UNIVERSITY OF MINNESOTA Program in Occupational Therapy Center for Allied Health Programs MMC 368, 516 Delaware Street, SE Minneapolis, MN 55455
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Grant Review Committee Office of the Vice President for Research Date: 9/14/17 Re: ‘Assistant Professor’ Grant-in-Aid proposal entitled, “Dynamic Stability Exercises for Women with Disabling Thumb Osteoarthritis: A Validation Study”. Dear Grant Review Committee: It is with great respect and humble optimism that I submit to you the grant-in-aid proposal entitled, “A Dynamic Stability Protocol for Women with Thumb Osteoarthritis: A Pilot Study”. This project and my line of study seek to improve the health of persons living with a decidedly prevalent and disabling form of osteoarthritis. The proposed project would involve the fluoroscopic validation of a protocolized intervention for women with thumb carpometacarpal osteoarthritis. This project expands on a retrospective study by O’Brien and Giveans (2013) and recent work of McGee et al. (2015) and is novel due to its prospective design and inclusion of fluoroscopy as measures of the underlying mechanisms of the intervention. The proposed project is partially supported by programmatic resources, a renowned hand orthopedist, a committed program director and experienced faculty, and a resource-rich research I university hospital and clinics. However, without additional funding, this project cannot be feasibly carried out. Efforts to support this project have been made in recent years through seeking support from both external and internal funders however were unsuccessful due to the absence of pilot data. Grant-in-Aid funding would enable me to gather the pilot data necessary to better justify to external funders the necessity of further study; including the need for prospective trials. I look forward to your decision. Sincerely,
Corey McGee, PhD, MS, OTR/L, CHT Assistant Professor Program in Occupational Therapy
Dynamic Stability Exercises for Women with Disabling Thumb Osteoarthritis: A Validation Study – McGee (PI)
1. Category Justification. PI in year two of tenure-track appointment in Occupational Therapy Program and seeking to build a research program on rehabilitation outcomes for women with musculoskeletal disorders. Early ‘mechanistic’ validation research is needed first yet PI has been unsuccessful in securing funding. RA and lab materials needed to conduct validation research. 2. Present Status of Knowledge 2.1 Background. Arthritis is our nation’s leading cause of disability1. Hand osteoarthritis (OA) affects an estimated 2.9 million U.S. residents, and 25% of women aged 60 to 70 years1. The thumb, accounting for 50% of hand function2, is afflicted by OA in 68% of persons between 71 and 80 years of age3. Thumb carpometacarpal (CMC) joint (Figure 1) OA is the most common and symptomatic form of hand OA, and a substantial source of hand dysfunction4. The demands on the thumb during pinch and grasp makes thumb CMC OA particularly debilitating5. Joint hypermobility is associated with the development of thumb OA. An incomplete dislocation of the joint (i.e., subluxation) is associated with this hypermobility, results in an incongruent joint, and subsequently results in Thumb CMC Joint the development of OA6. Non-operative approaches are the 7 first line of interventions for thumb CMC OA . The American College of Rheumatology recommends non-operative interventions for hand osteoarthritis including general hand exercises7 and the European League against Rheumatism’s (EULAR) task force on the management of hand osteoarthritis acknowledges the necessity of further investigation to “determine the most appropriate form or combination of exercise for the different subsets of hand Figure 1. Thumb CMC Joint. arthritis”8. Several researchers have investigated the effectiveness of hand strengthening in thumb OA. The “Dynamic Stability” protocol, a novel procedure designed by an occupational therapist 9 aims to improve thumb CMC stability through targeting select muscles previously demonstrated to instantaneously reduce joint instability in cadaveric and healthy thumbs10,11 . These mechanisms, however, have not been explored in those with thumb CMC OA.
Dynamic Stability Exercises for Women with Disabling Thumb Osteoarthritis: A Validation Study – McGee (PI) 2.2. Preliminary Data: This work builds from that of McGee et al.10. In this study, subluxation of the thumb CMC joint was temporarily created and radiographically confirmed in 32 non-arthritic hands though a noninvasive manipulation of the thumb joint. The First Dorsal Interosseous (FDI) muscle (Figure 2) of the manipulated hand was then maximally resisted as the subluxating force was sustained and the amount of subluxation was yet again measured radiographically (Figure 3). The findings illustrated a significantly large effect of FDI loading on subluxation [t(31)=10.6(
