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

Method of Use

Description:

• 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
• Participants must then remove the pegs from the holes, one by one, and replace them back into the container
• The board should be placed at the client's midline, with the container holding the pegs oriented towards the hand being tested
• Only the hand being evaluated should perform the test
• 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

Equipment Required:

• Board (wood or plastic): with 9 holes (10 mm diameter, 15 mm depth), placed apart by 32 mm (Mathiowetz et al, 1985; Sommerfeld et al., 2004) or 50 mm (Heller, Wade, Wood, Sunderland, Hewer, & Ward, 1987)
• 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)
• 9 pegs (7 mm diameter, 32 mm length) (Mathiowetz et al, 1985)
• A stopwatch

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, Healthy Adults) 

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

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)

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)

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

Links

Nine-Hole Peg Test