Nine Hole Peg Test (NHPT)

Nine Hole Peg Test (NHPT) Evaluation Summary
  What does the tool measure? Finger dexterity.
  What types of clients can the tool be used for? The NHPT can be used with, but is not limited to clients with stroke.
There are no restrictions when administering it to clients with chronic stroke. With clients with acute stroke the mode of scoring should be observed in order to avoid floor effects.
  Is this a screening or assessment tool? Assessment
Time to administer The amount of time it takes to administer the NHPT has not been reported and it will vary according to the client’s impairment or the mode of scoring.
  Versions There are no alternative versions.
Other Languages There are no official translations.
Measurement Properties
  Reliability – No studies have examined the internal consistency of the NHPT.
– Three studies have examined the intra-rater reliability of the NHPT. Both reported excellent intra-rater reliability and one reported adequate intra-rater reliability using correlation coefficients. One study used Spearman rho and the two others, Pearson correlation.
– Three studies have examined the inter-rater reliability of the NHPT and reported excellent inter-rater reliability using correlation coefficients. One study used Spearman rho and the two others, Pearson correlation.
  Validity

Criterion:
Concurrent:
Two studies have examined the concurrent validity of the NHPT. The first study examined the sensitivity of the NHPT comparing it to the Frenchay Arm Test as the gold standard and reported that NHPT has a low sensitivity, with 27% of misclassified results. The second study examined the concurrent validity of the NHPT and reported adequate to excellent correlation with the Box and Block Test (BBT) and the Action Research Arm Test (ARAT) at pre and post-treatment.

Predictive:
One study has examined predictive validity and reported that NHPT is not able to predict functional outcomes after six months of stroke.

Construct:
Convergent:
One study has examined convergent validity of the NHPT and reported excellent correlations between the NHPT and the Motricity Index using Pearson correlation coefficients.

  Floor/Ceiling Effects Two studies have examined floor effects of the NHPT. In both studies, clients were scored based on a cutoff of 50 or 100 seconds. Participants not able to complete the test within this time were scored as 0. In both studies, at earlier phases of the stroke, floor effects were poor or adequat. After six months of stroke the floor effects were adequate.
  Does the tool detect change in patients? Two studies have examined the ability to detect change of the NHPT and reported that the NHPT is able to detect change.
  Acceptability The NHPT should not be used clients with severe upper extremity impairment and those who are not able to pick up the pegs.
Feasibility

The administration of the NHPT is quick and simple, however it requires standardized equipment.

One study has examined the feasibility of the NHPT and reported that, on average, 52% of clients with acute stroke were not able to perform the NHPT (Jacob-Lloyd et al., 2005).

How to obtain the tool? The NHPT instructions can be obtained in the study by Mathiowetz et al., (1985). Also, a version of the measure can be obtained from the publication by Wade (1992).
Davis et al. (1999) reported the most used standardized equipments for NHPT in the United States are produced by Smith and Nephew Rehabilitation, Inc. and Sammons Preston.

Standardized equipment can be obtained at the website:
http://www.sammonspreston.com/Supply/Product.asp?Leaf_Id=A8515