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Evaluating a new test for hand and arm function

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Summary

Hand and arm function is vital for many daily activities but is often overlooked in clinical trials for new drug treatments, particularly for progressive MS.

The nine hole peg test (9HPT) is the gold standard used to assess hand and arm function. Researchers have developed a low cost and recyclable cardboard version which could be used by people at home to monitor their manual dexterity. Before the cardboard version could be widely used it was important to test whether it generated scores which were comparable to those produced using the conventional plastic version.

177 volunteers took part in the study, 68 without MS and 109 with MS at different degrees of disability. Volunteers carried out two tests of the 9HPT with their dominant hand and two with their non-dominant hand using both plastic and cardboard versions. Time taken to complete the test was compared.

People completed the cardboard test slightly faster; the average time taken to complete the cardboard test was 24.58 seconds compared to 26.03 for the plastic test. Analysis of the results found that peoples' performance on the two versions were very similar. The cardboard version gave smaller variation between an individual's first and second attempt.

Two thirds of the volunteers with MS preferred using the cardboard version. The researchers concluded that the cardboard version is at least equivalent to the plastic version and could be used at home to monitor hand and arm function within a clinical trial or to allow people to track how their MS changes over time.


Background

Hand and arm function is vital for many daily activities such as cleaning your teeth, writing a birthday card, peeling an orange or closing the curtains. Manual dexterity is often overlooked in clinical trials of new disease modifying treatments, yet for many people with MS, being able to use their arms and hands is at least as important as walking ability.  The development of the cardboard version of the nine hole peg test is part of a campaign to draw more attention to upper limb function as a key measure of the effectiveness of new treatments for progressive MS.

The nine hole peg test (9HPT) is the gold standard widely used in clinics to assess hand and arm function. A plastic version is routinely used but is relatively expensive, is not environmentally friendly and the plastic pegs are slippery. UK researchers have developed a low-cost cardboard version which could be distributed widely to allow people to self-monitor their manual dexterity at home. This study was designed to test whether the cardboard version generated results which were comparable to those produced using the conventional plastic version.

How this study was carried out

177 volunteers, 68 without MS and 109 with MS at different stages carried out the 9HPT. In this test, you sit at a table with a small, shallow container holding nine pegs and a block containing nine empty holes. You are asked to pick up the nine pegs, one at a time, as quickly as possible, put them in the nine holes and, once they are in the holes, remove them again as quickly as possible one at a time, replacing them into the shallow container. The total time to complete the task is recorded. You can watch a video of the test.

Each volunteer carried out two tests of the 9HPT with their dominant hand and two with their non-dominant hand using both plastic and cardboard versions.

What was found

People completed the cardboard test slightly faster; for people with MS the average time to complete the cardboard test was 28.61 seconds versus 30.47 for the plastic version; for people without MS, average for the cardboard version was 18.35 compared to 19.19 for the plastic versions. Analysis of the results found that an individual's performance on the two versions were very similar. There was less variation between an individual's first and second attempt using the cardboard version compared to first and second attempts using the plastic version.

Two thirds of the volunteers with MS preferred the cardboard version. Users found the wooden pegs easier to grasp and manipulate and the cardboard tray easier to use. There is a tendency to knock the pegs from the bowl in the plastic version, which slows down the performance of the test.

What does it mean?

The results show that the cardboard version of the 9HPT is at least equivalent to the plastic version and is actually preferred by the majority of users. The researchers concluded that they had achieved their goal of developing a low-cost, recyclable and environmentally-friendly alternative to the plastic nine hole peg test.

Dubuisson N, et al.
Validation of an environmentally-friendly and affordable cardboard 9-hole peg test
Multiple Sclerosis and Related Disorders 2017;17:172-176
Abstract 

More about the nine hole peg test and monitoring your MS

Why is the 9HPT such a good test of hand and arm function? To perform the 9HPT you need (1) upper limb strength to move the hand, (2) vision to locate the pegs, (3) depth perception to accurately judge picking-up and placing the pegs, (4) sensation to feel and grasp the pegs and (5) coordination to complete the movements smoothly.

The cardboard version of the nine hole peg test is now available to purchase and has been incorporated into a resource to monitor your MS over time. Two further tests are included in the resource: an online EDSS self-assessment and timed 25ft walk.

MS is a variable condition and when you see your nurse or neurologist for a check-up or review, they are only seeing how you are on that particular day. Any tests or assessments that are done are usually short and they are done in a clinic setting, so they don't necessarily reflect how you might complete a test in day to day life. Carrying out tests periodically at home could provide valuable additional information about fluctuations in your MS symptoms. You might also find it helpful to see how your own MS changes in response to different factors, such as activity levels, stress or diet or at different times of the year.

You could keep a diary containing doses of treatments, symptoms experienced and their impact, activities undertaken that seem connected to symptoms, appointments and questions to ask. Alternatively you could keep a more informal series of notes in a notebook with a brief description of anything you particularly want to remember, such as experiencing a new symptom, or something that made a symptom worse or better.

There are also phone apps available that can help you to monitor symptoms and enable you to share this information with your MS team. A number of different ones are available with features including interactive symptom trackers, logs for factors which could make symptoms worse such as weather, the ability to record medication and set reminders for taking them. The SymTrac app is one example and it is specific for MS. Other more generic apps are also available which help you track any health condition.

You can read more about keeping a symptom diary in the A to Z of MS. Or you can read, download or order a printed copy of the book MS and Me: a self-management guide to living with MS. This book helps you learn more about your own MS and find the most effective ways to manage it.

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