What is the recommended frequency for performing the 9-hole peg test in Multiple Sclerosis (MS) patients?

Recommended Frequency for the 9-Hole Peg Test in MS Patients

The recommended frequency for performing the 9-hole peg test in Multiple Sclerosis (MS) patients is every 6 months, which allows for detection of significant changes in cognitive function while minimizing practice effects. 1

Standard Testing Frequency Guidelines

• The 9-hole peg test should be performed every 6 months in most MS patients to effectively monitor upper limb function changes while aligning with other routine monitoring recommendations 1
• This testing frequency parallels recommendations for other MS monitoring tools, such as brain MRI scans which are recommended at similar intervals 2
• Regular 6-month testing intervals help detect clinically meaningful changes in manual dexterity, with research suggesting that a 20% change in test score is commonly used to define clinically meaningful worsening 3

Adjusted Testing Frequency Based on Risk Factors

• More frequent monitoring (every 3-4 months) is warranted in high-risk patients, particularly those:

  • On disease-modifying therapies with increased risk of complications 2
  • With JCV seropositive status and treatment duration ≥18 months 2
  • Showing signs of rapid disease progression 1

• Annual testing may be sufficient for:

  • Patients with stable disease and minimal symptoms 2
  • Patients at low risk of complications (e.g., JCV seronegative) 2
  • Patients with slowly progressing forms of MS 1

Clinical Considerations for Testing

• The 9-hole peg test should be integrated with other MS monitoring approaches, including regular brain MRI scans and clinical assessments 1
• Testing both hands is important as research shows significant between-hand asymmetry, particularly in patients with primary progressive disease course and higher disability levels 4
• The test has shown ceiling and floor effects in mildly (EDSS < 3.0) and severely (EDSS > 6.0) impaired patients, which should be considered when interpreting results 4
• In patients with progressive MS, using the "either hand" scoring method may be more sensitive for detecting changes than the standard method (averaging four measurements, two in each hand) 5

Special Monitoring Considerations

• Non-ambulatory MS patients may require more vigilant monitoring of upper limb function, as research shows they experience more 9-hole peg test worsening than ambulatory participants 5
• Patients switching between disease-modifying therapies should undergo more frequent monitoring (every 3-4 months) for up to 12 months after the switch 2
• Patients with primary progressive MS may need more careful monitoring as they show larger between-hand asymmetry and are at higher risk for manual dexterity impairment (OR = 7.27) 4

Importance of Consistent Testing

• The 9-hole peg test is highly reliable within and between test sessions, making it suitable for regular monitoring 3
• The test shows high convergent validity with other manual dexterity measures and correlates well with patients' perceived upper limb function in daily activities 3
• Abnormalities in fine manual dexterity (measured by the 9-hole peg test) are present in 85.4% of MS patients across the disease spectrum, highlighting the importance of regular monitoring 6