*Co esponding au ho : Sakshi Gopal Bhimjiyani
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
P e alence o inge dex e i y p o iciency using nine-hole peg es among su geons
Sakshi Gopal Bhimjiyani 1, *, Asmi a Ashok kadel 2 and Kalyani Jaywan Nagulka 3
1 BPTh In e n, D . Ulha Pa il College o Physio he apy, Jalgaon, Maha ash a, India.
2 MPTh in Paedia ic and Rehabili a ion, S ini as uni e si y, Mangalo e, Ka na aka, India.
3 MPT in Neu oscience, MUHS, Nashik, Maha ash a, India.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 095-100
Publica ion his o y: Recei ed on 24 No embe 2024; e ised on 28 Decembe 2024; accep ed on 31 Decembe 2024
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.21.1.1114
Abs ac
Objec i es: This s udy examined he p e alence o inge dex e i y p o iciency using Nine-hole peg es among
su geons.
Me hods: The pu pose & p ocedu e o he s udy was explained o pa icipan s. Subjec s we e sc eened acco ding o
inclusion & exclusion c i e ia, a w i en consen was ob ained, & he p ocedu e was explained o hem. Pa icipan
pe o med Nine-hole peg es acco ding o he no ms; p o iciency o inge dex e i y was concluded on he basis o age,
sex, and dominance.
Resul s: The esul indica es a signi ican dec ease in a e age inge dex e i y p o iciency (p< 0.003), pa icula ly in
dominan hand(p<0.001) among su geons.
Conclusions: The s udy concludes wi h a p e alence o educed inge dex e i y p o iciency among su geons,
pa icula ly in he dominan hand.
Keywo ds: Finge dex e i y; Su geons; Nine-hole peg es ; Coo dina ed con ol mo emen
1. In oduc ion
Dex e i y is abili y o ind a mo o solu ion o ex e nal si ua ion which adequa ely sol e an eme ging mo o p oblem
accu a ely, quickly, a ionally, and esou ce ully [1]. I is one o he unique cha ac e is ic o human beings which is
essen ial o accomplishing a ious ac i i ies o daily li e and occupa ions[2].I shows he ela ionship be ween he
ne ous sys em and skills and how success ully a pe son can de elop ce ain mo o skill and also he le el o pe ec ion
he o she is able o equi e .I equi es bo h g oss and ine hand mo ions and coo dina ion o i s pe o mance [3].The
e ec o dex e i y on hand-objec in e ac ions has been iden i ied by h ee main limi a ions, which includes cogni ion,
s eng h and dex e i y[1,2].Dex e i y is also impo an o minimize su gical damage as i is p oposed o be a cause o
many inju ies and o he e o s.[4,5] Though i is help ul h oughou medicine, and especially impo an in su gical
b anches[5].
The condi ions which may cause issues on one’s inge dex e i y ha p e en hem om ul illing hei occupa ions and
wo k asks include epe i i e mo emen s o inge s o long hou s, poo ly designed equipmen which does no i o he
indi idual’s physical needs [6]. I is also in luenced by a ious ac o s such as age, gende , dominance, e c. [4]
Su ge y is an a and acqui ing dex e i y is ad an ageous o a su geon and hey should acqui e he a o using he
ins umen s wi h nea ness, apidi y and ce ain y. Dex e i y should no be mis aken o echnical skill and he e appea s
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o be a e y hin line o dema ca ion be ween dex e i y and echnical skills. The use o bo h he hands du ing su ge y
de e mines he o e all quali y o he su gical p ocedu e and con idence in using bo h hands wi h equal p ecision
inc eases he e iciency o a su geons [7]. The su geons wo k in ol es p ecise, coo dina ed, ine mo o ac i i ies along
wi h he use o many delica e ins umen s and cogni i e skills [5]. A G ea hand g ip s eng h (HGS) and excellen
dex e i y a e wo o he majo skills equi ed o he su geons o pe o m complex su gical p ocedu es, bu i migh be
a gued ha su gical di e en ia ion has led o di e ences in bo h skills among su geons o a ious su gical speciali ies[8].
As o hopedic auma su geons egula ly pe o m su gical p ocedu es on ac u ed bony s uc u es using hei s eng h
and ela i ely hea y su gical ools, on he o he hand du ing ascula , oncological and gas o-in es inal su ge ies,
p ecisely coo dina ed mo emen s o he hands a e essen ial o pe o ming on he small s uc u es [6]. Basically,
Su geons ac oss di e en special ies ace unique challenges based on he na u e o hei wo k and he speci ic skills
equi ed.
The 9-Hole Peg Tes (9-HPT) is a b ie , simple, s anda dized and imed measu e es o uppe ex emi y unc ion and
dex e i y which use o assess he main aspec s in e e y pa icipan s like ine skill, coo dina ion and speed[9,2]. The
ad an ages o he NHPT include - i is simple, cheap and easily po able equipmen which is easy o adminis e and ime-
e icien , i also equi es a p ecise and coo dina ed inge mo emen s, and do no ely hea ily on mo e p oximal o axial
mo emen s ha could be used o compensa e o de ici s in ine mo o dex e i y[10,11]. The es equi ed a coo dina ed
con ol o he muscles o inge s and humb[2].
2. Ma e ials and Me hodology
2.1. Me hodology
• S udy design: C oss sec ional s udy.
• S udy se ing: D . Ulhas Pa il Medical Hospi al, Jalgaon
• S udy Du a ion: 6 mon hs
• Type o sampling: Con enien sampling
• S udy popula ion: Su geons
• Sample size: minimum sample size is 51.
• Place o s udy: D . Ulhas Pa il Medical Hospi al, Jalgaon.
2.2. Inclusion c i e ia
• Su geons (Gene al su geon, O hopedic su geon, Neu osu geon, gynecologis , oph halmologis , ENT su geon,
Neph ologis )
• In ol e in su ge y mo e han 6 mon hs (minimum 50 su ge ies done)
• Age 27yea & abo e.
• Pa icipan s willing o pa icipa e.
2.3. Exclusion c i e ia
• No in ol e in su ge y less han 6mon hs (less han 50 su ge ies done)
• Age below 27 yea s.
• Pa icipan s unde gone uppe ex emi y su ge y.
• Pa icipan s ha ing pa hological uppe ex emi y condi ions and diso de .
• Pa icipan s any se e e oph halmic diso de .
• Pa icipan s no ha ing adequa e sleep in las 24 hou s.
• Pa icipan s wi h CNS impai men s.
• Pa icipan s no willing o pe o m.
Ma e ials: Nine-hole peg boa d, Chai , Table, pape , pen, S opwa ch, Calcula o .
2.4. Ou come measu es
• Nine-hole peg es : The Nine Hole Peg Tes (NHPT) is an ins umen ha was de eloped o measu e inge
dex e i y ( ine manual dex e i y). The NHPT consis s o a squa e boa d composed o a small con aine wi h nine
holes and nine pegs a anged in a 3×3 squa e pa e n. NHPT is widely conside ed a gold s anda d me ic o
inge dex e i y because o i s simplici y, low cos , and sho ime o adminis e . Di e en e sions o he NHPT
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appa a us a e a ailable a ying in he ype o ma e ial, dimension o he su ounding su ace and he shape o
he con aine , bu no he size o he holes o pegs, no he dis ances be ween he holes(Figu e1) Ins umen s
ha o e s in o ma ion on mo o aspec s and le els o s a egy ha a ec he unc ionali y o he subjec s’
hands.
• Assessmen p ocedu e: We assu ed applican s du ing he consen p ocess ha he esul s o he es ing would
no ha e an impac on hei p ac ice. The pa icipan is asked o si com o ably on a chai wi h ee comple ely
in ouch wi h he loo . The pegboa d is cen e ed in on o he subjec , wi h he pegs placed in he con aine
nex o he boa d on he same side as he hand being es ed. The dominan hand was es ed i s . The ollowing
ins uc ions a e gi en o subjec s as he examine b ie ly demons a es he es : The subjec is asked o pick up
he pegs one a a ime, using he es ing hand, and pu hem in o holes a he maximum possible speed un il all
holes a e illed. Then pegs should be emo ed om he holes, one by one, and eplaced back in he con aine .
The s opwa ch is s a ed by he examine as soon as he subjec ouches he i s peg and s ops when he las
peg hi s he con aine . The con aine is hen placed on he opposi e side o he pegboa d. Regis e s he ime
ha he subjec akes o comple e he ask. This p ocess mus be done wi h bo h hands independen ly. The
dominan hand is es ed i s , ollowed by he non-dominan hand. The ime du a ion o each hand a e a e aged,
and he esul s a e in e p e ed based on gende , age, and dominance, using s anda d no ms.
3. Resul s and discussion
Table 1 Dominance wise
Dominance wise
No mal
Abno mal
Va iable
G oups
N
F equency
Pe cen age
F equency
Pe cen age
Mean
SD
alue
p alue
Dominance
Righ
48
2
3.92
46
90.20
25.34
3.22
3.87
0.001
Le
3
0
0.00
3
5.88
27.36
0.41
Commen - Unpai ed es was used o compa e means. Tes s a is ics alue o es was 3.87 wi h p alue 0.001. He e p alue less han 0.05, shows
signi ican di e ence in means.
In his s udy, a o al numbe o 51 su geons we e included. The esul indica es a signi ican dec ease in a e age inge
dex e i y (p< 0.003), pa icula ly in dominan hand(p<0.001) among su geons.
Table 2 Non dominance wise
Non-Dominance wise
No mal
Abno mal
Va iable
G oups
N
F equency
Pe cen age
F equency
Pe cen age
Mean
SD
alue
p alue
Dominance
Righ
48
3
5.88
45
88.24
26.95
3.89
0.01
0.990
Le
3
0
0.00
3
5.88
26.93
0.01
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Commen - Unpai ed es was used o compa e means. Tes s a is ics alue o es was 0.01 wi h p alue 0.99. He e p alue mo e han 0.05, shows
no signi ican di e ence in means.
Figu e 1 S a is ical analysis o dominan & non dominan hand
Table 3 O e all
O e all
No mal
Abno mal
Va iable
G oups
N
F equency
Pe cen age
F equency
Pe cen age
Mean
SD
alue
p alue
Gende
Male
30
1
1.96
29
56.86
26.77
4.03
0.41
0.684
Female
21
2
3.92
19
37.25
27.21
3.57
Commen - Pai ed es was used o compa e means. Tes s a is ics alue o es was 3.15 wi h p alue 0.003. He e p alue less han 0.05, shows
signi ican di e ence in means
Figu e 2 S a is ical analysis o o e all p esen a ion
The pu pose o ou s udy aimed o in es iga e inge dex e i y among su geons, ocusing on ac o s such as epe i i e
mo emen s, poo ly designed equipmen , and age, which highligh ed he impo ance o inge dex e i y in su ge y. The
p esen s udy used a wooden nine-hole peg es o measu e inge dex e i y and o unde s and be e senso y
in eg a ion by using a wooden se . As p e ious s udies ha e used de ices like he Pe due Pegboa d, he Minneso a Small
Pa s Tes , and he Impe ial College Su gical Assessmen De ice (ICSAD), which a e all s eel-based se s.
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This esea ch is aluable o unde s anding ha dex e i y declines wi h age due o changes in he ne ous, ascula , and
musculoskele al sys ems, muscle mass educ ion, senso y loss, and cold exposu e. These physiological changes can
impac hand unc ion, g ip s eng h, and p op iocep ion, as well as sleep dep i a ion and addic ions among su geons,
which ha e led o educed inge dex e i y.
Acco ding o he obse a ion o Muni a Abbas Hi kani and Jee end a Yogi, hey ound he e ec o sleep dep i a ion
(SD) on inge dex e i y du ing he esiden s' on-call pe iod and ound ha SD signi ican ly dec eased inge dex e i y
a he end o he 24-hou du y pe iod. The changes in inge dex e i y co ela ed nega i ely wi h subjec i e sleepiness
assessmen which signi ican ly dec eases inge dex e i y in esiden doc o s, po en ially causing medical e o s.
Ou analysis highligh s a signi ican dec ease in a e age inge dex e i y(p<0.003) among su geons, pa icula ly in he
dominan hand(p<0.001), bu no signi ican di e ence in local mean sco es ac oss age g oups o sexes. A su geon has
75% decision-making and 25% dex e i y, which inc eases e iciency. A s udy has ound ha expe ienced su geons can
pe o m asks in a be e way wi h hei dominan hand as compa ed o he non- dominan hand. The s udy also ound
a hin line be ween dex e i y and echnical skills and ha ambidex e i y is no limi ed o kno - ying o su u ing. Mo o
p ac ice induces plas ic changes in he p ima y mo o co ex, p omo ing mo o lea ning and pe o mance
imp o emen s bila e ally by imp o ing basic daily li e changes.
The wea and ea heo y, which ocuses on aging and join heal h, is applied o su geons due o hei epe i i e
mo emen s du ing su ge y. This can lead o join s ain, muscle a igue, cumula i e inju y, and dec eased pe o mance.
O e use o ce ain muscle g oups can weaken o he s, causing po en ial inju ies and dec eased e iciency. Ch onic
condi ions like ca pal unnel synd ome o os eoa h i is can also impac su geons' abili y o pe o m p ocedu es
e ec i ely. As wea and ea accumula e lipo uscin, su geons may expe ience dec eased dex e i y, inc eased pain, and
educed s amina, ul ima ely a ec ing su gical ou comes.
Su geons need ou s anding inge dex e i y o p ecision in hei ope a ions, honed h ough ex ensi e aining and
epe i i e asks. Howe e , o e use o s ain can diminish his dex e i y, highligh ing he physical demands o hei ole.
The s udy highligh s ha main aining inge dex e i y is c ucial o su geons o ensu e op imal su gical pe o mance.
Encou aging su geons o engage in ac i i ies ha enhance hei dex e i y can lead o signi ican imp o emen s in hei
p ac ice, ul ima ely bene i ing pa ien .
4. Conclusion
The s udy concludes wi h a p e alence o educed inge dex e i y p o iciency among su geons, pa icula ly in he
dominan hand.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o e hical app o al
The esea ch wo k ob ained e hical clea ance om he ins i u ional e hical commi ee.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
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