The 9-hole peg test (NHPT) could be useful as a primary outcome measure for select circumstances in clinical trials regarding multiple sclerosis (MS), according to a study recently published in Multiple Sclerosis and Related Disorders.

“Our exploration of NHPT change in nonambulatory people with MS suggests that clinical trials in nonambulatory people may be possible using the NHPT as the primary outcome measure, but more research into the precision of the measures in this patient group is necessary,” the authors wrote.

This retrospective study included 1832 patients previously diagnosed with MS; 889 were from the ASCEND clinical trial and 943 were from the PROMISE dataset. In both cohorts, more than half of the patients were female (61.86% and 51.21%, respectively), and the mean ages were 47.1 and 50.4 years, respectively.

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The median baseline Expanded Disability Status Scale (EDSS) scores were 30 and 25.5, the standard NHPT scores were 25.6 and 24.3, the dominant hand NHPT scores were 28.6 and 24.3, and the nondominant hand NHPT scores were 29.7 and 25.7, respectively.

The researchers noted that the standard NHPT score varied slightly, indicating fewer worsening events when compared to the dominant hand and nondominant hand NHPT scores. Conversely, on either hand, the NHPT showcased significantly more worsening events.

Interestingly, when comparing ambulatory and nonambulatory patients with primary progressive MS, the NHPT demonstrated greater variation in the nonambulatory participants. This result was especially evident with either hand NHPT.

These findings suggest that either hand NHPT could identify more worsening events than the standard NHPT, making either hand NHPT particularly useful in patients with primary progressive MS.

“In summary, our investigation shows that the NHPT can be redefined to increase its sensitivity to change,” the study authors concluded.

Patient characterization according to MS subtype and clinical status is of utmost importance when selecting the proper outcome measure for each case, Koch et al explained.


Koch MW, Repovic P, Mostert J, et al. The nine hole peg test as an outcome measure in progressive MS trials. Mult Scler Relat Disord. Published online November 24, 2022. doi:10.1016/j.msard.2022.104433