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

• Published in: Journal of neurology Vol. 270; no. 9; pp. 4179 - 4191
• Main Authors: Grange, Erica, Solaro, Claudio, Di Giovanni, Rachele, Marengo, Davide
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2023; Springer Nature B.V
• Subjects: Clinical outcomes; Disability Evaluation; Humans; Medicine; Medicine & Public Health; Meta-analysis; Multiple Sclerosis; Neurology; Neuroradiology; Neurosciences; Patient Reported Outcome Measures; Persons with Disabilities; Review; Systematic review; Upper Extremity; Multiple sclerosis; Patient-Reported Outcome Measures; Upper limb function; 9-Hole Peg Test; Meta-analysis
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-023-11801-3

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.