Nine-Hole Peg Test

 

Original Editor - Sinead Greenan

Top Contributors - Sinead Greenan, Scott Buxton, Oyemi Sillo, Evan Thomas and Naomi O'Reilly

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 Disease

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[1]; Sommerfeld et al., 2004[2]) or 50 mm (Heller, Wade, Wood, Sunderland, Hewer, & Ward, 1987[3])
  • 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[4])
  • 9 pegs (7 mm diameter, 32 mm length) (Mathiowetz et al, 1985[5])
  • A stopwatch

Reference

Evidence

Reliability

Test-retest Reliability:

Stroke:
(Chen et al, 2009, Acute and Chronic Stroke) [6]

  • 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:

(Earhart et al, 2011) [7]

  • 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) [8]

  • 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) [9]

  • 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) [10]

  • 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) [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) [12]

  • 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) [13]

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

Responsiveness

Stroke:

(Beebe and Lang, 2009, Acute Stroke) [14]

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

Miscellaneous

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Links

Nine-Hole Peg Test

References

  1. Mathiowetz, V., Kashman, N., et al. "Grip and pinch strength: normative data for adults." Arch Phys Med Rehabil 1985 66(2): 69-74
  2. 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
  3. 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
  4. 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
  5. Mathiowetz, V., Kashman, N., et al. "Grip and pinch strength: normative data for adults." Arch Phys Med Rehabil 1985 66(2): 69-74
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  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. 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
  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. 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