9-Hole Peg Test (9-HPT)
The 9-HPT is a brief, standardized, quantitative test of upper extremity function. It is the second component of the MSFC to be administered at each visit. Both the dominant and non-dominant hands are tested twice. The patient is seated at a table with a small, shallow container holding nine pegs and a wood or plastic block containing nine empty holes. On a start command when a stopwatch is started, the patient picks up the nine pegs one at a time as quickly as possible, puts them in the nine holes, and, once they are in the holes, removes them again as quickly as possible one at a time, replacing them into the shallow container. The total time to complete the task is recorded. Two consecutive trials with the dominant hand are immediately followed by two consecutive trials with the non-dominant hand.
Administration time will vary depending upon the ability of the patient. Total administration time should be approximately 10 minutes or less.
The 9-HPT is administered in person by a trained examiner. The examiner need not be a physician or nurse.
The score for the 9-HPT is an average of the four trials. The two trials for each hand are averaged, converted to the reciprocals of the mean times for each hand and then the two reciprocals are averaged. This score can be used individually or used as part of the MSFC composite score.
In clinical studies of MS, assessment of gait has generally had a more prominent role than assessment of arm and hand function. However, in recent years, there has been increasing recognition of the usefulness of measuring arm and hand function in clinical studies, especially in patients with severe disability. In the last few years, the 9-HPT has been one of the most frequently used measures of upper extremity function in MS. The 9-HPT provides a brief, standardized approach to assessment and can be administered by a wide variety of trained examiners.
The 9-HPT has high inter-rater reliability and good test-retest reliability. There is evidence for concurrent and convergent validity as well as sensitivity to detect minor impairments of hand function. Performance on the 9-Hole Peg Test may be sensitive to practice effects, that is, patients often display poorer performance when first tested due to lack of familiarity with the task. It is recommended that three or four administrations be given prior to a baseline assessment if accurate (rather than comparative) assessments of change over time are needed.