{
  "resourceType": "ActivityDefinition",
  "id": "thumb-putty-program",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/thumb-putty-program",
  "version": "1",
  "name": "ThumbPuttyProgram",
  "title": "Comprehensive Thumb Putty Program",
  "status": "draft",
  "experimental": true,
  "description": "Therapy putty program targeting thumb opposition, abduction, adduction, and pinch strength. Ottawa Panel: 46 grade A recommendations for ROM + isotonic + isometric + functional exercise. Hand exercises reduce short-term pain (SMD -5.0) and improve grip strength (21 lbs). Minimum 12 weeks for sustained benefit.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "thumb-putty-program",
          "display": "Comprehensive Thumb Putty Program"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hand",
          "display": "Hand"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "782474003",
          "display": "Structure of ligament of first carpometacarpal joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "56310002",
          "display": "Structure of metacarpophalangeal joint structure of thumb"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "56103003",
          "display": "Structure of collateral ligaments of metacarpophalangeal joints"
        }
      ],
      "text": "Hand"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3x/week minimum, 12 weeks for sustained benefit. Progress putty resistance by color. Modified Borg moderate-to-somewhat-hard [Brosseau 2018, Lamb 2015]"
    }
  ],
  "usage": "Evidence: strong. CMC OA: short-term pain reduction SMD -5.0, grip strength improvement 21 lbs [Thakker 2025]. Ottawa Panel: 46 grade A recommendations [Brosseau 2018]",
  "note": [
    {
      "text": "Quiet wrist, isolated thumb — thenar muscles drive each task",
      "authorString": "focus:internal"
    },
    {
      "text": "Press the thumb pad into the putty against each fingertip",
      "authorString": "focus:external"
    },
    {
      "text": "Squeeze the putty into the shape of a small ball",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on thenar eminence to confirm activation",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Digitorum Superficialis"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "89895007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Opponens Pollicis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "79727005"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Abductor Pollicis Brevis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "32573001"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Adductor Pollicis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "60114005"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Pollicis Brevis"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "20588008"
          }
        }
      ]
    }
  ]
}