Correlations between three upper limb objective measures in multiple sclerosis


  • The correlations between the Box and Block Test (BBT), Hand Grip Strength (HGS) and 9-Hole Peg Test (9-HPT) were generally low, but BBT may be considered as an alternative measure of upper limb (UL) function in patients with multiple sclerosis (MS) who are unable to perform 9-HPT, due to its stronger association with 9-HPT in patients with high disability. 

Why this matters

  • Currently, there is no single measure that sufficiently covers the whole range of UL functionality across different disability levels in patients with MS.

  • The 9-HPT is considered the gold standard in assessing UL function in MS in clinical practice and an endpoint in clinical trials, but it only assesses manual dexterity and does not encompass manipulation of larger objects and muscle strength.

  • Specific evaluations using the HGS to measure muscle strength and BBT to test gross manual dexterity are required to assess these other important domains of UL function.

  • According to the authors, there are currently no data on correlations between 9-HPT, HGS and BBT, the distribution and associations of HGS and BBT scores, or their associations with clinical variables in patients with MS.