:

They are usually located in hospitals, special needs schools, sports injury clinics and military establishments.

Definition:

Hydrotherapy pools are defined by their warm water temperature and design for aquatic physiotherapy, treatment and rehabilitation. They tend to be no more than 15m in length with a maximum capacity of 100m3.

They are used to treat people after injury, surgery, or for managing a medical condition. Aquatic physiotherapy in a hydrotherapy pool can improve blood circulation, reduce muscle spasm and help relieve pain. The weight-supported environment can improve mobility which may not be possible out of the water.

Exercises using the resistance of water can be used for strengthening and conditioning, as well as for improving balance and coordination.
The ideal temperature for a hydrotherapy pool is thermoneutral (34-35°C), which is the temperature range where the body's core temperature will not increase or decrease.

II. Design & Operational Standards

The people that use and are treated in Hydrotherapy Pools are vulnerable and as a result the Design & Operation of such facilities must comply with higher standards than those of a recreational commercial swimming pool.

Role of the Designated Aquatic Physiotherapist:

• Point of contact for all involved with the hydrotherapy pool
• Needs sufficient training to understand:
  - All potential microbial, chemical and physical hazards and the risks to health associated with them
  - Patient needs and risk factors
  - Pool plant flow dynamics and treatment
  - Monitoring requirements and what results mean
  - Appropriate remedial actions
  - Pool closing / reopening criteria

Surveillance & Communication:

Effective working relationships between the designated aquatic physiotherapist, trained pool operators/engineers and microbiologists to ensure:

• smooth running and daily maintenance
• an accurate daily log (medico-legal document) which contains details of:
  - chemical disinfection
  - pool water quality monitoring
  - water and air temperatures
  - humidity levels
  - backwashing
  - microbiological testing

The Pool Safety Operating Procedure (PSOP):

This should include:

• Identification of responsibilities for all involved with the pool to ensure smooth running
• Stated procedures for all potential hazards that could occur
• A statement of policy and description of the pool including size, depth, steps, gradient, handrails, type of hoist(s), pool volume, turnover period and bather load, type of disinfection and filtration
• Cleaning schedules / regimes for clinical standards of healthcare
• Pool chemistry testing, recording and what to do if out of parameter
• Microbiology sampling and what to do if a positive result
• Risk analysis procedures and schedules

Hydrotherapy Pool Design Requirements:

• Deck level pool for optimum pool water quality, ease of emergency evacuation and cleaning
• No single depth can meet the treatment requirements of all patients. The Aquatic Therapy Association for Chartered Physiotherapists (ATACP) recommends a therapist depth for safe patient handling at mid position between chest and waist height
• Pools for adult use should include areas 1-1.35m and for adults and children 0.85- 1.25m depth
• Consider user group (eg. if spinal cord injuries deep-end required)
• Steps, gradient, moveable floors (ladders are not recommended for hydrotherapy pools)
• The concourse should be a minimum of 2m² on at least two sides to allow for stretchers and wheelchairs with 1.5m² on the other sides
• Changing facility: size, provision of showers pre and post, disability access, and separate staff
• Ventilation, lighting and visibility
• Hoists - fixed, mobile, tracking - positioning; a depth the therapist can safely manage patient handling and not over steps. Enough space for a full turning circle whether a chair or stretcher type (if hydraulic hoists are used ensure adequate backflow protection within the installation)
• Alarm system
• Storage provision equipment and patient mobility aids
• Rest/waiting area with drinking water

Environmental Control Systems:

The most important part of running a Hydrotherapy Pool is the maintenance of the pool hall environment.

A water temperature of 34 - 35°C is at the upper end of the range in which an in-situ Vinyl Liner will provide satisfactory service for at least 5 years and it is very important to ensure that this temeperature is not exceeded. Tiled pools will resist higher temperatures in theory but will double the initial cost of a hydrotherapy pool and the tiling will need to be regrouted in the same time frame.

III. HYDROTHERAPY LEGISLATION

Within the UK, it is the Health & Safety at Work Act 1974 that places a legal duty on pool operators to ensure a safe working environment and safe working practices.
They also have a Duty of Care to all those who use the facility, including those who are not lawfully entitled to use them such as trespassers. Should anyone be hurt or damaged as a result of non-compliance with the law, there will be an investigation which could lead to the prosecution of individuals and organisations, and the almost inevitable claim for compensation, for injuries or damages.
There are also several publications which have helped to interpret the requirements of the law, in relation to the operation of hydrotherapy pools.

Publications:

• Managing Health and Safety in Hydrotherapy pools - HSG 179, 2003, 3"‘ Edition, published by the HSE
• Hydrotherapy pool Water Treatment and Quality Standards in Pools and Spa Pools - Pool Water Treatment Advisory Group (PWTAG) 2009
• HSG282: the control of legionella and other infectious agents in spa-pool systems
• Guidelines for Safe Recreational Water Environments: Volume 2, Hydrotherapy pools and similar environments (World Health Organisation 2006)
• BS EN 13451-1. Swimming pool equipment. Part 1. General safety requirements and test methods
• BS EN 15288 - 1.2008: Swimming pools. Safety requirements for design
• BS EN 15288- 2:2008: Swimming pools. Safety requirements for operation

The hydrotherapy pool industry has adopted Managing Health & Safety in Swimming Pools HSG179 and the Pool Water Treatment Advisory Group publication Swimming Pool Water Treatment & Quality Standards in Pools and Spas as being the key authoritative texts and it will be found that most normal operating procedures and emergency action plans for hydrotherapy pools are based upon them.

IV. Hydrotherapy Pool Consultancy & Design Services

Bluepools provides specialist hydrotherapy pool design and consultancy services where new premises can be designed or existing pools brought up to current standards.