Tdah Adulto

Adult Nonns For The Nine Hole Peg
Test OfFinger Dexterity
Virgil Mathiowetz
Karen Weber
Nancy Kashman
Gloria Volland
The purposes of this study were to establish standardized

procedures for the Nine Hole Peg Test offinger dexterity, to
evaluate its reliability and validity, and to establish new
clinical norms based on these standardized procedures. For
the reliability and validity study, 26 female occupational
therapy students were tested Very high interrater reliability
(right r = .97, left r = .99) was found Test-retest reliability
was reported to be moderate to high (right r = .69, left r =
.43) and a significant practice effect uas found between the
Virgil Mathiowetz, MS, OTR, is Assistant Professor, Occupational Therapy Pro-

gram, University ofWisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI 53201.
Karen Weber, OTR, is staff occupational therapist, Sacred Heart Rehabilitation
Hospital, Milwaukee.
Nancy Kashman, OTR,is staff occupational therapist, Milwaukee County Mental
Health Complex, Milwaukee.
Gloria Volland, OrR, is Director of Occupational Therapy, River Hills West Health
Care Center, Pewaukee, WI.
Key Words: motor skills. occupational therapy evaluation. motor coordination • hand evaluation
Licenciado para - Lilian Queiroz Frossard - Protegido por Eduzz.com

Downloaded from otj.sagepub.com at Bobst Library, New York University on May 19, 2015
THE OCCUPATIONAL THERAPY JOURNAL OF RESEARCH 5:1 25
test and retest occasions. Possible variables that may have

affected these results are discussed To evaluate concurrent
validity, theNine HolePeg Test was compared to thePurdue
Pegboard The observed correlations (right r = -.61, left
r = -.53) indicated that the tests aresimilar but not equiv-
alent tests offinger dexterity. For the normativedata study,
628 normal subjects from 20 to 94 years were tested Data
were stratified by sex and by 12 age groups to allow the
therapist to easily compare patients' scores to a normative
population. Data showed thatfemales scored slightly better
than males, finger dexterity decreased with age, and right-
hand and left-handdominant subjects demonstrated mini-
mal differences in performance.
The Nine Hole Peg Test is commonly used by occupational therapists as

a quick measurement of finger dexterity. A relatively inexpensive con-
struction cost and brief administration time may account for its wide-
spread use. Only one published report on the Nine Hole Peg Test was
found (Kellor, Frost, Silberberg, Iversen, & Cummings, 1971). That study
used a sample of 250 males and females, stratified by sex and three large
age groups. Normative data based on regression analysis were provided
for 20- to 80-year-old adults in 5-year intervals. The norms were presented
in tabular form, facilitating comparison of patient scores with normal
individuals of the same age and sex. A description of the pegs and peg-
board was provided, but the container for the pegs was not described in
sufficient detail to be replicated. The general procedure for testing was
described, but there were no standardized instructions reported. In addi-
tion, no reliability or validity data were reported in the article. Due to
these limitations, the validity of the Nine Hole Peg Test and its available
norms were seriously compromised.
An alternative measurement of finger dexterity is the Purdue Pegboard,
which has been standardized for factory workers in a wide variety of
industrial jobs. Reliability and validity data have been reported, and nor-
mative data have been established for various employee groups (Tiffin,
1968) and school children (Gardner & Broman, 1979). Unfortunately,
normative data are lacking for a general adult population. For clinicians,
perhaps the most obvious limitations of the Purdue Pegboard is that the
normative data for factory workers poorly represent the older adults seen
in most physical disabilities clinics. In addition, the test in its entirety is
somewhat lengthy to administer.

26 MATHIOWETZ, WEBER, KASHMAN, VOLLAND
Another standardized test of dexterity is the ]ebsen Test of Hand Func-

tion (jebsen, Taylor, Trieschmann, Trotter, & Howard, 1969). This tool
uses a wide variety of functional hand activities to assess dexterity. ]ebsen
and colleagues provided data on 360 normal subjects and several patient
groups. While reliability data were reported for patient groups, they were
not presented for the normal population. Mean times and standard devia-
tions for normal subjects are presented in two large groups (ages 20-59
and 60-94) on all test items. However, to facilitate clinical comparisons,
a more detailed breakdown of the data by age is needed (Agnew & Mass,
1982). In view of the described weaknesses of these dexterity tests, a
reliable and valid test with useful norms would be of considerable value
to therapists.
From a clinical viewpoint, the Nine Hole Peg Test is a simple, quick
test of finger dexterity. Easy to decipher norms have been established by
Kellor et al. (1971); however, further research is needed to determine
the test's reliability and validity. Therefore, the purpose of this study was
( 1) to establish standardized procedures for the administration of the
Nine Hole Peg Test, (2) to evaluate its interrater and test-retest reliability,
(3) to assess concurrent validity, and ( 4) to establish clinical norms for
interpretation of Nine Hole Peg Test results.
Description of the Test

The Nine Hole Peg Test (Figure 1) consists of a square board with 9 holes,
spaced 3.2 em ( 1 V4 in.) apart measured center to center. Each hole is 1.3
em (112 in.) deep and is drilled with a .71 em (%2 in.) drill bit. The 9
wooden pegs are .64 cm (V4 in.) in diameter and 3.2 em (1 V4 in.) in
length. The container for the pegs was designed to be more stable than
the saucedish suggested by Kellor et al. (1971) and to additionally serve
as a container for the test. The container was constructed from .7-cm
(Ikin.) plywood. The sides were attached to the outside of the base ( 13
cm x 13 em) using nails and white glue. After sanding, a coat of varnish
was applied to the pegboard and container. Self-adhesive bathtub ap-
pliques were attached to the bottom of the pegboard and the container
to decrease slippage.
Test Procedures and Instructions

The pegboard was centered in front of the subject, with the pegs placed
in the container next to the board on the same side as the hand being

THE OCCUPATIONAL THERAPYJOURNAL OF RESEARCH 5:1 27
o 1
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1
Figure 1 Construction drawing for the Nine Hole Peg Test (cm)

Figure 2 The Nine Hole Peg Test being administered to a subject

tested (Figure 2). The dominant hand was tested first. The following
instructions were given to the subject as the examiner briefly demon-
strated the test:
Pick up the pegs one at a time. using your right (or left) hand only and put them into the holes
in any order until all the holes are filled. Then remove the pegs one at a time and return them to
the container. Stabilize the peg board with your left (or right) hand. This is a practice test. see how
fast you can put all the pegs in and take them out again. Are you ready? Go'
After the subject completed the practice trial, the examiner then said:
This will be the actual test. The instructions are the same. Work as quickly as you can. Are you
ready? Go' [During the test] "Faster." [Assoon as the last peg is in the board] "Out again ... faster."
The stopwatch was started by the examiner as soon as the subject

touched the first peg and stopped when the last peg hit the container.
The container was then placed on the opposite side of the pegboard. The
test was repeated in the same way for the nondominant hand.
Subjects and Procedures

Reliability and Validity Study. Twenty-six occupational therapy
students volunteered for this study. All subjects were females, and their
ages ranged from 20 to 39, with the mean age being 25. Screening criteria
for subjects included no previous history of neuromuscular or ortho-
paedic dysfunction that would significantly affect dexterity.
Design. To establish interrater reliability, during the initial testing
two examiners were present and each independently timed and recorded
the Nine Hole Peg Test scores. To determine test-retest reliability, an
initial test and a follow-up test were conducted for all subjects within a
l-week period. To establish concurrent validity, each subject performed
the right-hand and left-hand subtests of the Purdue Pegboard during either
the initial or follow-up testing. The Purdue Pegboard was administered
according to the standardized procedures (Tiffin, 1968). The right-hand
and left-hand subtests of the Purdue Pegboard were selected because they
appeared to be similar to the Nine Hole Peg Test.
Normative Study. This study included 618 volunteers (310 males
and 318 females) age 20 to 94 years. Subjects were solicited at shopping
centers, fairs, senior citizen centers, a rehabilitation center (staff), and the
university. All sites were within the seven-county Milwaukee area, which
includes urban, suburban, and rural areas. Therefore, it was assumed that
a broad range of socioeconomic and occupational groups were obtained.
Male and female subjects were divided into 12 age groups (Table 1) with
5-year intervals, with the exception of the 75 + age group. All subjects

Table 1
Characteristics of Subjects: Age, Sex, and Hand Dominance
Males Females
Age Range N Mean Age Right" Left" N Mean Age Right" Left"
20-24 29 21.7 26 3 26 22.4 26 0
25-29 27 27.4 21 6 27 26.6 25 2
30-34 27 32.1 24 3 26 32.1 23 3
35-39 25 37.3 24 I 25 36.4 17 8
40-44 26 41.5 22 4 31 42.3 30 I
45-49 28 47.1 28 0 25 47.1 25 0
50-54 25 51.9 25 0 25 51.9 22 3
55-59 21 57.1 21 0 25 56.5 25 0
60-64 24 62.1 22 2 25 62.4 24 1
65-69 27 66.7 27 0 28 67.3 25 3
70-74 26 72.0 23 3 29 71.8 28 1
75+ 25 78.9 25 0 26 78.8 25 1
Total 310 288 22 318 295 23
"Right-hand or left-hand dominance.
from 20 to 59 years of age were free from disease or injury that could
affect their dexterity. The following less stringent criteria were followed
for subjects over age 60: (1) no acute pain present in their arms and
hands; (2) at least 6 months post-hospitalization (i.e., heart attack or any
surgery); (3) maintained a normal lifestyle (i.e., subject had not had
restricted activity level because of a health problem). Consequently, peo-
ple with degenerative joint disease who were not currently experiencing
pain and who were maintaining their normal activity level were included
in this study. The rationale for using these less stringent criteria is that
people of this age group frequently have some chronic health problems
(jack & Ries, 1981).
A brief interview preceded all the testing procedures to determine if
subjects met the above criteria. The subject's name, age, sex, hand dom-
inance, and occupation were recorded. Hand dominance was determined
by asking, "Are you right-handed or left-handed?" If the subject reported
they used both hands equally, the hand used to write was determined to
be the "dominant" hand. This study was part of a larger study of hand
strength and dexterity (Mathiowetz, Kashman, Volland, Weber, Dowe, &
Rogers, in press; Mathiowetz, Volland, Kashman, & Weber, in press). The
Nine Hole Peg Test was the first test administered in a series of tests. It
was followed by a test of manual dexterity, the Box and Block Test, and

Table 2
Test-Retest Reliability of Nine Hole Peg Test
for 27 Females, Ages 20-39,
Using the Pearson Correlation Coefficient
Test Retest
M SD SE M SD SE Correlation
Right 16.1 1.8 .35 15.2 1.6 .32 .693""
Left 18.7 3.6 .70 17.1 2.2 .43 .428"
"p<.05.
··p<.OOl.
four tests of hand strength. The latter were administered after the two
dexterity tests to avoid having fatigue affect the dexterity test scores.
RESULTS
Reliability and Validity Study

A very high interrater reliability (right r = .97, left r = .99) was obtained
using the Pearson correlation coefficient. Test-retest reliability was high
(r = .69) for the right hand and moderate (r = .43) for the left hand
(Table 2). Using the same test-retest reliability data (Table 2), a two-
tailed, paired data t test was used to evaluate the practice effect between
the two occasions for each hand. A significant difference was noted for
the right hand (p<.OOI) and for the left hand (p<.05). A Pearson cor-
relation coefficient was used to assess the concurrent validity of the Nine
Hole Peg Test with the Purdue Pegboard as the parameter. A significant
inverse relationship was obtained for the right hand (r = - .61) and the
left hand (r = -.53). An inverse relationship was expected, because the
lower the score on the Nine Hole Peg Test, the better the performance,
whereas on the Purdue Pegboard, the higher the score, the better the
performance.
Nonnative Study
The average performance of males on the Nine Hole Peg Test is reported
in Table 3 and the average performance of females in Table 4. For both
males and females, the 20-24 age group demonstrated the highest per-
formance (lowest score), and the 75 + age group demonstrated the lowest

Table 3
Average Performance of Normal Males
on the Nine Hole Peg Test (time in seconds)
Age Hand Mean SD SE Low High

20-24 R 16.1 1.9 .35 13 22
L 16.8 2.2 .41 13 23
25-29 R 16.7 1.6 .31 14 21
L 17.7 1.6 .31 15 21
30-34 R 17.7 2.5 .48 14 24
L 18.7 2.2 .43 14 24
35-39 R 17.9 2.4 .48 15 26
L 19.4 3.5 .70 14 28
40-44 R 17.7 2.2 .43 14 22
L 18.9 2.0 .39 16 24
45-49 R 18.8 2.3 .43 15 24
L 20.4 2.9 .55 15 27
50-54 R 19.2 1.8 .36 15 22
L 20.7 2.3 .46 16 25
55-59 R 19.2 2.6 .56 14 25
L 21.0 3.2 .70 17 27
60-64 R 20.3 2.6 .54 15 25
L 21.0 2.5 .51 18 27
65-69 R 20.7 2.9 .55 15 29
L 22.9 3.5 .67 18 30
70-74 R 22.0 3.3 .65 17 30
L 23.8 3.9 .77 16 33
75+ R 22.9 4.0 .80 17 35
L 26.4 4.8 .96 19 37
All Male R 19.0 3.2 .18 13 35
Subjects L 20.6 3.9 .22 13 37
performance (highest score). Thus, it was not surprising that there was
a high correlation between the Nine Hole Peg Test and age (males: right
hand r = .62, left hand r = .65; females: right hand r = .61, left hand
r = .63).
When the scores of all male subjects and all female subjects were com-
pared using the data from Tables 3 and 4, it was clear that the average
female scored slightly better than the average male. This can be graphi-
cally seen in Figure 3, which also demonstrates a relatively normal curve
in the distribution of scores on the Nine Hole Peg Test.
When the scores of right-hand dominant and left-hand dominant sub-

THE OCCUPATIONAL THERAPY JOURNALOF RESEARCH 5:1 33
Table 4
Average Performance of Normal Females
on the Nine Hole Peg Test (time in seconds)
Age Hand Mean SD SE Low High
20-24 R 15.8 2.1 .41 12 22

L 17.2 2.4 .47 14 26
25-29 R 15.8 2.2 .43 13 23
L 17.2 2.1 .40 15 25
30-34 R 16.3 1.9 .36 13 20
L 17.8 2.0 .40 15 22
35-39 R 16.4 1.6 .32 14 20
L 17.3 2.0 .40 15 21
40-44 R 16.8 2.1 .37 14 23
L 18.6 2.8 .51 15 24
45-49 R 17.3 2.0 .39 13 23
L 18.4 1.9 .38 16 24
50-54 R 18.0 2.5 .50 14 24
L 20.1 3.0 .60 16 26
55-59 R 17.8 2.6 .52 14 26
L 19.4 2.3 .47 16 24
60-64 R 18.4 2.0 .39 15 22
L 20.6 2.2 .44 17 25
65-69 R 19.5 2.3 .44 16 25
L 21.4 2.7 .51 17 26
70-74 R 20.2 2.7 .51 15 26
L 22.0 2.7 .51 18 27
75+ R 21.5 2.9 .58 17 31
L 24.6 4.3 .85 18 35
All Female R 17.9 2.8 .16 12 31
Subjects L 19.6 3.4 .19 14 35
jects were compared, there was little functional difference between their
mean scores. As would be expected, for male and female right-hand dom-
inant subjects, their right-hand mean scores were 1 to 2 seconds better
than their left-hand mean scores. For male left-hand dominant subjects,
their left-hand mean scores were less than 1 second better than their
right-hand mean scores. In contrast, female left-hand dominant subjects
scored better with their right hands than with their left hands. Due to
these mixed results with left-hand dominant subjects, the relatively small
differences between their mean scores, and the fact that left-hand domi-
nant subjects comprised only 7% of the sample, the normative data in

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Figure 3 Frequency polygons for female and male, right Nine Hole Peg Test scores

Tables 3 and 4 are the combination of both right- and left-hand dominant
subjects.
DISCUSSION
Reliability and Validity Study

The very high interrater reliability demonstrated that two independent
raters scored the test in nearly the exact same way. The moderate to high
test-retest reliability scores were lower than desirable for a test of finger
dexterity. The Purdue Pegboard, a similar test, has reported higher reli-
ability (r = .60 to .79) for one trial testing. One possible explanation is
that the sample tested in this study was a very homogeneous group of
normal subjects (minimal variance in scores). Since the average test scores
were relatively low, a small change in scores could have affected the
reliability. Test-retest reliability might be improved by requiring two or
three trials to obtain a larger sample of the subject's performance. Many
tests of dexterity, such as the Purdue Pegboard and the Minnesota Rate
of Manipulation Test, suggest multiple trials to improve reliability. In
addition, the square container designed for the pegs may have affected
scores. Some subjects had difficulty picking up pegs that were in the
corners, which might not be a problem with a round container. Another
consideration is that the Nine Hole Peg Test has been recommended as
a clinical test for physically handicapped subjects and not for normal
subjects. Since handicapped subjects tend to be a more heterogeneous
group (wider variance in scores), test-retest reliability might be higher
with that sample. The )ebsen Hand Function Test, which also has low
scores and was designed for physically handicapped subjects, has test-
retest reliability data on subjects with stable hand disorders only. The
implication is that reliability data on normal subjects is less important
since the test was recommended for handicapped subjects only.
Although a practice trial was added to the standardized procedures of
the Nine Hole Peg Test, a significant practice effect remained. This means
that an improvement in a subject's retest score could simply be due to
the practice obtained in the initial testing. Since some therapists also use
the test as a method of treatment, the retest scores would become even
more influenced by the practice effect. It is speculated that a three-trial
sample, as suggested above to improve test-retest reliability, might decrease
the practice effect. Further research is needed to address these issues.
The moderate to high inverse relationship between the Nine Hole Peg
Test and the Purdue Pegboard indicated that the test measured similar

but not equivalent aspects of finger dexterity. This would imply that both
tests might be useful in evaluating finger dexterity and that neither could
completely substitute for the other.
Normative Study
The normative data in this study support conclusions of previous studies.
That is, females have slightly better dexterity than males (Mathiowetz,
Volland, Kashman, & Weber, in press; Rushmore, 1942), right-hand scores
are better than left-handscores, and for adults dexterity graduallydecreases
with age (Kellor et al., 1971; Mathiowetz, Volland, Kashman, & Weber,
in press).
Future research regarding the Nine Hole Peg Test should address the
following questions:
1. Would two or three trials of the test improve test-retest reliability
and decrease the practice effect?
2. Would test-retest reliability improve with a sample of physically
handicapped subjects?
3. Would a shallow round container improve test-retest reliability?
4. Does the Nine Hole Peg Test distinguish between normal subjects
and subjects with poor finger dexterity?
5. If the standardized procedures of the test need to be changed to
improve the reliability of the test, does the normative data collected in
this study remain accurate?
An additional question of interest to occupational therapists would con-
cern the relationship between tests of dexterity (e.g., Nine Hole Peg Test,
Box and Block Test, etc.) to tests of hand function (e.g., )ebsen) or to
performance of functional activity. Although relationships might be pre-
sumed, these have never been well documented.
Due to the many unresolved questions regarding the Nine Hole Peg
Test, it should be used with caution. It should not be used to test normal
subjects (i.e., evaluating normal individuals for job placement). There are
better dexterity tests available (e.g., Purdue Pegboard, Minnesota Rate of
Manipulation Test, etc.) that have been designed for this purpose. The
test also should not be used to research the effectiveness of treatment to
improve poor finger dexterity. The test might be cautiously used as a
quick screening tool for finger dexterity. If a deficit were found, additional
testing would be indicated to confirm the deficit and to evaluate the
effectiveness of treatment over time.

Acknowledgments
Many thanks to Franklin Stein, PhD, OTR, for research and statistical con-
sultation, and to Mary Dowe, Sandra Rogers, Lori Donahue, and Cheryl
Rennells for assistance in data collection and analysis. Also thanks to the
many places and people who helped make this study possible: Waukesha
County Fair (Terry Foreman), Rummage-O-Rama (Walter Rasner), North-
ridge and Southridge Shopping Centers, Fiesta Mexicana, Washington Park
Senior Center (Betty Masek), McGovern Park Senior Center (Gloria Hall),
Lake Park Lutheran Church Senior Center (Carol Hauer), Lisbon Senior
Center and Sacred Heart Rehabilitation Center (Elaine Strachota). This
study was partially funded by an American Occupational Therapy Foun-
dation research grant. Research results were reported at the American
Occupational Therapy Association Annual Conference, Kansas City, MO,
1984.
REFERENCES
Agnew, P. )., & Mass, F. (1982). Hand function related to age and sex.
Archives of Physical Medicine and Rehabilitation, 63, 269-271.
Gardner, R. A., & Broman, M. (1979). The Purdue Pegboard: Normative
data on 1334 school children. journal of Clinical Child Psychology,
7, 156-162.
Jack, S., & Ries, P. ( 1981). Current estimate from national health interview
survey in the United States. Vital and Health Statistics, Series 10-136.
(DHHS Publication No. 81-1564). Washington, DC: Public Health Serv-
ice.
jebsen, R. H., Taylor, N., Trieschrnann, R. B., Trotter, M. )., & Howard,
L. A. (1969). An objective and standardized test of hand function. Ar-
chives of Physical Medicine and Rehabilitation, 50, 311-319.
Kellor, M., Frost, J., Silberberg, N., Iversen, I., & Cummings, R. (1971).
Hand strength and dexterity. Americanjournal ofOccupational Ther-
apy, 25, 77-83.
Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers,
S. L. (in press). Grip and pinch strength: Normative data for adults.
Archives of Physical Medicine and Rehabilitation.
Mathiowetz, V., Volland, G., Kashman, N., & Weber, K. (in press). Adult
norms for the Box and Block Test of manual dexterity. American jour-
nal of Occupational Therapy.

Rushmore,). R. (1942). The R-Gpegboard test of finger dexterity.]ournal

ofApplied Psychology, 26, 523-529.
Tiffin, ). (1968). Purdue Pegboard Examiner Manual. Chicago: Science
Research Associates.


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Adult Nonns For The Nine Hole Peg

Test OfFinger Dexterity

The purposes of this study were to establish standardized

Virgil Mathiowetz, MS, OTR, is Assistant Professor, Occupational Therapy Pro-

Licenciado para - Lilian Queiroz Frossard - Protegido por Eduzz.com

test and retest occasions. Possible variables that may have

The Nine Hole Peg Test is commonly used by occupational therapists as

Licenciado para - Lilian Queiroz Frossard - Protegido por Eduzz.com

Another standardized test of dexterity is the ]ebsen Test of Hand Func-

Description of the Test

Test Procedures and Instructions

Licenciado para - Lilian Queiroz Frossard - Protegido por Eduzz.com

Licenciado para - Lilian Queiroz Frossard - Protegido por Eduzz.com

Figure 2 The Nine Hole Peg Test being administered to a subject

Licenciado para - Lilian Queiroz Frossard - Protegido por Eduzz.com

The stopwatch was started by the examiner as soon as the subject

Subjects and Procedures

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"Right-hand or left-hand dominance.

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Reliability and Validity Study

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Age Hand Mean SD SE Low High

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Age Hand Mean SD SE Low High

20-24 R 15.8 2.1 .41 12 22

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Reliability and Validity Study

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Licenciado para - Lilian Queiroz Frossard - Protegido por Eduzz.com

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Rushmore,). R. (1942). The R-Gpegboard test of finger dexterity.]ournal

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