Nine-Hole Peg Test

The 9HPT is a single fine motor task (pegboard placement/removal); the JHFT includes 7 diverse hand function tasks (writing, grasping, stacking, lifting). 9HPT is faster (~1–2 min) and narrower in scope; JHFT is more comprehensive but time-consuming (~10–15 min). 9HPT is ideal for repeated administration and research (e.g., MS trials); JHFT is better for detailed hand function assessment in clinical settings. Both are responsive to hand therapy.

Standard protocol includes two trials per hand; the mean of the two trials is the 9HPT score. Both trials should be performed to establish a reliable baseline and reduce variance from single-trial variability. If time is very limited, one trial per hand is acceptable but less reliable and should be noted. For serial assessments, consistency (always two trials, same environment) is important for valid comparison.

The stopwatch continues running; the client retrieves the dropped peg and completes placement. The task does not restart. Dropping pegs may reflect tremor, weakness, or incoordination and contributes to slower overall time, which is appropriate for measuring real-world dexterity. If many pegs are dropped, this should be documented as it may indicate severe ataxia or coordination loss beyond simple slowing.

A change of 5–10 seconds per hand is generally considered clinically meaningful. In sensitive populations (MS trials), even 2–3 second improvements may indicate pharmacological response. Early post-hand injury/surgery, improvements of 10–20 seconds over 4–8 weeks are typical. Individual patient context matters; for someone trying to return to piano playing, a 3-second improvement may be functionally significant.

Standard protocol typically tests the dominant hand first, then the non-dominant hand. Order should be consistent. Some fatigue or learning effects may occur; the second hand tested may be slightly slower due to fatigue or faster due to task familiarity. Consistency in order across administrations is more important than which hand is tested first.

The 9HPT can be used in school-age children (6+); pediatric norms are available but less extensive than adult norms. Task comprehension is important; younger children may need more detailed instruction or demonstration. Peg size may need to be larger for very young children (smaller hand size). Pediatric reference data should be consulted; adult norms should not be used.