Full Length Article| Volume 35, ISSUE 3, P346-357, July 2022

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Characterizing response to a dynamic stability modeled approach for thumb carpometacarpal joint pain: A retrospective study

Published:August 01, 2022DOI:


      • Less pain and disability after hand therapy with a dynamic stabilization approach
      • Clients with unilateral thumb pain improved more than those with bilateral pain
      • Persons in early radiographic stages had more functional gains than late stages
      • Persons with higher pain levels improved more than those with lower pain levels


      Study Design

      Retrospective case series.


      Literature trends indicate that thumb dynamic stabilization may benefit clients with thumb carpometacarpal (CMC) joint pain and arthritis. There is minimal research investigating whether client characteristics predict responsiveness to hand therapy for thumb dynamic stabilization.

      Purpose of the Study

      1) To investigate how adults with thumb CMC joint pain responded to a hand therapy dynamic stabilization modeled intervention. 2) To determine if various client factors influenced responsiveness and to what extent.


      An electronic medical record search identified adults treated from August 2009 through December 2015 for thumb CMC joint pain. Radiographs were retrospectively staged. Outcome measures were 1) Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) total disability score and 2) Numerical Pain Rating Scale (NPRS). Paired t-tests were performed to compare pre and post treatment measures. Multivariate analyses were used to investigate predictive factors.


      A total of 249 charts were analyzed. Large overall significant effects were noted for disability score (QuickDASH P <.001, X = 12.1, Cohen's d = 0.9). The average improvement of 2.1 (SD = 2.6) points exceeded the minimal clinically important difference (MCID) of 1.7 points on the NPRS pain scale. Significant predictors of QuickDASH Scores were radiographic staging, bilateral hand involvement and initial pain ratings. Significant predictors for change in pain scores (meeting or exceeding the minimal clinically important difference for the NPRS) were bilateral thumb involvement and initial “pain at worst” rating.


      After completing hand therapy with a dynamic stabilization approach, clients had less pain and disability. Those who had unilateral thumb pain, or those who started with higher pain levels were most likely to have clinically meaningful improvements in pain. Clients in early CMC osteoarthritis (OA) stages responded better than those in later stages, indicating that early referral to therapy is important.



      MCID (minimal clinically important difference), NPRS (Numerical Pain Rating Scale), CMC (carpometacarpal), MP (metacarpophalangeal), AdP (adductor pollicis), OP (opponens pollicis), 1st DI (1st dorsal interosseous), EPB (extensor pollicis brevis), AE (adaptive equipment), JPE (joint protection education), IP (interphalangeal), APB (abductor pollicis brevis), APL (abductor pollicis longus)
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      JHT Read for Credit

      Quiz: # 869

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The study design is
        • a.
        • b.
        • c.
          case study
        • d.
          case series
      • # 2.
        Improvement scores
        • a.
          were significantly better using the NPRS than the QuickDASH
        • b.
          were not significant
        • c.
          met the criteria for MCID
        • d.
          exceeded all author expectations
      • # 3.
        Data were gathered from
        • a.
          chart reviews
        • b.
          patient interviews
        • c.
          therapist interviews
        • d.
          videography of therapy sessions
      • # 4.
        The clinical techniques of dynamic stabilizing were
        • a.
          alluded to, but not described in sufficient detail to allow clinical application
        • b.
          well described in order to be followed by readers of the article
        • c.
          based on the concepts of Mennell and Cyriax
        • d.
          based on the concepts of Colditz et al
      • # 5.
        The authors advocate for early hand therapy intervention
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.