Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Sep;270(9):4179-4191.
doi: 10.1007/s00415-023-11801-3. Epub 2023 Jun 9.

The correlation between 9-HPT and patient-reported measures of upper limb function in multiple sclerosis: a systematic review and meta-analysis

Erica Grange  1   2 , Claudio Solaro  1   3 , Rachele Di Giovanni  1 , Davide Marengo  4
Affiliations
Meta-Analysis

The correlation between 9-HPT and patient-reported measures of upper limb function in multiple sclerosis: a systematic review and meta-analysis

Erica Grange et al. J Neurol. 2023 Sep.

Abstract

Upper limb function is one of the most affected domains in people with multiple sclerosis (PwMS), as self-reported by 50% of patients. Heterogeneous results have been found about the correlation between objective and subjective upper limb function. The aim of the present study is to perform a systematic review and meta-analysis of studies presenting data on the strength of association between the gold standard for 9-Hole Peg Test scores and Patient-Reported Outcome Measures (PROMs) of manual ability. Primary research studies including assessments of 9-Hole Peg Test scores and Patient-Reported Outcome Measures were searched in Scopus, Web of Science, and PubMed. Meta analytical calculations were performed using a random-effects model. We retrieved n = 27 studies including n = 75 distinct effect sizes (N of subjects = 3263). The central tendency analysis showed a strong correlation between 9-HPT scores and PROMs (r = 0.51, 95% CI [0.44, 0.58]). Moderator analysis showed the effect size to be significantly larger in studies with a mean or median EDSS level indicating severe disability. The publication bias hypothesis was not supported; instead, we noted that studies based on larger samples also tend to report stronger effect sizes. Results of the study indicate that the correlation between 9-HPT and PROMs is strong, although the constructs measured by these instrument does not fully overlap. The correlation between 9-HPT and PROMs was stronger in larger studies and when samples include a sizeable subgroup of PwMS with severe disability, pointing out the importance of sample diversity.

Keywords: 9-Hole Peg Test; Meta-analysis; Multiple sclerosis; Patient-Reported Outcome Measures; Upper limb function.

PubMed Disclaimer

Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Literature search and study selection according to PRISMA 2020 flow diagram
Fig. 2
Fig. 2
Forest plot of effect sizes of the association between 9-HPT scores and PROMs assessing upper limb function
Fig. 3
Fig. 3
Funnel plot of effect sizes against their standard error
See this image and copyright information in PMC

References

    1. McDonald I, Compston A. The symptoms and signs of multiple sclerosis. In: Compston A, Ebers G, Lassmann H, editors. McAlpine's multiple sclerosis. 4. London: Curchill Livingstone; 2006. pp. 287–346.
    1. Confavreux C, Compston A, McDonald I, Noseworthy J, Lassmann H, Miller D, et al., editors. McAlpine’s multiple sclerosis. 4. London: Churchill Livingstone Elsevier; 2006. pp. 183–269.
    1. Lublin FD, Reingold SC, Cohen JA, et al (2014) Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology 83(3):278–286. 10.1212/WNL.0000000000000560 - PMC - PubMed
    1. Holper L, Coenen M, Weise A, Stucki G, Cieza A, Kesselring J. Characterization of functioning in multiple sclerosis using the ICF. J Neurol. 2010;257(1):103–113. doi: 10.1007/s00415-009-5282-4. - DOI - PubMed
    1. Johansson S, Ytterberg C, Claesson IM, et al. High concurrent presence of disability in multiple sclerosis. Associations with perceived health. J Neurol. 2007;254(6):767–773. doi: 10.1007/s00415-006-0431-5. - DOI - PubMed