Validity and reliability of the Box and Block Test for individuals with schizophrenia spectrum disorder

BackgroundThe Box and Block Test (BBT) is recognized for assessing manual dexterity; however, its reliability and validity, specifically for individuals with schizophrenia spectrum disorders, remain underexplored. The objective of this study was to establish the validity and reliability of the BBT f...

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Main Authors: Jing-Wen Su, Hsiang-Yu Chen, Kuan-Yi Li
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Psychiatry
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Online Access:https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1584352/full
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author Jing-Wen Su
Hsiang-Yu Chen
Hsiang-Yu Chen
Kuan-Yi Li
Kuan-Yi Li
Kuan-Yi Li
author_facet Jing-Wen Su
Hsiang-Yu Chen
Hsiang-Yu Chen
Kuan-Yi Li
Kuan-Yi Li
Kuan-Yi Li
author_sort Jing-Wen Su
collection DOAJ
description BackgroundThe Box and Block Test (BBT) is recognized for assessing manual dexterity; however, its reliability and validity, specifically for individuals with schizophrenia spectrum disorders, remain underexplored. The objective of this study was to establish the validity and reliability of the BBT for individuals with schizophrenia spectrum disorders.MethodsThis cross-sectional observational study was conducted in community psychiatric rehabilitation centers. The participants were individuals with schizophrenia spectrum disorders, ranging in age from 20 to 65 years. A total of seventy participants underwent the BBT, Purdue Pegboard Test (PPT), and Minnesota Manual Dexterity Test (MMDT) to assess manual dexterity. The validity and reliability of the BBT were evaluated using Pearson correlation coefficient and intraclass correlation coefficient (ICC).ResultsThe BBT strongly correlated with the PPT across all subtests (p < 0.001) and demonstrated moderate to strong correlations with the MMDT, except for the two-hand turning subtest. Intra- and inter-rater reliability ICCs ranged from 0.80 to 0.95 (p < 0.05), and test-retest reliability ICCs were between 0.70 and 0.71 (p < 0.001). A notable moderate negative correlation was observed between manual dexterity performance and both the total score and the positive symptom subscale of the Brief Psychiatric Rating Scale-Chinese version (BPRS-C) (r = -0.42 ~ -0.56, all p <0.001). Additionally, there were significant low correlations between the BBT and monthly income (r = 0.29 ~ 0.30, all p = 0.01).ConclusionsBBT has good validity and reliability in individuals with schizophrenia. Thus, BBT has emerged as a more favorable option for clinical assessment, avoiding the limitations that hamper PPT and MMDT. The simplicity and rapidity of BBT, combined with the provision of normative data, support the creation of customized rehabilitation plans that are crucial for rehabilitation focused on vocational and daily living skills.
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spelling doaj-art-80aa7292a13f4ee58629ca0759f6c4eb2025-08-20T02:32:33ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-06-011610.3389/fpsyt.2025.15843521584352Validity and reliability of the Box and Block Test for individuals with schizophrenia spectrum disorderJing-Wen Su0Hsiang-Yu Chen1Hsiang-Yu Chen2Kuan-Yi Li3Kuan-Yi Li4Kuan-Yi Li5Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, TaiwanKangHsin Psychiatric Halfway House, Taoyuan, TaiwanYangFeng Psychiatric Community Rehabilitation Center, Taoyuan, TaiwanDepartment of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, TaiwanDivision of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanHealthy Aging Research Center, Chang Gung University, Taoyuan, TaiwanBackgroundThe Box and Block Test (BBT) is recognized for assessing manual dexterity; however, its reliability and validity, specifically for individuals with schizophrenia spectrum disorders, remain underexplored. The objective of this study was to establish the validity and reliability of the BBT for individuals with schizophrenia spectrum disorders.MethodsThis cross-sectional observational study was conducted in community psychiatric rehabilitation centers. The participants were individuals with schizophrenia spectrum disorders, ranging in age from 20 to 65 years. A total of seventy participants underwent the BBT, Purdue Pegboard Test (PPT), and Minnesota Manual Dexterity Test (MMDT) to assess manual dexterity. The validity and reliability of the BBT were evaluated using Pearson correlation coefficient and intraclass correlation coefficient (ICC).ResultsThe BBT strongly correlated with the PPT across all subtests (p < 0.001) and demonstrated moderate to strong correlations with the MMDT, except for the two-hand turning subtest. Intra- and inter-rater reliability ICCs ranged from 0.80 to 0.95 (p < 0.05), and test-retest reliability ICCs were between 0.70 and 0.71 (p < 0.001). A notable moderate negative correlation was observed between manual dexterity performance and both the total score and the positive symptom subscale of the Brief Psychiatric Rating Scale-Chinese version (BPRS-C) (r = -0.42 ~ -0.56, all p <0.001). Additionally, there were significant low correlations between the BBT and monthly income (r = 0.29 ~ 0.30, all p = 0.01).ConclusionsBBT has good validity and reliability in individuals with schizophrenia. Thus, BBT has emerged as a more favorable option for clinical assessment, avoiding the limitations that hamper PPT and MMDT. The simplicity and rapidity of BBT, combined with the provision of normative data, support the creation of customized rehabilitation plans that are crucial for rehabilitation focused on vocational and daily living skills.https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1584352/fulldexteritymental illnessMinnesota Rate of Manipulation Testhand functionMinnesota Manual Dexterity TestPurdue Pegboard Test
spellingShingle Jing-Wen Su
Hsiang-Yu Chen
Hsiang-Yu Chen
Kuan-Yi Li
Kuan-Yi Li
Kuan-Yi Li
Validity and reliability of the Box and Block Test for individuals with schizophrenia spectrum disorder
Frontiers in Psychiatry
dexterity
mental illness
Minnesota Rate of Manipulation Test
hand function
Minnesota Manual Dexterity Test
Purdue Pegboard Test
title Validity and reliability of the Box and Block Test for individuals with schizophrenia spectrum disorder
title_full Validity and reliability of the Box and Block Test for individuals with schizophrenia spectrum disorder
title_fullStr Validity and reliability of the Box and Block Test for individuals with schizophrenia spectrum disorder
title_full_unstemmed Validity and reliability of the Box and Block Test for individuals with schizophrenia spectrum disorder
title_short Validity and reliability of the Box and Block Test for individuals with schizophrenia spectrum disorder
title_sort validity and reliability of the box and block test for individuals with schizophrenia spectrum disorder
topic dexterity
mental illness
Minnesota Rate of Manipulation Test
hand function
Minnesota Manual Dexterity Test
Purdue Pegboard Test
url https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1584352/full
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