Multiple sclerosis and related disorders · 2026
Upper limb rehabilitation in multiple sclerosis: A retrospective analysis of nine hole peg test and box and block test responses across disability levels and disease courses.
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Bertoni Rita, Spedicato Albino, Meotti Matteo, Cattaneo Davide, Jonsdottir Johanna
Аннотация
BACKGROUND: Early impairments in Multiple Sclerosis, such as reduced hand dexterity, worsen as disability progresses. Rehabilitation is essential, yet evidence on the efficacy of upper limb (UL) interventions remains limited. This study investigates the effects of UL rehabilitation on fine and gross motor function in a large cohort of people with multiple sclerosis (pwMS).
METHOD: We examined data from 237 pwMS enrolled in studies on arm function interventions. Demographic characteristics and hand dominance were recorded; manual dexterity was assessed by blinded therapists using the Box and Block Test (BBT) and the Nine Hole Peg Test (NHPT). Statistical analyses evaluated dominant and non-dominant hands, stratified results by MS type and EDSS disability levels and tested pre-post differences using Wilcoxon or paired-t tests.
RESULTS: Rehabilitation led to statistically significant improvements in fine and gross hand function, with median gains of 2.5-3 s on the NHPT and 7-8 cubes on the BBT, and moderate effect sizes. Approximately 20% of participants reached a 20% improvement on NHPT and one-third on BBT. Mild and moderate EDSS groups showed gains on NHPT and BBT, while severe groups improved more on BBT. Relapsing-Remitting and Primary Progressive types exhibited consistent improvements on both tests, whereas Secondary Progressive showed smaller NHPT changes.
CONCLUSION: UL rehabilitation in pwMS appears more effective for individuals with milder disability and a relapsing-remitting course. Interventions were more successful in improving gross motor function, while fine hand function showed limited improvement in higher disability levels or progressive MS.
METHOD: We examined data from 237 pwMS enrolled in studies on arm function interventions. Demographic characteristics and hand dominance were recorded; manual dexterity was assessed by blinded therapists using the Box and Block Test (BBT) and the Nine Hole Peg Test (NHPT). Statistical analyses evaluated dominant and non-dominant hands, stratified results by MS type and EDSS disability levels and tested pre-post differences using Wilcoxon or paired-t tests.
RESULTS: Rehabilitation led to statistically significant improvements in fine and gross hand function, with median gains of 2.5-3 s on the NHPT and 7-8 cubes on the BBT, and moderate effect sizes. Approximately 20% of participants reached a 20% improvement on NHPT and one-third on BBT. Mild and moderate EDSS groups showed gains on NHPT and BBT, while severe groups improved more on BBT. Relapsing-Remitting and Primary Progressive types exhibited consistent improvements on both tests, whereas Secondary Progressive showed smaller NHPT changes.
CONCLUSION: UL rehabilitation in pwMS appears more effective for individuals with milder disability and a relapsing-remitting course. Interventions were more successful in improving gross motor function, while fine hand function showed limited improvement in higher disability levels or progressive MS.