CHAPTER 46: NINE HOLE PEG TEST (NHPT)

Description

The Nine Hole Peg Test (NHPT) is commonly used measure of finger dexterity that is a relatively quick standardized assessment designed to quantify the manual dexterity of an individual. During assessment the subject is asked to place pegs into holes on a specially designed board. The standardized equipment consists of 9 pegs (7-mm diameter, 32-mm length), a 100 cm x 100 cm x 10 cm container for the pegs, and a wooden board slightly smaller than the container with 9 holes evenly spaced and slightly wider than the pegs to be placed 32 mm apart. During assessment the subject is asked to pick up the pegs one at a time and put them into the holes as fast as possible using only one hand and starting with the unaffected hand or, if not affected on either side, with the dominant hand (Sommerfeld, Eek, Svensson, Widén Holmqvist, & von Arvin, 2004). The assessment typically takes less than 5 minutes to complete with the actual test taking less than 2 minutes. The person is scored on how fast it takes to complete the task. Several activities can be measured as well, such as the placement of pegs in, putting pegs both in and out, and how many pegs placed within a set time (i.e., 50 seconds or 100 seconds).

Psychometrics

A study by Mathiowetz, Weber, Kashman, and Volland (1985) found very high inter-rater reliability for the right hand (r = 0.97) and for the left (r = 0.99) from a cohort of 26 female occupational therapy students; however, test-retest reliability was reported to be only moderate (r = 0.69; right and r = 0.43; left). Concurrent validity of the NHPT was also explored with the Purdue Pegboard Test where observed correlations were r = –0.61 right and r = –0.53 left. An analogous designed study by Oxford-Grice et al. (2003) produced similar results from a cohort of 26 occupational therapy students with very high inter-rater reliability (r = 0.98; right and r = 0.99; left), whereas test–retest reliability produced only low to moderate coefficients for both the right and left hand at r = 0.46 and r = 0.44, respectively. A study of 262 individuals with Parkinson’s disease (PD) found that the average time to complete the NHPT was 31.4 ± 15.7 seconds with the dominant hand and 32.2 ± 12.4 seconds with the non-dominant hand (Earhart et al., 2011). The same study found test-retest reliabilities to be high also (r = 0.88; dominant and r = 0.91; non-dominant) and that performance times were generally better among participants at Hoehn and Yahr Stage 1 relative to those at more advanced stages, and on average, people with PD took approximately 50% longer than healthy adults to complete the battery (Earhart et al., 2011). Gender (W) was also found to be a significant predictor, but for the non-dominant hand only (Earhart et al., 2011). Normative data from a cohort of 618 subjects aged 20 to 94 years established by Mathiowetz et al. (1985) demonstrated a high correlation between NHPT scores and age with the 20- to 24-year-old age group producing the best scores and those in the 75-years-old or older age group producing the worst, supporting the theory that dexterity gradually decreases with age. Outcomes also found that females performed slightly better than males and right-hand scores were typically better than left-hand scores. Normative data from the 2003 study by Oxford-Grice et al. of 703 subjects aged 21 to 70 years or older discussed earlier generally supports those conclusions, and as expected, a high correlation was found between performance on the NHPT and age (for males at r = 0.91; right hand, r = 0.92; left hand and females: r = 0.89; right hand and r = 0.90; left hand).

Advantages

There is a good amount of research in support of its use in clinical practice and the test can be administered throughout the adult age range as well as for a number of conditions in which hand/finger dexterity is of concern. No special training is needed and the time to complete is less than 5 minutes. The NHPT is a standardized tool with well-established norms that is commercially available and is portable for use in a variety of settings and is relatively inexpensive.

Disadvantages

There are several different commercial versions of the test available on the market and some researchers have found statistical differences in performance times between these various versions.

Administration

The NHPT has standardized instructions for the clinician to follow as well as score interpretations located in the examiner’s manual. During assessment, the subject is asked to complete various tasks related to the placing and removing of pegs from the recessed container at the bottom portion of the board. Results are expressed in correct placements/removal as well as time in seconds.

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