Nine Hole Peg Test (NHPT)

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Nine-Hole Peg Test (NHPT) in two different populations – healthy normal subjects and individuals with stroke. We identified seven. The results of these suggest that the NHPT may be a floor effects.

In a literature review, Croarkin, Danoff, and Barnes (2004) identified the level of evidence for nine upper extremity motor function tests. The level of evidence was established based on the total number of psychometric properties addressed in studies of each test. Compared to the Action Research Arm Test (Lyle, 1981), Chedoke-McMaster Stroke Assessment (Gowland, VanHullenaar, & Torresin et al., 1995), Fugl-Meyer Sensorimotor Assessment (Fugl-Meyer, Jääskö, Leyman, Olsson, & Steglind, 1975), Modified Motor Assessment Chart (Lindmark & Hamrin, 1988), Motor Assessment Scale (Carr, Shepherd, Nordholm, & Lynne, 1985), Motor Club Assessment (Ashburn, 1982), Motricity Index (Demeurisse, Demol, & Rolaye, 1980), and Rivermead Motor Assessment (Lincoln & Leadbitter, 1979), the NHPT was found to have the greatest number of psychometric properties supported, with studies on intra-rater reliability, inter-rater reliability, convergent validity and predictive validity.

Floor/Ceiling Effects

Jacob-Lloyd, Dunn, Brain, and Lamb (2005) examined the floor effect.

Sunderland, Trinson, Bradley, and Langton-Hewer (1989) examined the presence of a floor effect of 65% but decreased at the 6 month follow up. Note: no values were provided by the authors for the six month follow-up.

Reliability

NOTE: A number of the publications on reliability reviewed below used statistical analyses such as Pearson’s correlation coefficient that are not considered the analyses of preference for testing reliability and may artificially inflate reliability coefficients. Future studies should examine the reliability of the NHPT using Kappa statistics.

Test-retest
No studies were identified examining the test-retest reliability of the NHPT.

Intra-rater
Heller, Wade, Wood, Sunderland, Hewer, and Ward (1987) examined the intra-rater reliability of the NHPT, Frenchay Arm Test (Heller et al., 1987), Finger Tapping Rate (Lezak, 1983), and Grip Strength (Mathiowetz, Kashman, Volland, Weber, Dowe, & Rogers, 1985) in 10 patients with chronic stroke. Participants were re-assessed with a 2-week interval by the same rater. In this study, results describe the range of reliability of the four measures mentioned above, and values for each individual measure were not provided. Spearman rho correlation and statistically significant, suggesting that the NHPT may be reliable with stable stroke clients.

Mathiowetz, Weber, Kashman, and Volland (1985) examined the intra-rater reliability of the NHPT in 26 healthy female young adults. Participants were re-assessed with a 1-week interval by the same rater. The Pearson correlation agreement (r = 0.43) for the left.

Grice et al. (2003) reproduced the Mathiowetz et al. (1985) study in order to estimate the intra-rater reliability of the NHPT, after its design was slightly modified. In the Mathiowetz and associates’ study, the NHPT equipment was composed of a wooden board for the holes and a wooden square container for the pegs. The NHPT equipment was then modified to a plastic board with a shallow round dish as container, at the end of the board. Pearson correlation (r = 0.46; r = 0.44) for the right and left hand, respectively.

Inter-rater.
Heller et al. (1987) examined the inter-rater reliability of the NHPT, Frenchay Arm Test (Heller et al., 1987), Finger Tapping Rate (Lezak, 1983), and Grip Strength (Mathiowetz et al., 1985) in 10 patients with chronic stroke. Participants were assessed twice within a week by two different raters. Spearman rho correlation.

Mathiowetz et al. (1985) examined the inter-rater reliability of the NHPT in 26 healthy young female adults. Participants were evaluated simultaneously and independently by two raters. Pearson correlation agreement (r = 0.97; r = 0.99) for the right and left hand, respectively.

Grice et al (2003) reproduced Mathiowetz et al. (1985) study to estimate the inter-rater reliability of the new NHPT. Pearson correlation agreement (r = 0 .98; r = 0.99) for the right and left hand, respectively.

Validity

Content

Not available.

Criterion

Concurrent.
Sunderland et al. (1989) estimated the sensitivity of the NHPT, the Motor Club Assessment (Ashburn, 1982) and the Motricity Index (Demeurisse et al., 1980) by comparing them to the Frenchay Arm Test (Heller et al., 1987), as the gold standard, in 31 participants with acute stroke. The NHPT had the lowest sensitivity with 27% of the cases incorrectly classified. The most sensitive measure, with 0% of cases misclassified, was the Motricity Index (Demeurisse et al., 1980).

Lin, Chuang, Wu, Hsieh and Chang (2010) compared the Motor Activity Log (MAL) for evaluating dexterity.

Predictive.
Sunderland et al. (1989) examined whether the NHPT, Motor Club Assessment (Ashburn, 1982) and Motricity Index (Demeurisse et al., 1980) were able to predict functional outcomes at six months after stroke measured by the Frenchay Arm Test (Heller et al., 1987). Predictive validity of the NHPT was examined in 31 participants with acute stroke. Assessments were performed at four points in time: admission, 1, 3 and 6 months post-stroke. The NHPT administered at 1 month did not predict functional outcomes at 6 months. The best predictor of functional outcomes at 6 months was the Motricity Index (Demeurisse et al., 1980).

Construct

Convergent/Discriminant.
Parker, Wade, and Hewer (1986) tested the Motricity Index (r = 0.82).

Known groups.
No studies have examined known groups’ validity of the NHPT.

Responsiveness

Jacob-Lloyd et al. (2005) examined the effect size in this study, no reference values were provided. The NHPT was more likely to detect change than the Motricity Index (Demeurisse et al., 1980).

Lin, Chuang, Wu, Hsieh and Chang (2010) evaluated the SRM (0.64 0.79, 0.74 respectively), indicating sensitivity for detecting change in hand dexterity. When considering both the results of responsiveness and validation components of the study, the ARAT and BBT are believed to be more appropriate than the NHPT for evaluating dexterity.

References
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