Quantitative assessment of hand disability by the Nine-Hole-Peg test (9-HPT) in cervical spondylotic myelopathy

<B>Objective:</B> To determine whether the Nine-Hole-Peg Test (9-HPT) constitutes valid means to assess hand motion disability in cervical spondylotic myelopathy (CSM) patients. <B>Methods:</B> Forty CSM patients were tested in a prospective observational study in two teaching hospitals. They were assessed in preoperative and postoperative (at month 1) time with the following tests: 9-HPT, modified Japanese Orthopedic Association scale, Nurick scale and 30 meters walking time. Mean time ± 2 standard deviations of 9-HPT in 20 healthy controls defined the normal range in our population. Scores of functional tests in pre and postoperative periods were compared using the non-parametric Wilcoxon rank test. The validity and the test-retest reliability of the 9-HPT was assessed using the Spearman’s rank correlation coefficient. <B>Results:</B> In preoperative time, 9-HPT in dominant and non dominant hands were over the normal range limit in 42.5% and 50% whereas 25% of both dominant and non dominant 9-HPT were abnormal in postoperative time. 9-HPT showed a statistically significant improvement between pre and postoperative times (p<0.0001) and was highly correlated with the other validated tests. Intrarater reliabilities were high with coefficient correlations estimated at 0.97 and 0.99 for dominant and non dominant hands. Interrater agreements were also excellent with coefficient correlations of 0.97 and 0.98. <B>Conclusions:</B> 9-HPT is an easily performed, quantitative, and valid means of assessing hand dexterity in CSM and the effects of surgery. The present study constitutes a step in the development of a composite scale that could include the assessment of gait and hand motion disabilities by the walking time test and the 9-HPT.