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Subject of the scale: Impairment: prehension

Nine Hole Peg test (NHP)


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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].

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Psychometric properties:


Psychometric properties



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)



Intra-rater reliability

[7] [8]

Inter-rater reliability

[5] [7] [9] [10]


[3] [9] [10] [12] [14]

Internal consistency (alpha)



[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]

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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.

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