Box and block test, hand grip strength and nine‐hole peg test: correlations between three upper limb objective measures in multiple sclerosis

Abstract

Background and purpose Limited data are available in the literature for upper limb impairment in multiple sclerosis (MS). This study aimed to report the distribution of values of hand grip strength (HGS), of the box and block test (BBT) and of the nine‐hole peg test (9HPT) correlated with demographic and clinical data in subjects with MS. Methods This study involved five Italian neurological centres. The inclusion criteria were age ≥ 18, MS diagnosis, stable disease phase, right‐hand dominance. All subjects underwent HGS, BBT and 9‐HPT evaluation. Results In all, 202 subjects with MS were enrolled: 137 females; mean age 48.4 years; mean Expanded Disability Status Scale (EDSS) 4.17; mean disease duration 14.12 years; disease course 129 relapsing–remitting, 21 primary progressive and 52 secondary progressive MS subjects; mean right HGS 25.3 kg, left 23.2 kg; mean right BBT 45.7 blocks, left 44.9 blocks; mean right 9‐HPT 30.7 s, left 33.4 s. All results were statistically significantly different compared to healthy controls. HGS, BBT and 9‐HPT were associated with age, EDSS and disease duration, whilst disease course correlated with BBT and 9‐HPT. The BBT and 9‐HPT scores significantly differed according to level of disability (EDSS ≤3.0, 3.5–5.5, ≥6.0). Conclusion Hand grip strength and BBT value distribution in a large MS population is reported. Correlations between HGS, BBT and 9‐HPT were generally low.

Virtual Reality Neurorehabilitation

“…Each participant underwent 12 serious and supervised games (45 minutes, 12 times) aimed at improving the most severely affected upper limbs. The authors chose Nine Hole Peg Test [77] and Box and Blocks Test [78] for validation and used the Visual Analogue Scale [79] of EuroQual-5DL [80] to evaluate the perceived health before and after the intervention. Besides, they adopted non-parametric tests and set p to 0.05.…”

Ultrasound-Guided Injections and Proprioceptive Neuromuscular Facilitation as Shoulder Rehabilitation for Multiple Sclerosis and Neuropathic Pain

“…To evaluate the effectiveness of the rehabilitation protocol on our RR MS patient suffering from chronic shoulder pain, we assessed the following outcome measures: pain, assessed by VAS; passive range of motion (ROM) in flexion, extension, abduction, adduction, internal and external rotation, and muscle strength, measured by the Medical Resource Council (MRC) Scale of shoulder flexors, extensors, abductors, adductors, and internal and external rotators; upper limb muscle strength, using the Hand Grip Strength Test (HGS), to measure the maximum isometric force exerted by the muscles of the upper limb through a dynamometer [ 52 , 53 ]; hand dexterity, through the Nine-Hole Peg Test (NHPT), the most used measure in the literature and clinical practice, which consists in evaluating the time needed to insert and then remove, one at a time and as quickly as possible, nine pegs in as many holes on a tablet [ 54 ]; upper limb functioning, using the Quick Disability of the Arm, Shoulder and Hand (Quick DASH), including eleven questions regarding upper limb functionality and pain. The score obtained (from 0 to 100) indicates the degree of disability (0 = absence of disability; 100 = maximum disability) [ 55 ]; Berg Balance Scale, comprising 14 tests, each rated from 0 to 4; the sum of the scores indicates the balance level [ 56 ]; Timed Up and Go Test (TUG), to assess the risk of falling.…”

“…upper limb muscle strength, using the Hand Grip Strength Test (HGS), to measure the maximum isometric force exerted by the muscles of the upper limb through a dynamometer [ 52 , 53 ];…”

Facing the urgency of therapies for progressive MS — a Progressive MS Alliance proposal

“…Concerning the suggested clinical measures, besides EDSS it is important to consider specific functions (i.e. arm/hand function), particularly in severely disabled patients86,87 . Peripheral transcriptomics is also recommended for non-hypothesis driven measurements of the biological effects.…”