Nine-Hole Peg Test

 

Original Editor - Sinead Greenan

Top Contributors - Sinead Greenan, Kim Jackson, Scott Buxton, Evan Thomas, Oyemi Sillo, Chloe Waller, Admin, Naomi O'Reilly, WikiSysop and Amrita Patro

Objective

The Nine-Hole Peg Test (9HPT) is used to measure finger dexterity in patients with various neurological diagnoses.

Intended Population

Patients with Stroke, Brain Injury, Parkinson's, Multiple Sclerosis or other neurological conditions.

Example of the equipment

Method of Use

Equipment Required:

• Board (wood or plastic): with 9 holes (10 mm diameter, 15 mm depth), placed apart by 32 mm or 50 mm.
• A container for the pegs: square box (100 x 100 x 10 mm) apart from the board or a shallow round dish at the end of the board.
• 9 pegs (7 mm diameter, 32 mm length).
• A stopwatch.

Description:

• Instruct the patient to take the pegs from a container, one by one, and place them into the holes on the board, as quickly as possible, using only the hand being evaluated.
• Then, instruct the patient to remove the pegs from the holes, one by one, and replace them back into the container.
• The evaluator should start the stopwatch as soon as the patient touches the first peg.
• The evaluator should stop the stopwatch once the last peg is in the container.

Scoring:

• The number of seconds it takes for the patient to complete the test.
• Alternative scoring - the number of pegs placed in 50 or 100 seconds can be recorded. In this case, results are expressed as the number of pegs placed per second.

Example:

Evidence

Reliability

Test-retest Reliability:

Stroke:
(Chen et al, 2009, Acute and Chronic Stroke) 

• Excellent test-retest reliability for entire group (ICC = 0.85)
• Adequate test-retest reliability for individuals with hand spasticity (ICC = 0.64). Excellent test-retest reliability for individuals without hand spasticity (ICC = 0.86)

Parkinson's:

(Earhart et al, 2011) 

• Excellent test retest reliability (ICC = 0.88 for dominant hand and ICC = 0.91 for nondominant hand)

Healthy Adults:

(Wang et al 2011; n = 305; mean age = 32 (26); age range = 3 - 85 years) 

• Excellent test retest reliability (ICC = 0.95 for right hand, ICC = 0.92 for left hand)

Interrater/Intrarater Reliability:

Healthy Adults:

(Grice et al, 2003) 

• Excellent interrater reliability for the right hand (r = 0.984) and the left hand (r = 0.993)

Stroke:

(Heller et al, 1987; n = 56; mean age = 72 (9.9) years; assessed < 3 months post-stroke, Acute Stroke) 

• Adequate to excellent intrarater reliability (r = 0.68 to 0.99)
• Excellent interrater reliability (r = 0.75 to 0.99)

Cerebral Palsy:

(Mendoza-Sánchez et al, 2022)

• Excellent intra-rater inter-session reliability in patients with spastic unilateral CP

Validity

Criterion Validity:

Stroke:
(Sunderland et al, 1989; n = 38; mean age = 67, Acute Stroke) 

• Poor concurrent validity with Frenchay Arm Test: 27% of cases incorrectly classified
• Poor predictive validity: NHPT administered at 1 month did not predict functional outcomes at 6 months post stroke

Healthy Adults:
(Wang et al, 2011) 

• Adequate correlation with the Purdue Pegboard test (p = -0.74 to -0.75)
• Excellent correlation with the Bruininks-Oseretsky Test of Motor Proficiency (p = -0.87 to -0.89)

Myotonic Dystrophy:

(Cutelle et al, 2018)

• Found to be a reliable, valid and sensitive test of dexterity in Myotonic Dystrophy Type 1.

Construct Validity: 

Stroke:
(Parker et al, 1986; 2 weeks, 3 & 6 months post onset, Acute Stroke) 

• Excellent convergent validity with Motricity Index (r = 0.82)

Healthy children:

(Smith, Hong and Presson, 2000)

• Adequate concurrent validity for screening fine motor dexterity of school-age children.

Responsiveness

Stroke:

(Beebe and Lang, 2009, Acute Stroke) 

Responsiveness:
	1–3 months	1–6 months
Grip	0.50	0.65
Pinch	0.52	0.56
ARAT	0.55	0.63
9HPT	0.52	0.66
SIS-Hand	1.02	0.86

Responsiveness was calculated using the single population effect size method. Values closer to 1.00 = more responsive to change. Low responsiveness < 0.20; moderate responsiveness < 0.50, and high responsiveness < 0.80