Related scale:


	Subject of the scale: Impairment: prehension

Nine Hole Peg test (NHP)		Download / Print : PDF

The Nine Hole Peg Test is regularly used by therapists as a simple and rapid evaluation of dexterity [9].

The patient sits in front of a table and with one hand must place 9 pegs (9 mm in diameter and 32 mm long) in a wooden box containing 9 holes (10 mm in diameter and 15 mm deep).

The time required to perform this task is recorded, or if it is greater than 50 seconds, the number of pins placed is recorded.

The normal is 18 seconds for 9 pins. The unevaluated hand can be used to hold the frame, but not to place pins.

In general, this test can only be used for people with moderate partial deficits. It is not indicated in the initial phase of recovery from severe CNS lesions.

The purchase price of new equipment is between 100 and 150 Euros.

Performing the test takes less than 10 minutes, and no special training is required for the evaluator.

While the majority of studies are conducted in patients with vascular disease, 2 studies were conducted on multiple sclerosis patients [8, 14].

> Access to the scale is free

Criteria	Psychometric properties		References
Validity	Face validity
	Content validity
	Criterion validity	Concurrent validity	[6] [13]
		Predictive validity	[6] [10]
	Construct validity	Convergent validity	[4] [10]
		Divergent validity
		Discriminant validity (sensitivity and distinctiveness)	[8]
Reliability	Intra-rater reliability		[7] [8]
	Inter-rater reliability		[5] [7] [9] [10]
	Test-retest		[3] [9] [10] [12] [14]
Internal consistency (alpha)			[14]
Responsiveness			[2] [11] [13] [14]

General comment on reliability:

This is the only grip test with three psychometric criteria (inter judge reproducibility, validity and test -retest convergence/Concurrence) [10].
Internal consistency is high [14].
Excellent convergent validity with the Motricity Index [4].
Very good inter-judge reproducibility [9, 14], and moderate correlation [ 9] good [ 12, 14 ] between the scores of the subjects (test-retest).
The MDC (Minimal Change Detection, which is a statistical estimate of the smallest amount of change that can be detected by measuring, and representing a significant change) is high on the most affected side (32.8 s) [12].
It can detect an improvement in distance after patients have achieved a maximum score in the Frenchay Arm Test [5].
BBT and ARAT seem more appropriate for evaluating dexterity than the Nine Hole Peg Test but the sensitivity to change, which is moderate [1], is the same between the three tests. [13]

Reference update:

To notify us of a missing reference, please use: contact@scale-library.com

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Thibaud Honoré : honore.thibaud@gmail.com

References: Inaugural references: [1] Kellor M, Frost J, Silberberg N, Iversen I, Cummings R. "Hand strength and dexterity." Am J Occup Ther. 1971 Mar;25(2):77-83. Psychometric references: [2] Demeurisse G, Demol O, Robaye E. "Motor evaluation in vascular hemiplegia." Eur Neurol. 1980;19(6):382-9. [3] Mathiowetz V, Volland G, Kashman N, Weber K. "Adult norms for theNine Hole Peg Test of finger dexterity". Am J Occup Ther. 1985 Jun;39(6):386-91. [4] Parker VM, Wade DT, Langton Hewer R. "Loss of arm function after stroke: measurement, frequency, and recovery." Int Rehabil Med. 1986;8(2):69-73. [5] Heller A, Wade DT, Wood VA, Sunderland A, Hewer RL, Ward E. "Arm function after stroke: measurement and recovery over the first three months." J Neurol Neurosurg Psychiatry. 1987 Jun;50(6):714-9. [6] Sunderland A, Tinson D, Bradley L, Hewer RL. "Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator." J Neurol Neurosurg Psychiatry. 1989 Nov;52(11):1267-72. [7] Cohen JA, Fischer JS, Bolibrush DM, Jak AJ, Kniker JE, Mertz LA, Skaramagas TT, Cutter GR. "Intrarater and interrater reliability of the MS functional composite outcome measure." Neurology. 2000 Feb 22;54(4):802-6. [8] Erasmus, L. P., S. Sarno, et al. (2001). "Measurement of ataxic symptoms with a graphic tablet: standard values in controls and validity in Multiple Sclerosis patients." J Neurosci Methods 108(1): 25-37. [9] Oxford Grice K, Vogel KA, Le V, Mitchell A, Muniz S, Vollmer MA.. "Adult norms for a commercially available Nine Hole Peg Test for finger dexterity." Am J Occup Ther. 2003 Sep-Oct;57(5):570-3. [10] Croarkin E, Danoff J, Barnes C. "Evidence-based rating of upper-extremity motor function tests used for people following a stroke." Phys Ther. 2004 Jan;84(1):62-74. [11] Beebe JA, Lang CE. "Relationships and responsiveness of six upper extremity function tests during the first six months of recovery after stroke." J Neurol Phys Ther. 2009 Jun;33(2):96-103. doi: 10.1097/NPT.0b013e3181a33638. [12] Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL. "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair. 2009 Jun;23(5):435-40. doi: 10.1177/1545968308331146. Epub 2009 Mar 4. [13] Lin KC, Chuang LL, Wu CY, Hsieh YW, Chang WY."Responsiveness and validity of three dexterous function measures in stroke rehabilitation." J Rehabil Res Dev. 2010;47(6):563-71. [14] Rasova K, Martinkova P, Vyskotova J, Sedova M. "Assessment set for evaluation of clinical outcomes in multiple sclerosis: psychometric properties." Patient Relat Outcome Meas. 2012;3:59-70. doi: 10.2147/PROM.S32241. Epub 2012 Oct 11.

Finding a clinical assessment scale - Physical Medicine and Rehabilitation

Search by subject

Adult Child/Teenager

List of scales

Available scales and analyses
Click here

Goal Attainment Scaling (GAS)

Partnership

This work is supported by Ipsen

Report a missing scale


< Back	Subject of the scale: Impairment: prehension

Box and Blocks Test (BBT)		Download / Print : PDF

The BBT was created originally for adult patients with cerebral palsy, to be a measure of gross dexterity. This test was then validated in patients within the framework of a stroke, a CT, MS and other neurological disorders [5], such as Charcot Marie Tooth disease [14], and also in the elderly [7].

It has recently been evaluated in fibromyalgia [2].

This test was patented in 1957 by Patricia Buehler Holser and Elizabeth Fuchs.

It goes like this: The patient is seated at a table in front of him with a wooden box with 2 compartments of equal size (25 x 15 x 7.5 cm). At the beginning of the test, all coloured wooden cubes (150 in number, 2.5 cm edge) are placed in a compartment. The aim is to move the most cubes possible, cube after cube, from one compartment to another, in 60 seconds, and with one hand.
The examiner is opposite the patient.

The total score is the number of cubes located in the initially empty compartment. [1].

Norms in healthy [9] and healthy adult children were defined. And for adults under 50, the average score is higher than 80, between 50 and 70 years it is between 70 and 80, and for patients older than 70 years it is between 64 and 69 [1].

The total time for performing the test is less than 5 minutes. A complete kit costs about 250-300 Euros.

> Access to the scale is free

Criteria	Psychometric properties		References
Validity	Face validity
	Content validity
	Criterion validity	Concurrent validity	[3] [6] [8]
		Predictive validity
	Construct validity	Convergent validity	[7] [10]
		Divergent validity	[7] [10]
		Discriminant validity (sensitivity and distinctiveness)	[7] [10]
Reliability	Intra-rater reliability		[3]
	Inter-rater reliability		[4] [9] [10]
	Test-retest		[6] [7] [9] [10] [12]
Internal consistency (alpha)
Responsiveness			[3] [8]

General comment on reliability:

Very good inter-judge reproducibility [10] and high test-retest reliability [4, 7, 10, 12].
The BBT has a sensitivity to change ranging from high [3] to moderate [8] as well as excellent concurrent validity with the ARAT.
It can effectively evaluate the function of paretic MS [3].
The ARAT also seems more appropriate for evaluating dexterity than the Nine Hole Peg Test [8].
The significant correlations between the BBT, upper limb performance and functional independence measurements show the validity of BBT [7].
Also strong correlations with ARAT and FMA but different ceiling and floor effects between these 3 tests [10].
The MDC (Minimal Change Detection, which is a statistical estimate of the smallest amount of change that can be detected by measuring and representing a significant change) is quite high: for the most affected side, 5.5 cubes / min and the least affected side 7.8 cubes/min [4].
A literature review was performed [5] to examine the psychometric properties and clinical utility of various assessment tools of the upper limbs in people with motor disabilities of neurological origin in order to provide recommendations for practice. Of a total of 31 tools identified, only two measures meet the psychometric properties and clinical utility criteria: the BBT and ARAT.
Among fibromyalgia patients, the BBT is a reliable measurement of upper extremity function and is able to reveal a reduction of upper limb function in these patients compared to healthy individuals and standard scores [2].

Reference update:

To notify us of a missing reference, please use: contact@scale-library.com

Action Research Arm test (ARAT)

Arm Motor Ability Test (AMAT)

Nine Hole Peg test (NHP)

Wolf Motor Function Test (WMFT)

Fugl Meyer

For more details of the scale, the comments or the psychometric properties presented here, please contact Dr. Thibaud Honoré : honore.thibaud@gmail.com

Inaugural references:

[1] Mathiowetz V, Volland G, Kashman N, Weber K. "Adult norms for the Box and Block Test of manual dexterity." Am J Occup Ther. 1985 Jun;39(6):386-91.

Psychometric references:

[2] Canny ML, Thompson JM, Wheeler MJ. "Reliability of the box and block test of manual dexterity for use with patients with fibromyalgia." Am J Occup Ther. 2009 Jul-Aug;63(4):506-10.

[3] Chanubol R, Wongphaet P, Ot NC, Chira-Adisai W, Kuptniratsaikul P, Jitpraphai C. "Correlation between the action research arm test and the box and block test of upper extremity function in stroke patients." J Med Assoc Thai. 2012 Apr;95(4):590-7.

[4] Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL.. "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair. 2009 Jun;23(5):435-40. doi: 10.1177/1545968308331146. Epub 2009 Mar 4.

[5] Connell LA, Tyson SF. "Clinical reality of measuring upper-limb ability in neurologic conditions: a systematic review." Arch Phys Med Rehabil. 2012 Feb;93(2):221-8. doi: 10.1016/j.apmr.2011.09.015.

[6] Cromwell FS. "Occupational Therapist's Manual for Basic Skill Assessment; Primary Prevocational Evaluation". Altadena, CA: Fair Oaks Printing, 1976, pp 29-30c.

[7] Desrosiers J, Bravo G, Hébert R, Dutil E, Mercier L. "Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies." rch Phys Med Rehabil. 1994 Jul;75(7):751-5.

[8] Lin KC, Chuang LL, Wu CY, Hsieh YW, Chang WY. "Responsiveness and validity of three dexterous function measures in stroke rehabilitation." J Rehabil Res Dev. 2010;47(6):563-71.

[9] Paltamaa J, West H, Sarasoja T, Wikström J, Mälkiä E. "Reliability of physical functioning measures in ambulatory subjects with MS." Physiother Res Int. 2005;10(2):93-109.

[10] Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G. "Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study." Clin Rehabil. 2005 Jun;19(4):404-11.

[11] Smith DA. "The Box and Block Test: Normative Datafor 7, 8, 9 Year-Old Children (master's thesis)". Los Angeles: Univ of Southern California, 1961.

[12] Svensson E, Häger-Ross C. "Hand function in Charcot Marie Tooth: test retest reliability of some measurements." Clin Rehabil. 2006 Oct;20(10):896-908.