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The 9-Hole Peg Test of Upper Extremity Function: Average Values, Test-Retest Reliability, and Factors Contributing to Performance in People With Parkinson Disease

Earhart, Gammon M. PT, PhD; Cavanaugh, Jim T. PT, PhD; Ellis, Terry PT, PhD, NCS; Ford, Matt P. PT, PhD; Foreman, K. Bo PT, PhD; Dibble, Lee PT, PhD, ATC

Journal of Neurologic Physical Therapy: December 2011 - Volume 35 - Issue 4 - p 157–163
doi: 10.1097/NPT.0b013e318235da08
Research Articles

Background and Purpose: Pegboard tests of hand dexterity are commonly used in clinical settings to assess upper extremity function in various populations. For individuals with Parkinson disease (PD), the clinical utility of pegboard tests has not been fully evaluated. Our purpose was to examine the commercially available 9-Hole Peg Test (9HPT) using a large sample of individuals with PD to determine average values, test-retest reliability, and factors predictive of 9HPT performance.

Methods: A total of 262 participants with PD (67% men, Hoehn & Yahr stage = 2.3 ± 0.7) completed the 9HPT along with a battery of other tests including the Movement Disorder Society Unified PD Rating Scale—Motor Subscale III and Freezing of Gait Questionnaire.

Results: Average time to complete the 9HPT was 31.4 ± 15.7 s with the dominant and 32.2 ± 12.4 s with the nondominant hand. Test-retest reliability of 2 trials performed with the same hand was high (dominant ICC2,1 = 0.88, nondominant ICC2,1 = 0.91). Women performed the test significantly faster than men, and nonfreezers significantly faster than freezers. For either hand, age, bradykinesia, and freezing of gait scores individually predicted significant portions of the variance in 9HPT time. Sex also was a significant predictor, but for the nondominant hand only. Tremor and rigidity did not predict performance.

Discussion and Conclusions: The 9HPT appears to be a clinically useful measure for assessing upper extremity function in individuals with PD. The 9HPT has advantages over previously used methods including standardization, known normative values for healthy controls, commercial availability, transportability, and ease of administration.

Program in Physical Therapy, Washington University in St Louis-School of Medicine, St Louis, Missouri (G.M.E.); Department of Physical Therapy, University of New England, Portland, Maine (J.T.C.); Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts (T.E.); Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham (M.P.F); and Department of Physical Therapy, University of Utah, Salt Lake City, Utah (K.B.F., L.D.)

Correspondence: Gammon M. Earhart, PT, PhD, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Blvd, St Louis, MO 63108 (

A portion of this work was presented as a poster at the World Parkinson Congress in September 2010.

This work was directly supported by grants from the Davis Phinney Foundation and the Parkinson's Disease Foundation. Additional support came from the Greater St Louis Chapter of the American Parkinson Disease Association (APDA), the APDA Center for Advanced PD Research at Washington University and the Utah Chapter of the APDA.

The authors declare no conflict of interest.

© 2011 Neurology Section, APTA