The 9-Hole Peg Test appears to be a good marker of declining hand function in patients with multiple sclerosis (MS) and could therefore serve as a useful tool for assessing motor impairments in this patient population, according to research presented at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held October 25-28, 2021 in Orlando, Florida.

Currently, there are patients with MS enrolled in the North American Registry for Care and Research in Multiple Sclerosis (NARCRMS), a longitudinal registry that is studying the course of MS in what researchers have dubbed the “disease-modifying era.” Researchers were prompted to examine motor performance for upper and lower extremities of this patient population group using the Expanded Disability Status Scale (EDSS) and the 25-Foot Timed Walk (25FTW) times.

The study included 855 patients with MS recruited from multiple centers across the United States and Canada. Patients included in the study had any MS subtype within 15 years of disease onset and presented with an EDSS score of ≤6.5. Motor performance for upper and lower extremities, among other clinical metrics, were collected. The researchers focused their assessment on EDSS, the 25-Foot Timed Walk (25FTW) test, and the 9-Hole Peg Test.


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Overall, EDSS scores and 25FTW times were available for 692 patients, while 676 patients had available EDSS and upper extremity function scores available. The researchers observed a mean walking speed of 4.92 seconds in 113 patients with an EDSS of 0, while the mean walking speed was 5.09 seconds until an EDSS score of 3.0 (n=44; 5.56 seconds). Walking speed was noticeably impacted at an EDSS score of 3.5, which was observed in 31 patients, the researchers stated. In these patients, the mean walking speed was 6.56 patients.

The mean walking speed continued to decline after an EDSS score of 3.5 and with each increase in EDSS score. For the 30 patients with an EDSS score of 4.0, the mean walking speed was 8.3 seconds, while the mean walking speed in 7 patients with an EDSS score of 4.5 was 8.64 seconds. In 12 patients with an EDSS score of 6.5, the mean walking speed was 17 seconds.

In terms of the 9-Hole Peg Test, the 107 patients with MS and an EDSS score of 0 had an average speed of 19.44 seconds in the dominant hand and 20.59 seconds in the nondominant hand. The investigators noted that hand function was unimpaired until patients reached an EDSS of 2.0, with significant reductions occurring starting at an EDSS score of 2.5. “Decline in hand function at an EDSS score of 2.5 was unexpected since hands are often perceived to be unaffected early in MS and seldom observed as impaired by patients,” the researchers wrote.

In 48 patients with an EDSS score of 2.5, the mean speed was 24.53 seconds and 23.57 seconds in the dominant and nondominant hands, respectively. Additionally, in 31 patients with an EDSS score of 4.0, the mean speeds were 26.18 seconds in the dominant hand and 26.19 seconds in the nondominant hand. In the 16 patients with an EDSS of 6.5, the hand function was reduced to a mean speed of 37.59 seconds in the dominant hand and 48.19 seconds in the nondominant hand.

“Progressive decline of hand function at every EDSS score increase would suggest that the 9-Hole Peg Test is a good marker of declining hand function and should be included in clinical monitoring of patients,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Rammohan K, Li D, Halper J, et al. Motor impairment in multiple sclerosis: Analysis from the North American Registry for Care and Research in Multiple Sclerosis (NARCRMS). Presented at: CMSC 2021 Annual Meeting; October 25-28, 2021; Orlando, Florida. Abstract EPI03.