Nine-Hole Peg Test: Difference between revisions

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== Objective<br>  ==
== Objective   ==


The '''Nine-Hole Peg Test''' (9HPT) is used to measure finger dexterity in patients with various neurological diagnoses.
The Nine-Hole Peg Test (9HPT) is used to measure finger [[Dexterity Tests|dexterity]] in patients with various [[Neurological Disorders|neurological]] diagnoses<ref>Stroke Engine. Nine Hole Peg Test. Available from: <nowiki>http://strokengine.ca/en/assessments/nine-hole-peg-test-nhpt/</nowiki> (Accessed 11/08/2022)</ref>.  


== Intended Population<br>  ==
== Intended Population   ==


Patients with Stroke, Brain Injury, Parkinson's Disease
Patients with [[Stroke]], [[Traumatic Brain Injury|Brain Injury]], [[Parkinson's]], [[Multiple Sclerosis (MS)|Multiple Sclerosis]] or other neurological conditions<ref name=":0">Shirley Ryan Ability Lab. Nine Hole Peg Test. Available from: <nowiki>https://www.sralab.org/rehabilitation-measures/nine-hole-peg-test</nowiki> (Accessed 11/08/2022)</ref>.
[[File:9-hole-pin-test.webp|thumb|Example of the equipment]]


== Method of Use  ==
== Method of Use  ==


<u>Description:</u>
<u>Equipment Required:</u>  


*Administered by asking the client to take the pegs from a container, one by one, and place them into the holes on the board, as quickly as possible
*Board (wood or plastic): with 9 holes (10 mm diameter, 15 mm depth), placed apart by 32 mm<ref name=":1">Mathiowetz, V., Kashman, N., et al. "Grip and pinch strength: normative data for adults." Arch Phys Med Rehabil 1985 66(2): 69-74</ref><ref>Sommerfeld, D. K., Eek, E. U., et al. "Spasticity after stroke: its occurrence and association with motor impairments and activity limitations." Stroke 2004 35(1): 134-139</ref> or 50 mm<ref name=":2">Heller, A., Wade, D. T., et al. "Arm function after stroke: measurement and recovery over the first three months." Journal of Neurology, Neurosurgery and Psychiatry 1987 50(6): 714-719</ref>.
*Participants must then remove the pegs from the holes, one by one, and replace them back into the container
*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<ref name=":3">Grice, K. O., Vogel, K. A., et al. "Adult norms for a commercially available Nine Hole Peg Test for finger dexterity." The American journal of occupational therapy 2003 57(5): 570-573</ref>.
*The board should be placed at the client's midline, with the container holding the pegs oriented towards the hand being tested
*9 pegs (7 mm diameter, 32 mm length)<ref name=":1" />.
*Only the hand being evaluated should perform the test
*A stopwatch.
*Hand not being evaluated is permitted to hold the edge of the board in order to provide stability
*Scores are based on the time taken to complete the test activity, recorded in seconds
*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
*Stopwatch should be started from the moment the participant touches the first peg until the moment the last peg hits the container




<u>Description:</u><ref name=":0" />
*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.


<u>Equipment Required:</u>


*Board (wood or plastic): with 9 holes (10 mm diameter, 15 mm depth), placed apart by 32 mm (Mathiowetz et al, 1985<ref>Mathiowetz, V., Kashman, N., et al. "Grip and pinch strength: normative data for adults." Arch Phys Med Rehabil 1985 66(2): 69-74</ref>; Sommerfeld et al., 2004<ref>Sommerfeld, D. K., Eek, E. U., et al. "Spasticity after stroke: its occurrence and association with motor impairments and activity limitations." Stroke 2004 35(1): 134-139</ref>) or 50 mm (Heller, Wade, Wood, Sunderland, Hewer, &amp; Ward, 1987<ref>Heller, A., Wade, D. T., et al. "Arm function after stroke: measurement and recovery over the first three months." Journal of Neurology, Neurosurgery and Psychiatry 1987 50(6): 714-719</ref>)
<u>Scoring:</u>
*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 (Grice et al, 2003<ref>Grice, K. O., Vogel, K. A., et al. "Adult norms for a commercially available Nine Hole Peg Test for finger dexterity." The American journal of occupational therapy 2003 57(5): 570-573</ref>)
*9 pegs (7 mm diameter, 32 mm length) (Mathiowetz et al, 1985<ref>Mathiowetz, V., Kashman, N., et al. "Grip and pinch strength: normative data for adults." Arch Phys Med Rehabil 1985 66(2): 69-74</ref>)
*A stopwatch


== Reference<br> ==
*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.
 
 
<u>Example:</u>{{#ev:youtube|kkyfI5OvfJo}}


== Evidence  ==
== Evidence  ==
Line 40: Line 43:
=== Reliability  ===
=== Reliability  ===


<u>Test-retest Reliability:</u>
<u>Test-retest Reliability:</u>
 
<u></u>''Stroke:''<br>(Chen et al, 2009, Acute and Chronic Stroke)&nbsp;<ref>Chen, H. M., Chen, C. C., et al. "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair 2009 23(5): 435-440</ref>  


<u></u>''Stroke:''<br>(Chen et al, 2009, Acute and Chronic Stroke)&nbsp;<ref>Chen, H. M., Chen, C. C., et al. "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair 2009 23(5): 435-440</ref>
*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)


*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 Disease:''
''Parkinson's:''


(Earhart et al, 2011)&nbsp;<ref>Earhart, G. M., Cavanaugh, J. T., et al. "The 9-hole PEG test of upper extremity function: average values, test-retest reliability, and factors contributing to performance in people with Parkinson disease." J Neurol Phys Ther 2011 35(4): 157-163</ref>
(Earhart et al, 2011)&nbsp;<ref>Earhart, G. M., Cavanaugh, J. T., et al. "The 9-hole PEG test of upper extremity function: average values, test-retest reliability, and factors contributing to performance in people with Parkinson disease." J Neurol Phys Ther 2011 35(4): 157-163</ref>  


*Excellent test retest reliability (ICC = 0.88 for dominant hand and ICC = 0.91 for nondominant hand)
*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)&nbsp;<ref>Wang, Y. C., Magasi, S. R., et al. "Assessing dexterity function: a comparison of two alternatives for the NIH Toolbox." Journal of Hand Therapy 2011 24(4): 313-320; quiz 321</ref>
''Healthy Adults:''
 
(Wang et al 2011; n = 305; mean age = 32 (26); age range = 3 - 85 years)&nbsp;<ref name=":4">Wang, Y. C., Magasi, S. R., et al. "Assessing dexterity function: a comparison of two alternatives for the NIH Toolbox." Journal of Hand Therapy 2011 24(4): 313-320; quiz 321</ref>  


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


<br>


<u>Interrater/Intrarater Reliability:</u><br>


<u>Interrater/Intrarater Reliability:</u><br>
<u></u>''Healthy Adults:''


<u></u>''Healthy Adults:''
(Grice et al, 2003)&nbsp;<ref name=":3" />  


(Grice et al, 2003, Healthy Adults)&nbsp;<ref>Grice, K. O., Vogel, K. A., et al. "Adult norms for a commercially available Nine Hole Peg Test for finger dexterity." The American journal of occupational therapy 2003 57(5): 570-573</ref>
*Excellent interrater reliability for the right hand (r = 0.984) and the left hand (r = 0.993)


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


''Stroke:''
''Stroke:''  
(Heller et al, 1987; n = 56; mean age = 72 (9.9) years; assessed &lt; 3 months post-stroke, Acute Stroke)&nbsp;<ref>Heller, A., Wade, D. T., et al.  "Arm function after stroke: measurement and recovery over the first three months." Journal of Neurology, Neurosurgery and Psychiatry 1987 50(6): 714-719</ref>


*Adequate to excellent intrarater reliability (r = 0.68 to 0.99)
(Heller et al, 1987; n = 56; mean age = 72 (9.9) years; assessed &lt; 3 months post-stroke, Acute Stroke)&nbsp;<ref name=":2" />
 
*Adequate to excellent intrarater reliability (r = 0.68 to 0.99)  
*Excellent interrater reliability (r = 0.75 to 0.99)
*Excellent interrater reliability (r = 0.75 to 0.99)
''Cerebral Palsy:''
(Mendoza-Sánchez et al, 2022)<ref>Mendoza-Sánchez S, Molina-Rueda F, Florencio LL, Carratalá-Tejada M, Cuesta-Gómez A. [https://pubmed.ncbi.nlm.nih.gov/35212827/ Reliability and agreement of the Nine Hole Peg Test in patients with unilateral spastic cerebral palsy]. Eur J Pediatr. 2022 Jun;181(6):2283-2290.</ref>
* Excellent intra-rater inter-session reliability in patients with spastic unilateral CP


=== Validity  ===
=== Validity  ===


<u>Criterion Validity:</u>
<u>Criterion Validity:</u>  


<u></u>''Stroke:''<br>(Sunderland et al, 1989; n = 38; mean age = 67, Acute Stroke)&nbsp;<ref>Sunderland, A., Tinson, D., et al. "Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator." British Medical Journal 1989 52(11): 1267</ref>
<u></u>''Stroke:''<br>(Sunderland et al, 1989; n = 38; mean age = 67, Acute Stroke)&nbsp;<ref>Sunderland, A., Tinson, D., et al. "Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator." British Medical Journal 1989 52(11): 1267</ref>  


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


''Healthy Adults:''<br>(Wang et al, 2011)&nbsp;<ref>Wang, Y. C., Magasi, S. R., et al. "Assessing dexterity function: a comparison of two alternatives for the NIH Toolbox." Journal of Hand Therapy 2011 24(4): 313-320; quiz 321</ref>


*Adequate correlation with the Purdue Pegboard test (p = -0.74 to -0.75)
''Healthy Adults:''<br>(Wang et al, 2011)&nbsp;<ref name=":4" />
 
*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)
*Excellent correlation with the Bruininks-Oseretsky Test of Motor Proficiency (p = -0.87 to -0.89)


<u>Construct Validity:</u>&nbsp;


''Stroke:''<br>(Parker et al, 1986; 2 weeks, 3 &amp; 6 months post onset, Acute Stroke)&nbsp;<ref>Parker, V. M., Wade, D. T., et al. "Loss of arm function after stroke: measurement, frequency, and recovery." Int Rehabil Med 1986 8(2): 69-73</ref><br>
''Myotonic Dystrophy'':
 
(Cutelle et al, 2018)<ref>Cutellè C, Rastelli E, Gibellini M, Greco G, Frezza E, Botta A, Terracciano C, Massa R. [https://pubmed.ncbi.nlm.nih.gov/30270126/ Validation of the Nine Hole Peg Test as a measure of dexterity in myotonic dystrophy type 1.] Neuromuscul Disord. 2018 Nov;28(11):947-951.</ref>
 
* Found to be a reliable, valid and sensitive test of dexterity in Myotonic Dystrophy Type 1.
 
<u>Construct Validity:</u>&nbsp;
 
''Stroke:''<br>(Parker et al, 1986; 2 weeks, 3 &amp; 6 months post onset, Acute Stroke)&nbsp;<ref>Parker, V. M., Wade, D. T., et al. "Loss of arm function after stroke: measurement, frequency, and recovery." Int Rehabil Med 1986 8(2): 69-73</ref><br>  


*Excellent convergent validity with Motricity Index (r = 0.82)
*Excellent convergent validity with Motricity Index (r = 0.82)
''Healthy children:''
(Smith, Hong and Presson, 2000)<ref>Smith YA, Hong E, Presson C. [https://pubmed.ncbi.nlm.nih.gov/10883762/ Normative and validation studies of the Nine-hole Peg Test with children.] Percept Mot Skills. 2000 Jun;90(3 Pt 1):823-43</ref>
* Adequate concurrent validity for screening fine motor dexterity of school-age children.


=== Responsiveness  ===
=== Responsiveness  ===


=== Miscellaneous<span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span><br>  ===
''Stroke:''


== Links  ==
(Beebe and Lang, 2009, Acute Stroke)&nbsp;<ref>Beebe, J. A. and Lang, C. E. "Relationships and responsiveness of six upper extremity function tests during the first six months of recovery after stroke." J Neurol Phys Ther 2009 33(2): 96-103</ref>


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
{| width="200" border="1" cellpadding="1" cellspacing="1"
<div class="researchbox">
|-
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
| colspan="3" | Responsiveness:
</div>
|-
|
| 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 &lt; 0.20; moderate responsiveness &lt; 0.50, and high responsiveness &lt; 0.80
== References  ==
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial]].
<references />


<references />
[[Category:Outcome_Measures]]
[[Category:Neurological - Outcome Measures]]
[[Category:Stroke]]
[[Category:Stroke - Outcome Measures]]
[[Category:Acquired Brain Injuries]]
[[Category:Parkinson's]]
[[Category:Occupational Health]]
[[Category:Head]]
[[Category:Head - Outcome Measures]]

Latest revision as of 15:55, 21 August 2022

 

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[edit | edit source]

The Nine-Hole Peg Test (9HPT) is used to measure finger dexterity in patients with various neurological diagnoses[1].

Intended Population[edit | edit source]

Patients with Stroke, Brain Injury, Parkinson's, Multiple Sclerosis or other neurological conditions[2].

Example of the equipment

Method of Use[edit | edit source]

Equipment Required:

  • Board (wood or plastic): with 9 holes (10 mm diameter, 15 mm depth), placed apart by 32 mm[3][4] or 50 mm[5].
  • 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[6].
  • 9 pegs (7 mm diameter, 32 mm length)[3].
  • A stopwatch.


Description:[2]

  • 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[edit | edit source]

Reliability[edit | edit source]

Test-retest Reliability:

Stroke:
(Chen et al, 2009, Acute and Chronic Stroke) [7]

  • 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) [8]

  • 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) [9]

  • 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) [6]

  • 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) [5]

  • 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)[10]

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

Validity[edit | edit source]

Criterion Validity:

Stroke:
(Sunderland et al, 1989; n = 38; mean age = 67, Acute Stroke) [11]

  • 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) [9]

  • 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)[12]

  • 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) [13]

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


Healthy children:

(Smith, Hong and Presson, 2000)[14]

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

Responsiveness[edit | edit source]

Stroke:

(Beebe and Lang, 2009, Acute Stroke) [15]

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

References[edit | edit source]

  1. ↑ Stroke Engine. Nine Hole Peg Test. Available from: http://strokengine.ca/en/assessments/nine-hole-peg-test-nhpt/ (Accessed 11/08/2022)
  2. ↑ 2.0 2.1 Shirley Ryan Ability Lab. Nine Hole Peg Test. Available from: https://www.sralab.org/rehabilitation-measures/nine-hole-peg-test (Accessed 11/08/2022)
  3. ↑ 3.0 3.1 Mathiowetz, V., Kashman, N., et al. "Grip and pinch strength: normative data for adults." Arch Phys Med Rehabil 1985 66(2): 69-74
  4. ↑ Sommerfeld, D. K., Eek, E. U., et al. "Spasticity after stroke: its occurrence and association with motor impairments and activity limitations." Stroke 2004 35(1): 134-139
  5. ↑ 5.0 5.1 Heller, A., Wade, D. T., et al. "Arm function after stroke: measurement and recovery over the first three months." Journal of Neurology, Neurosurgery and Psychiatry 1987 50(6): 714-719
  6. ↑ 6.0 6.1 Grice, K. O., Vogel, K. A., et al. "Adult norms for a commercially available Nine Hole Peg Test for finger dexterity." The American journal of occupational therapy 2003 57(5): 570-573
  7. ↑ Chen, H. M., Chen, C. C., et al. "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair 2009 23(5): 435-440
  8. ↑ Earhart, G. M., Cavanaugh, J. T., et al. "The 9-hole PEG test of upper extremity function: average values, test-retest reliability, and factors contributing to performance in people with Parkinson disease." J Neurol Phys Ther 2011 35(4): 157-163
  9. ↑ 9.0 9.1 Wang, Y. C., Magasi, S. R., et al. "Assessing dexterity function: a comparison of two alternatives for the NIH Toolbox." Journal of Hand Therapy 2011 24(4): 313-320; quiz 321
  10. ↑ Mendoza-Sánchez S, Molina-Rueda F, Florencio LL, Carratalá-Tejada M, Cuesta-Gómez A. Reliability and agreement of the Nine Hole Peg Test in patients with unilateral spastic cerebral palsy. Eur J Pediatr. 2022 Jun;181(6):2283-2290.
  11. ↑ Sunderland, A., Tinson, D., et al. "Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator." British Medical Journal 1989 52(11): 1267
  12. ↑ Cutellè C, Rastelli E, Gibellini M, Greco G, Frezza E, Botta A, Terracciano C, Massa R. Validation of the Nine Hole Peg Test as a measure of dexterity in myotonic dystrophy type 1. Neuromuscul Disord. 2018 Nov;28(11):947-951.
  13. ↑ Parker, V. M., Wade, D. T., et al. "Loss of arm function after stroke: measurement, frequency, and recovery." Int Rehabil Med 1986 8(2): 69-73
  14. ↑ Smith YA, Hong E, Presson C. Normative and validation studies of the Nine-hole Peg Test with children. Percept Mot Skills. 2000 Jun;90(3 Pt 1):823-43
  15. ↑ Beebe, J. A. and Lang, C. E. "Relationships and responsiveness of six upper extremity function tests during the first six months of recovery after stroke." J Neurol Phys Ther 2009 33(2): 96-103
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