A digital version of the nine-hole peg test: Speed may be a more reliable measure of upper-limb disability than completion time in patients with multiple sclerosis.

Background: A digital adaptation of the nine-hole peg test (9HPT) was developed with the potential to provide novel disability features for patients with multiple sclerosis (PwMS).
Objectives: The objectives were to evaluate the 9HPT features based on reliability, prognosis, and discrimination between treatment groups.
Methods: The MS partners Advancing Technology and Health Solutions (MS PATHS) cohort data were used to derive new features including completion time and speed. Association and reliability between features and clinical outcomes were tested by intraclass correlation coefficients (ICCs) with repeated measures. The added prognostic value of the features for a clinically meaningful decline was assessed by time-to-event analyses with likelihood ratio tests. The estimated effect size between treatment efficacy groups was acquired from linear mixed-effects models. Sample size was calculated for a hypothetical randomized clinical trial.
Results: For the 10,843 PwMS, speed and completion time were associated with MS disability. Compared with time, speed showed higher reliability (ICC = 0.78 vs 0.74), added benefits in predicting disability worsening ( p < 0.001), better discrimination between high- and low-efficacy groups (effect size: 0.035 vs 0.015), and an 18% reduction in required sample size for a 1-year clinical trial.
Conclusion: Integrating horizontal hand distances traveled over the 9HPT pegboard can be a more reliable measure of hand function.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.M. serving on scientific advisory boards for Genzyme and Genentech and research support from AHRQ, Biogen, NIH, and Novartis. R.B. received consultant fees for Biogen, Genentech, Genzyme, and Novartis; research support from Biogen, Genentech, and Novartis; and shares rights to intellectual property underlying the Multiple Sclerosis Performance Test, currently licensed to Qr8 Health and Biogen. D.O. received research support from Genentech, Genzyme, and Novartis and consulting fees from Biogen, Genentech-Roche, Genzyme, Novartis, and Merck. R.T.N. has consulted for Alexion Pharmaceuticals, Biogen, Bristol Myers Squibb, Celltrion, Genentech, Genzyme, EMD Serono, Horizon Therapeutics, Lundbeck, and TG Therapeutics. X.J. and Z.S. are the employees of and may hold stock/stock options in Biogen. N.L. is the former employee of and may hold stock/stock options in Biogen. R.H. and J.v.B are the former employees of and may hold stock/stock options in Biogen and TW1 Healthcare and consultant for International Registry for Alzheimer’s Disease and other dementias (InRAD). N.C. is the former employee of and may hold stock/stock options in Biogen and current employee of Janssen Scientific Affairs, LLC. CB. is the former employee of and may hold stock/stock options in Biogen and current employee of Novartis. J.J. and J.A. have no disclosures.