Journal of Hand Therapy 34 (2021) 116e120

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Journal of Hand Therapy

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JHT READ FOR CREDIT ARTICLE #741.

Scientific/Clinical Article

Purdue manual dexterity testing: A cohort study of

community-dwelling elderly
Katherine Rule OTDS *, Jennifer Ferro OTDS, Audrey Hoffman OTDS, Jasmine Williams OTDS,
Sara Golshiri OTDS, Rachelle Padre OTDS, Jessica Avila OTDS, Carley Coca OTDS,
Kristin Valdes OTD, OT, CHT
Department of Occupational Therapy, Gannon University, Ruskin, FL, USA

a r t i c l e i n f o a b s t r a c t

Article history: Introduction: The Purdue Pegboard Test is a manual dexterity test that requires the manipulation of pegs,
Received 19 April 2019 washers, and collars. Our population for this research study focused on the geriatric community owing to
Received in revised form the lack of recent available normative data.
9 September 2019
Purpose of the Study: The purpose of this study was to provide updated normative data for hand ther-
Accepted 31 December 2019
Available online 7 March 2020
apists to use in clinical practice to determine if seniors have dexterity deficits.
Study Design: This is a cohort study.
Methods: This study was completed through a convenience sample which included 128 participants.
Keywords:
Purdue Pegboard Test
Participants were stratified into three age groups (60-69, 70-79, and 80þ). Participants were asked to
Manual dexterity complete the Purdue Pegboard Test. Mean scores were analyzed using an independent-sample t-test and
Normative data one-way analysis of variance to compare the mean scores of each designated age group.
Assessment Results: A one-way analysis of variance reported statistically significant differences between the 3 age
Measurement groups (F ¼ 15.03, P < .00). The results supported that those individuals who were younger (60-69)
scored better on the assessment than those aged 80þ years. There was not a statistically significant
difference between PPT mean scores of males and females.
Discussion: Mean scores for the PPT for community-dwelling seniors were established.
Conclusion: The findings from this study support that dexterity may decline with age, which can affect
occupational performance over time.
Ó 2020 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.

Introduction
A decline in manual dexterity can be the result of injury or
disease among various populations and may subsequently lead to a
wide array of activity restrictions or limitations.1,2 Owing to the
rapidly aging population, manual dexterityerelated deficits are
projected to increase by nearly 400% in the next few decades with
the absence of preventative measures.3 A method commonly used
by health professionals to measure the decline in manual dexterity
is the Purdue Pegboard Test 32020-A (PPT).
In a 2014 systematic review looking at manual therapy assess-
ments, the PPT was used in 14 of the included studies.4 Along with
* Corresponding author. 1128 Gate Post Court, Powder Springs, GA, 30127, USA.
Tel.: 678-327-7064
E-mail address: Hague003@knights.gannon.edu (K. Rule).
the PPT, the Grooved Pegboard and the Finger Tapping Test were all
evaluated for measuring dexterity. Of these 3 tests, the Purdue
Pegboard was most frequently used within the included studies.4
Based on the 14 studies that were examined, the test-retest cor-
relation for the PPT reported an average correlation between
r ¼ 0.63 and r ¼ 0.81.4 Research supports that the PPT, the Grooved
Pegboard Test, and the Finger Tapping Test were all recommended
for clinical use.4 Available evidence shows that these 3 tests have
high validity, reliability, and less confounding variables than other
tests that have been used to measure dexterity.4 However, there is a
need for further evaluation of the validity of these tests.4
Researchers recommend updating normative values every 15 to
20 years to reflect upon the respective population.5 Past perfor-
mance norms for healthy women aged 40 to 85 years ranged from
11 to 16 pins for the tasks.6 Research has also shown that men in the
same age groups typically have lower scores.7
Additional research is necessary to determine normative values
for the older adult population for practitioners to establish a

0894-1130/$ e see front matter Ó 2020 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jht.2019.12.006
 K. Rule et al. / Journal of Hand Therapy 34 (2021) 116e120 117

Table 1
Participant demographics

Descriptor Age 60-69 Age 70-79 Age 80þ Total (n, percent) Right hand dominant Left hand dominant
Males 18 26 15 (59, 46) n ¼ 48 n ¼ 11
Females 24 28 17 (69, 54) n ¼ 55 n ¼ 14
Total (n, percent) (42, 33) (54, 42) (32, 25) (128, 100) (103, 80) (25, 20)

n ¼ sample size.

baseline and treat accordingly. The purpose of this study is to the participant is asked to complete the task using both hands
establish normative PPT scores of community-dwelling seniors. simultaneously. The number of placed pegs is then recorded. After
the completion of the three trials, scores are averaged for each
Methods task.8 Interrater reliability has been shown to be accurate when
administered in three trials.5 The norms for the PPT have been
Participants established, ranging from 0.91 to 0.99.5,9 A certified hand therapist
and occupational therapy doctoral students performed the partic-
All participants were community-dwelling seniors in Hills- ipant testing following the established protocol provided by the
borough and Sarasota County, Florida, who were recruited via a Lafayette Instrument Company. The students received training in
convenience sample. Subjects gave oral and written consent to the procedure by the certified hand therapist.
participate in the study. Eligibility for this study required an age of
60 years or older and intact executive functioning skills assessed by Data analysis
the occupational therapist who explained the testing procedure to
the participants. Exclusion criteria consisted of participants that The distribution of participants was examined and stratified into
were not community-dwelling seniors. The study was approved by age groups to calculate the mean and percentile performance of
the Institutional Review Board (IRB) of Gannon University. each specific group. Participants were assigned into three stratified
groups: (1) 60 to 69, (2) 70 to 79, (3) 80 and older. Demographic
Materials and methods data including age and gender were collected to determine
normative data for this population. A one-way analysis of variance
This study used the standardized Purdue Pegboard Test-A (PPT- was conducted to identify any differences between means of the
A) (Lafayette Instrument Company, Lafayette, Indiana). The test three age groups. An independent-sample t-test was also used to
includes a board consisting of two parallel rows with 25 holes into identify any differences between gender scores on the PPT. The
which cylindrical metal pegs are placed. The PPT-A consists of an level of statisical signifance was set as less than .05.
examiner's manual, pegboard, 25 collars, 45 washers, and 55 pegs.
Participants are asked to retrieve a pin from a cup and place it into Results
one of the holes on the board, beginning with the first hole that is
closest to the cups. The objective is to fill as many holes with the Participant description
pins as possible within a 30-second time limit. Participants are
asked to begin with their dominant hand. The participant com- One hundred twenty-eight participants were selected via con-
pletes this process three times before repeating these steps with venience sample. Fifty-nine males and 69 females participated in
their nondominant hand. Once this portion of the test is finished, the study. Participants' ages ranged from 60 to 99 years. Approxi-
Table 2
mately 80% of participants were right hand dominant and 20% were
Purdue Pegboard Test-A participant score left hand dominant (Table 1).
Percentile Right hand Left hand Both hands Right and left and both Assembly
1 18 17 14 46 38
Mean PPT score
0.99 18 17 14 43 37
0.95 16 16 12 39 29 The population's mean PPT scores for right hand (x¼ 11,
0.90 14 14 11 36 26 SD ¼ 2.68; [range ¼ 4-18]), left hand (x¼ 10, SD ¼ 2.75; [range 2-
0.85 13 13 10 35 24
17]), bilateral hand use (x¼ 8, SD ¼ 2.41; [range 2-14]), combined
0.80
0.75 12 11 9 32 23 right, left, and bilateral (combined RLB) use (x¼ 28, SD ¼ 6.72;
0.70 [range 13-46]), and assembly (x¼ 19, SD ¼ 6.4; [range 5-38]) can be
0.65 12 11 9 31 21 seen in Table 2. Table 2 also provides percentile scores for the
0.60 population. The highest score recorded for combined RLB (right,
0.55 11 10 8 29 19
0.50 11 10 8 28 18
left, bilateral) on the PPT, 46, was achieved by the youngest
0.45 10 9 8 27 18
0.40
0.35 9 8 7 25 16 Table 3
0.30 Mean scores on Purdue Pegboard Test-A
0.25 9 8 6 23 14
Participant group Right hand Left hand Both Right and left Assembly
0.20
and both
0.15 8 7 5 20 12
0.10 7 6 5 19 11 Males aged 60-69 11 10 8 29 20
0.05 6.5 5 4 16 9 Females aged 60-69 12 11 10 33 24
0.01 4 2 3 13 7 Males aged 70-79 10 10 8 27 18
x 11 10 8 28 19 Females aged 70-79 11 10 8 29 16
SD 2.68 2.75 2.41 6.72 6.40 Males aged 80þ 9 8 6 23 16
Females aged 80þ 9 8 6 24 16
x ¼ mean score; SD ¼ standard deviation.
118 K. Rule et al. / Journal of Hand Therapy 34 (2021) 116e120
Fig. 1. PPT mean scores with error bars. Age is displayed in years. Mean of the scores
recorded for right-handed trials, left-handed trials, and bilateral hand trials (RLB) are
displayed on the y-axis.
participant in the sample. The lowest score recorded for combined
RLB on the PPT, 13, was achieved by a 65-year-old woman. Looking
at the combined RLB scores, the highest scoring group included
females between the ages of 60 and 69 years old (x¼ 33, n ¼ 24)
(Table 3). The lowest scoring group comprised males who were
above the age of 80 years (x¼ 23, n ¼ 15) (Table 3). Figure 1 depicts
PPT scores in relation to age for the combined RLB. As illustrated in
Table 4, an independent-sample t-test showed no statistically sig-
nificant differences in scores between males and females
(t ¼ 1.09, P ¼ .06). A one-way analysis of variance found a sta-
tistically significant difference between the three age groups
(F ¼ 15.03, P < .00), with those who are younger scoring higher on
the PPT (Table 5).
Discussion
Our findings are in accordance with those from Lawrence et al
and Şahin et al, who investigated the relationship between finger
dexterity performance and age.10 Their results support that finger
dexterity is significantly affected by age.10 Dissimilar to our study,
Lawrence et al.10 and Agnew et al6 revealed differences in dex-
terity relating to gender, with females scoring significantly higher
than males. However, our study found no statistically significant
difference between gender and performance on the PPT. Vasy-
lenko et al11 also found no significant gender differences among
the older adult group in reference to dexterity parameters.
Without a significant difference in PPT scores among genders, this
finding suggests that dexterity may decrease with age regardless
of gender.
A similar study examined the correlation between manual
dexterity and cognition in the same population.12 Similar to our
findings, their conclusion indicated that the older population
commonly experiences difficulties with fine motor skills.12 A
cross-sectional study examined the relationship between
Table 4
Independent-sample T-test
RLB
Variation assumption Levene's test t-test for equality of means
for equality
of variances
F Sig. t df
Equal variances not assumed 1.900 124.025
RLB ¼ combined right-hand trial, left hand trial, and bilateral hand trial score; Sig. ¼ significance presented as P ¼ .06; df ¼ degrees of freedom; F ¼ F ratio; t ¼ T-value score.
manual dexterity with visual perception function in community-
dwelling seniors.13 Occupational therapists evaluated partici-
pants using four clinical tools commonly used to measure dex-
terity.13 The PPT was not used in this study, although the
findings discuss age-related visual deficits and how visual
perception may impact performance on the PPT.13 As prevalence
of visual perception impairments increases with age, it is
important that clinicians consider perception as a variable
influencing the score on the PPT.13 Vision could have an effect
on the consistent findings that performance in dexterity tends
to decrease with age.8,13
A study aiming to determine if there was a negative correlation
between hand dexterity and executive functioning found that in
addition to sensory motor coordination, manual dexterity requires
complex cognitive processes such as adequate attention, working
memory, planning, judgment, task flexibility, and inhibition.14 The
study results were similar to ours in that younger participants had
significantly higher PPT scores compared to the oldest group in
the study.14 In addition, the study found this same correlation to
be true of executive functioning.14 As age increased, scores on an
executive functioning test decreased.14 Manual dexterity is sub-
ject to the effects of aging and is strongly associated with execu-
tive functioning; therefore, assessing hand dexterity may help
identify individuals at higher risk of impairment of executive
functioning.14
Desrosiers et al7 collected normative data for senior adults'
performance on the PPT, using a similar design in which partici-
pants were divided into the same three age groups. Our findings are
in agreement with those of Desrosiers et al,7 who found older
participants had lower PPT scores. They reported higher scores
across the board for every age group when compared to the mean
scores collected in our study.7 These differences could be due to the
small sample sizes of the study (n ¼ 35).7 Overall decreases in
performance norms may also be a result of the increasing popu-
larity of tablet use. Increased work done on computers and with
tablet-like devices may decrease opportunities for individuals to
engage in activities requiring finger dexterity and hand manipula-
tion skills in this technological age.
Clinically, therapists should be confident using the PPT to assess
manual dexterity for community-dwelling seniors. Our results
provide normative data that can be used to compare to client
scores. This can help determine if the client needs to work on
improving manual dexterity. Clinicians should also be aware that
poor vision and limited executive functioning skills may interfere
with a client's performance on the PPT. Perhaps, the clinician
should use a test such as the Finger Tapping Test15 or the NK dex-
terity test16 with clients with poor vision or limited executive
functioning skills due to those tests requiring less visual acuity and
less complex directions.
Our study has limitations such as small sample size, indicating
that a replication study should be conducted in the future. An
Sig. (2-tailed) Mean Std. error 95% confidence
difference difference interval of the
difference lower
0.060 2.23729 1.17755 4.56799
 K. Rule et al. / Journal of Hand Therapy 34 (2021) 116e120 119

Table 5 References
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ANOVA
dexterity and grip strength after distal radius fracture. A 2-year prospective
RLB cohort study. Hand Ther. 2018;23:28e37.
2. Bobos P, LaLone EA, Grewal R, MacDermid JC. Recovery, age and gender effects
Method Sum of squares df Mean square F Sig. on hand dexterity following a distal radius fracture. A 1-year prospective
Between groups 1113.344 2 556.672 15.027 0.000a cohort study. J Hand Ther. 2018;31:465e471.
Total 5743.875 127 3. Gallus J, Mathiowetz V. Test-retest reliability of the Purdue Pegboard for per-
sons with multiple sclerosis. Am J Occup Ther. 2003;57:108e111.
ANOVA ¼ analysis of variance; RLB ¼ combined right-hand trial, left hand trial, and 4. Causby R, Reed L, Mcdonnell M, Hillier S. Use of objective psychomotor tests in
bilateral hand trial score; df ¼ degrees of freedom; F ¼ F-statistic; Sig., statistical health professionals. Percept Mot Skills. 2014;118:765e804.
significance. 5. Lindstrom-Hazel DK, Veenstra NV. Examining the purdue pegboard test for
a occupational therapy practice. Open J Occup Ther. 2015;3:1e13.
Indicated statistical significance.
6. Agnew J, Bolla-Wilson K, Kawas C, Bleecker M. Purdue pegboard age and sex
norms for people 40 years old and older. Dev Neuropsychol. 1988;4:29e35.
7. Desrosiers J, Hebert R, Bravo G, Dutil E. The purdue pegboard test: normative
additional limitation includes having multiple test administra- data for people aged 60 and over. Disabil Rehabil. 1995;17:217e224.
tors; however, because the PPT is a standardized assessment and 8. Wittich W, Nadon C. The Purdue Pegboard Test: normative data for older
test administrators were trained on how to administer the adults with low vision. Disabil Rehabil Assist Technol. 2016;12(3):272e279.
9. Amirjani N, Ashworth NL, Olson JL, Morhart M, Chan KM. Validity and reli-
assessment, administrative threats to validity and reliability of the ability of the purdue pegboard test in carpal tunnel syndrome. Muscle Nerve.
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dexterity as the dynamical regulation of instabilities: comparisons across
on the relationship between age and hand dexterity. Future gender, age, and disease. Front Neurol. 2014;5:53.
research should focus on the role that executive functioning plays 11. Vasylenko O, Gorecka M, Rodríguez-Aranda C. Manual dexterity in young and
in completing all components of the PPT. Future studies should healthy older adults. 2. Association with cognitive abilities. Dev Psychobiol.
2018;60(4):428e439.
also aim to include a larger sample size to increase strength of 12. Curreri C, Trevisan C, Carrer P, et al. Difficulties with fine motor skills and
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13. Song C. Relationship between visuo-perceptual function and manual dexterity
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Conclusion
14. Kobayashi-Cuya K, Sakurai R, Sakuma N, et al. Hand dexterity, not handgrip
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Mean scores for the PPT for community-dwelling seniors were dwelling older adults: a cross-sectional study. BMC Geriatr. 2018;18(1):210.
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120 K. Rule et al. / Journal of Hand Therapy 34 (2021) 116e120

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Record your answers on the Return Answer Form found on the c. 30 seconds
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only one best answer for each Question. a. no real differences in age groups
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# 1. The study design was c. significant differences in right-handed vs. left-handed
a. RCTs groups
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