amuresearch.files.wordpress.com€¦ · web view2018. 4. 17. · 1.1 introduction. this chapter...

Association of dominant hand grip strength

withanthropometric measurements and Body Mass

Index

TABLE OF CONTENTS

CHAPTER I INTRODUCTION......................................................................................1

1.1 Introduction....................................................................................................1

1.2 Background of study.......................................................................................1

1.2.1 Body mass index (BMI)..............................................................................2

1.2.2 Forearm, wrist joint and palm circumference...........................................2

1.2.3 Middle finger and hand length..................................................................3

1.2.4 Hand grip strength....................................................................................4

1.3 Problem statement.........................................................................................5

1.4 Research question, objective and hypothesis.................................................7

1.4.1 Research question.....................................................................................7

1.4.2 General objective......................................................................................7

1.4.3 Specific objective......................................................................................7

1.4.4 Research hypothesis.................................................................................8

1.5 Significant of study..........................................................................................8

1.6 Limitation of study..........................................................................................9

1.7 Conceptual and operational definition...........................................................9

1.8 Conclusion.....................................................................................................11

CHAPTER II LITERATURE REVIEW...........................................................................12

2.1 Introduction..................................................................................................12

2.2 Literature review...........................................................................................12

2.2.1 Body mass index (BMI)............................................................................12

2.2.2 Forearm, wrist joint and palm circumference.........................................16

2.2.3 Middle finger and hand length................................................................19

2.3 Conceptual framework..................................................................................22

2.4 Summary.......................................................................................................23

CHAPTER III METHODOLOGY..................................................................................24

3.1 Introduction..................................................................................................24

3.2 Research design............................................................................................24

3.3 Research setting............................................................................................24

3.4 Population and sampling...............................................................................25

3.4.1 Population...............................................................................................25

3.4.2 Sampling.................................................................................................25

3.4.3 Sample size.............................................................................................26

3.5 Inclusion and exclusion criteria.....................................................................27

3.5.1 Inclusion criteria......................................................................................27

3.5.2 Exclusion criteria.....................................................................................27

3.6 Instruments...................................................................................................28

3.7 Precision and consistency.............................................................................30

3.8 Pilot study.....................................................................................................30

3.9 Data collection..............................................................................................30

3.9.1 Flow chart of data collection...................................................................31

3.10 Data analysis...............................................................................................32

3.10.1 Technique of data analysis....................................................................32

3.10.2 Dummy table........................................................................................33

3.11 Ethical consideration...................................................................................34

3.12 Summary.....................................................................................................34

REFERENCES...........................................................................................................35

APPENDIX A............................................................................................................38

GANTT CHART.....................................................................................................38

APPENDIX B............................................................................................................39

BUDGET...............................................................................................................39

APPENDIX C............................................................................................................40

INFORMATION FORM.........................................................................................40

APPENDIX D............................................................................................................41

CONSENT FORM..................................................................................................41

APPENDIX E............................................................................................................42

DATA COLLECTION FORM...................................................................................42

APPENDIX F............................................................................................................43

PERMISSION TO USE INSTRUMENT.....................................................................43

LIST OF TABLES

Table 1 Body mass index classification.....................................................................2

Table 2 Conceptual and operational definition......................................................10

Table 3 Technique of data analysis........................................................................32

Table 4 Demographic data.....................................................................................33

Table 5 Body mass index........................................................................................33

Table 6 Anthropometric measurement..................................................................33

Table 7 Hand grip strength measurement.............................................................34

LIST OF FIGURES

Figure 1 Examples of hand function.........................................................................1

Figure 2 Forearm, wrist joint and palm circumference............................................3

Figure 3 Middle finger and hand length...................................................................3

Figure 4 Hand dynamometer...................................................................................4

Figure 5 Conceptual framework.............................................................................22

Figure 6 Hand dynamometer with features...........................................................28

Figure 7 Hand dynamometer available at physiotherapy lab................................28

Figure 8 weight measuring machine......................................................................29

Figure 9 Measuring tape........................................................................................29

Figure 10 Flow chart of data collection..................................................................31

CHAPTER I INTRODUCTION

1.1 Introduction

This chapter describes background of study, problem statement, research objectives, research question

research hypothesis and lastly conceptual and operational definition for variables of this study.

1.2 Background of study

Hand grip is one of the actions that can be done by our fingers with the help of our thumb. Hand grip

play the major role on showing the strength of our muscle that located around the forearm region

especially the flexor palmar muscles. Grip strength is crucial for the human body while performing

prehensile and precision hand function (Khalid A Alahmari et al,2017). This is because only human can

perform hand grip and finger opposition movement due to our unique anatomical structure.

Hand grip finger opposition

Figure 1 Examples of hand function

Besides, hand grip is like one of the main indicator for testing the muscle power. Many studies have

correlated grip strength with various physical variables like nutritional status, bone mineral content, and

muscle strength (Khalid A Alahmari et al,2017). Some studies showed a significant age related increase

in absolute and relative hand grip strength irrespective of hand preference (Isa Sagiroglu et al,2016). But

the predominant factor that influencing hand grip strength remains unclear.

1

1.2.1 Body mass index (BMI)

The most common factor that has been discovering to put effect on hand grip strength is Body Mass

Index (BMI). BMI is calculated by weight of individual (kg)/height (m2). Many studies show that

increasing BMI corresponding on higher hand grip strength. This is due to, physical body composition

and people that has ideal and overweight BMI is proved to have better mineral uptake and bone

composition, thus ability to produce high grip strength more than the underweight people.

Table 1 Body mass index classification

1.2.2 Forearm, wrist joint and palm circumference

As for other causes that will put effect on hand grip strength that will be discuss in this study, are the

circumference of the hand structure such forearm, wrist joint and palm. These factors are being chosen

because of its anatomical function and it show direct result of the transverse structure of the hand.

Within these factors, we can easily relate whether transverse structure at different level of the hand will

influence dominant hand grip strength or not. Forearm and palm circumference will represent the

bulkiness of the hand and palm muscle meanwhile wrist joint circumference will represent the hand size

for each of the sample chosen.

2

Figure 2 Forearm, wrist joint and palm circumference

1.2.3 Middle finger and hand length

In contrast, longitudinal structure of the hand will be determined by the middle finger and hand length

respectively. These factors are chosen because middle finger length will determine the summation of

effort for stabilization of the hand. And, as the hand length, it will portray how long the force being

transmitted by the gripping effort, as individual that have longer hand length, there will have longer

pathway to grip the item that they need to hold. (Manjunath et al, 2014)

Figure 3 Middle finger and hand length

3

1.2.4 Hand grip strength

Hand grip strength measurement becomes reliable only when standardized method and calibrated

equipment are used, even when there are different assessors or different brand of dynamometer (Khalid

A Alahmari et al,2017).

Figure 4 Hand dynamometer

Hand dynamometer has been used to measure muscle strength, especially muscles that are strong

enough to exert force against the gravity. For research purpose, Jamar brand of dynamometer is always

being the main choice, because it can give the most accurate and acceptable measures of the grip

strength (Khalid A Alahmari et al,2017).

4

1.3 Problem statement

In general, everyone has the risk of injury regardless in any part of the body. Commonly distal part of

the body like hand and fingers are more prone toinjury. In rehabilitation process, people always neglect

the important of regaining hand functions. Component like gait training, body balancing and

coordination always be the priority of medical rehabilitation team to be development after an accident

or injury. An example in a trauma or motor vehicle accidents there will be a combination of multiple

injury involving and onset of the symptom to be appearing. The medical team will always focus on

bringing back the ability of walking, eating and other simple activity of daily living, but they all forgot the

important of hand grip function on each of the activity mention earlier.

Hand movement during walking help in body balance during walking, hand gripping and finger strength

help in eating process and to button up shirt, need good control of handgrip and hand function as well.

To be detail, there are a lot of factors that influence hand grip strength such body mass index and palm

circumference. But then, in these two mention factors, they are also conflict result based on prior

studies.

Across the studies, the contradict result is due to improper sampling chosen, studies that involve only

one race, age related and nutritional status factor among the sample chosen. Besides, study about hand

function is being monopoly by western country and less to be carried out by Asian population. On the

other hand, in the case of hand injury, people will have attention on treating the cause of the injury but

not consider the hand structure such finger and hand length and forearm circumference. With this

reason, there is less attention on relationship between hand structures and their impact on hand grip

strength.

For the target population, in this study, we will choose the sample from university students that age

more than 18 but less than 30. University student usually are from adolescent age group and they have

high percentage on performing active activities and more prone to get injuries. And as the age less than

18 and more than 30 can easily be influence by nutritional factor. The muscle content and element are

still immature and not fully develop in individual that are less than 18. Meanwhile, individual that age

more than 30, their aging process will start to develop.

5

To answer the entire question that arises from the problem and statement above, in this study we will

conduct a correlation cross sectional study focusing on several factors that influencing dominant hand

grip strength among Asia Metropolitan University student such forearm, wrist joint and palm

circumference, middle finger and hand length, and body mass index (BMI). All the factors will act as

independent variable and the hand grip strength will be the dependent variable that will be measured

using hand dynamometer. At the end, in this research, we will find the impact of each factor on the grip

strength of the dominant hand.

6

1.4 Research question, objective and hypothesis

1.4.1 Research question

1. Is there an association of dominant hand grip strength with body mass index (BMI)?

2. Is there an association of dominant hand grip strength with anthropometric measurement:

forearm, wrist joint and palm circumferenceand hand and middle finger length?

1.4.2 General objective

1. To determine the association of dominant hand grip strength with BMI and anthropometric

measurement.

1.4.3 Specific objective

1. To determine the association of dominant hand grip strength with body mass index (BMI).

2. To determine the association of dominant hand grip strength with anthropometric

measurement: forearm, wrist joint and palm circumference.

3. To determine the association of dominant hand grip strengthwith anthropometric

measurement: hand and middle finger length.

7

1.4.4Research hypothesis

1.4.4.2. Alternate hypothesis

1. Dominant hand grip strength has an association with Body mass index (BMI).

2. Dominant hand grip strength has an association with anthropometric measurement :forearm,

wrist joint and palm circumferenceand hand and middle finger length.

1.5 Significant of study

This research may contribute in exploring the ideal body mass index (BMI) that will produce the best

hand grip strength among the general population in Malaysia. Better understanding the important of

BMI will make our Malaysian population aware of having the ideal BMI and reason why we must

maintain it in orderto have optimum hand grip function.

Furthermore, this research will help to identify the factors that are on the human being itself that

affecting the hand grip strength. Many of us neglect the effects of maintaining the body measurement

due to lack in awareness about the important of hand grip strength and not realizing the contributing

factors that cause the hand grip to be reduce. Example of fracture or minor cuts that affect the forearm

circumference and length of the hand, usually people will always treat the main problem like undergo

surgery and rehabilitation process will only concentrate on regain back the hand function but not

considering about other factor such forearm circumference and hand length.

8

1.6 Limitation of study

a. This study does not consider on gender basis

b. This study does not consider ethnicity.

c. This study does not consider paediatric and geriatric group

1.7 Conceptual and operational definition

Variable Conceptual definition Operational definition

Body mass index (BMI) According to Merriam-Webster

dictionary,body mass index is a

measure of body fat that is the ratio

of the weight of the body in

kilograms to the square of its height

in meters.(Merriam-Webster

dictionary,2016)

In this study, body mass index is

defined basedon the formula=

weight(kg)/height(m)2.(khalid A

Alahmari et al, 2017)

Forearm cimcumference According to the free dictionary by

farlex, forearm circumference is the

measurement that being measure of

the circumference taken halfway

between the elbow and the wrist.

(The Free Dictionary By Farlex, 2017)

For this study, forearm

circumference is measurement that

we measured at a point 3 cm below

the cubital fossa using flexible

measuring tape (khalid A Alahmari

et al, 2017)

Wrist joint

cimcumference

Based on dictionary.com, wrist joint

circumference is the joint between

the distal end of the radius and its

articular disk and the proximal row

of carpal bones, except the pisiform

bone. Also called radiocarpal joint.

(Dictionary.com, 2017)

For this study, wrist joint

circumference isdetermined by the

circumference at wrist crease (Ali

Asghar fallahi et al, 2011)

Palm cimcumference Based on dictionary.com, palm

circumference is the part of the

inner surface of the hand that

For this study, palm circumference is

the distance between metacarpal-

phalangeal joint II-V (NASA

9

extends from the wrist to the bases

of the fingers. (Dictionary.com,

2017)

anthropometric source book, 1978)

Hand length According to the free dictionary by

farlex, The distance measured from

the end of the small wrist bone at

the base of the thumb to the tip of

the middle finger of the right hand,

palm turned up, with the fingers

extended and together.(The Free

Dictionary By Farlex, 2017)

In this study, hand length is

determine by the distance from

wrist landmark to dactylion-tip of

the middle finger (NASA

anthropometric source book, 1978)

Middle finger length According to Merriam-Webster

dictionary, middle finger length is

define as the midmost of the five

digits of the hand.(Merriam-

Webster dictionary,2016)

In this study, middle finger length is

determine by base of the middle

finger to the tip of the middle finger.

(Ali Asghar Fallahi, 2011)

Hand grip strength According to the free dictionary by

farlex, hand grip strength is defined

by the measurable ability to exert

pressure with the hand, fingers, or

both. It is measured by having a

patient forcefully squeeze, grip, or

pinch dynamometers; results are

expressed in either pounds or

kilograms of pressure. (The Free

Dictionary By Farlex, 2017)

In this study, hand grip strength is

determine by maximally squeeze the

handle of the dynamometer with

their dominant hand for 3 seconds

and this process was repeated for 3

times with 2 minutes rest period to

avoid effects of fatique. (khalid A

Alahmari et al, 2017)

Table 2 Conceptual and operational definition

10

1.8Conclusion

In conclusion, the background of the study is reviewed to have better understanding about the factors

that will influence dominant hand grip strength. The problems regarding the research topic were

discussed. Research questions and research objectives were formulated based on the problems that

were identified. Moreover, the significance of the study, limitations, conceptual and operational

definition is incorporated in this chapter. The next chapter will discuss about the literature review and

conceptual framework for this study.

11

CHAPTER II LITERATURE REVIEW

2.1 Introduction

This chapter will discuss about the literature reviewed by the researches that are related to research

topic which are factors that will influence hand grip strength and study related to hand grip strength.At

the end, conceptual framework will be discussed.

2.2 Literature review

2.2.1 Body mass index (BMI)

There is a lot of study done about effect of body mass index (BMI) on hand grip strength. One of it

recently done by (Khalid A Alahmari et al, 2017). He had done cross-sectional descriptive study on 116

healthy adult volunteers in Saudi Arabian males. This study basically correlates hand grip strength and

BMI using Pearson correlation coefficient. The results showing that BMI was significantly correlated with

hand grip strength.

The next study, done by (Diego Augusto Santos Silva et al, 2017) finds factors influence hand grip

strength among adolescents in a city in southern Brazil. He and his co-researchers comparing factor that

is BMI on hand grip strength base on two differences age group of adolescents that are 17-19 age group

and 14-16 age group. In their study, they concluded that 17-19 age group adolescents had significantly

higher body mass, BMI and hand grip strength (right, left and total). Meanwhile adolescent’s 14-16

group showing that they have low grip strength for boys and girls.In their study, they had used the

ANOVA type of statistical analysis and p-value was determined. Factor with p-value less that 0.05 were

significantly associated with the outcome.

In other research, comparing on different BMI group that is low, medium and high among 200 girls

participants randomly selected from Taiwan Shoufu University aged between 18-27, they come into

conclusion that there were significantly differences in hand grip strength among low, medium and high

12

BMI subjects, respectively. However, in this study, ANCOVA was based on covariance of sex, the three

groups did not show major variations in right HGS and left HGS. (Kun-His Liao, 2016)

Meanwhile in other study there is searching for relationship between BMI and hand grip strength of

population in Turkey. A sample of 211 (128 male and 83 female) volunteers aged between 18 and 69

were tested their static hand grip strength using Jamar hand dynamometer and measurement were took

placed. There we divided into different groups based on age, gender, BMI and anthropometric

measurement. In conclusion, they had decided that BMI for both gender females and males has

positively correlated with HGS. . (Mahmud Eksioglu, 2015)

On the other study, that conducted on 46 Jordanian college students. They found out that body mass

index (BMI) showing significant with the maximum voluntary contraction (MVC). By using the regression

model formula, researchers come into conclusion that BMI will affect the hand grip strength of an

individual. (Mohammed Shurrab et al, 2015)

In other study that aimed to find out the correlation between body mass index (BMI) and hand grip

strength. It was done on 40 males and 40 females on the age group of 17-19 years. This was a cross

sectional observational study which include healthy medical students for India population. Pearson’s

correlation coefficient test was applied to evaluate the correlation of BMI with hand grip strength. The

result shows that BMI shows high correlation for both gender males and females. (Manjunath et al,

2014)

In the meta-analysis, that which to determine whether grip strength changed on average over decades

at each of two age level (children and adolescent versus adult) in Canada and US. For each sex, weighted

least squares regression analysis were performed on mean grip strength values as reported in studies

conducted from 1960s onwards. In conclusion, researcher found that grip strength has been found to be

positively correlated with body weight. (Irwin W, Silverman, 2014)

Study done by (Ibegbu A. O et al, 2014) is to find out the relationship of body mass index (BMI)

association with hand grip strength of Nigerian students. The study involves 400 randomly selected

secondary school students in Kano Metropolis, Nigeria. The data analysis being used was Pearson’s

correlation coefficients to find out the correlation between BMI and hand grip strength. It may be

concluded that handgrip strength had strong positive correlation with BMI.

13

Next study was done by (Deepak G Bansode et al, 2014) and the aims were to find out the correlation of

BMI with the dominant hand grip strength. The cross-sectional study was to carry out by including 121

healthy adults, (76 males and 45 females). Pearson’s correlation coefficients and 5 th level of probability

was used to indicate the statistical significance. For conclusion, researchers proved that body height,

body weight and BMI have significant positive correlation of dominant hand grip strength for both

gender.

In other study done by (Alex de Andrade et al, 2013) is to find out relationship between hand grip

strength for both hand and BMI for Brazilian men. The study includes 1279 male that mean age is 27.15.

Statistical analysis being used is Spearman’s to find the correlation between BMI and both the hand grip

strength of man. In conclusion, a weak association was observed between the hand grip strength of the

dominant hand of Brazilian mean. Dominant and right hand showed greater grip strength compared to

non-dominant and left hands.

In a study done by (M. g. Hossain et al, 2012) that conducted to find out the effect of BMI on hand grip

strength among Malaysian population. 500 healthy volunteers recruited from the staff, medical students

and visitors of the University Malaya Medical Centre between January and April 2010. ANOVA was used

to find relationship of BMI and hand grip strength. Regression coefficient showed that height and BMI

were positively related to hand grip strength for both sexes.

Referring to other study that done by (Ali asghar et al, 2011), to find out effect of BMI on male hand grip

strength of athletes and non-athletes. Totally 80 subjects aged between 19 and 29 participated in this

study in two groups including hand grip related athletes n=40 and non-athletes n=40. Independent t test

was used to compare the means of BMI in the two groups. Pearson correlation test was used to evaluate

the correlation between variables. In conclusion, BMI significantly correlated with hand grip strength for

athletes but not correlated for non-athletes.

Another study done by (Ke Li et al, 2010), was to analyze correlations between anthropometric data and

maximal grip strength (MGS) to establish a simple model to predict ‘normal’ MGS. The study done on

100 populations and stepwise multiple linear regression analysis was selected as the data analysis. At

the end, researcher found out that BMI showing positive relationship with MGS.

14

Next, study done by (Baskaran C et al, 2010) was to find the correlation between body mass index and

hand grip strength in healthy normal adults. This study involves 229 subjects (115 males and 114

females) and hand grip strength was measured using modified sphygmomanometer. Stepwise multiple

regression analysis was used for the data analysis. At the end, researcher comes into conclusion that

BMI is important determinants of the handgrip evaluation.

Another study done by (Christian.M, 2008) was to update reference data of handgrip strength for

healthy adults of both genders spanning a wide age range and to analyze factors of influence.

Intraindividual and interindividual variations of grip strength and their relation to several

anthropometric factors were analyzed in a standardized manner for 769 healthy adults, women 403 and

men 366. Their aged are around 20-95 years old. One way ANOVA were chosen as the data analysis.

Body Mass Index showing positive correlation with grip strength.

15

2.2.2 Forearm, wrist joint and palm circumference

Many of priors study was done to find the relationship between forearm circumference, wrist joint

circumference and palm circumference on hand grip strength. One of it recently done by (Khalid A

Alahmari et al, 2017). He had done cross-sectional descriptive study on 116 healthy adult volunteers in

Saudi Arabian males. This study basically correlates hand grip strength and forearm circumference using

Pearson correlation coefficient. The results showing that forearm circumference was significantly

correlated with hand grip strength among the population selection for the study.

Meanwhile in other study there is searching for relationship between wrist joint and palm circumference

with hand grip strength of population in Turkey. A sample of 211 (128 male and 83 female) volunteers

aged between 18 and 69 were tested their static hand grip strength using Jamar hand dynamometer and

measurement were took placed. There we divided into different groups based on age, gender, BMI and

anthropometric measurement. In conclusion, they had decided that wrist joint and palm circumference

for females has positively correlated with HGS. On the other hand, the result also similar for males as

well, as wrist joint and palm circumference are positively correlated with HGS (Mahmud Eksioglu, 2015).

On different study done by (Vengata et al, 2015), is about finding the relationship between forearm

circumference with the hand grip strength. This study is one type of longitudinal study. In their result,

they come into conclusion that forearm circumference is also an important factor determining the grip

strength.

On the other study, that conducted on 46 Jordanian college students. They found out that palm

circumference showing significant with the maximum voluntary contraction (MVC). By using the

regression model formula, researchers come into conclusion that palm circumference will affect the

hand grip strength on an individual. (Mohammed Shurrab et al, 2015)

In other study that aimed to find out the correlation between forearm and hand circumference with

hand grip strength, was done on 40 males and 40 females on the age group of 17-19 years. This was a

cross sectional observational study which include healthy medical students of India population.

Pearson’s correlation coefficient test was applied to evaluate the correlation of forearm and palm

circumference with hand grip strength. The result shows that hand circumference shows strongest

correlation for both gender males and females. (Manjunath et al, 2014)

16

Study done by (Ibegbu A. O et al, 2014) is to find out the relationship of palm circumference with the



correlation coefficients to find out the correlation between palm circumference and hand grip strength.

It may be concluded that handgrip strength had strong positive correlation with palm circumference.

There is also study that done by (Rita S.Guerra et al, 2013) that find relationship between associated

factors and hand grip strength. This study conducted among 688 inpatient of university hospital. Type of

study is cross sectional study that range of aged is between 18-91 years old. In this study one of the

factors is wrist joint and palm circumference. By using Spearman correlation coefficients, wrist joint and

palm circumference significant value were calculated. At the end, researchers find out that wrist joint

shows negative association with HGS, meanwhile palm circumference shows positive association with

HGS.

Referring to other study that done by (Ali asghar et al, 2011), to find out effect of forearm, wrist joint

and palm circumference on male hand grip strength of athletes and non-athletes. Totally 80 subjects

aged between 19 and 29 participated in this study in such a way hand grip related athletes n=40 and

non-athletes n=40. Independent t test was used to compare the means of forearm, wrist joint and palm

circumference in the two groups. Pearson correlation test was used to evaluate the correlation between

variables. In conclusion, palm and wrist circumference significantly correlated with hand grip strength

for athletes but not correlated for non-athletes. Meanwhile, forearm circumference significantly with

handgrip strength for non-athletes but not correlated for athletes.


maximal grip strength (MGS) in order to establish a simple model to predict ‘normal’ MGS. The study

done on 100 populations and stepwise multiple linear regression analysis was selected as the data

analysis. In conclusion, hand, wrist joint and forearm circumference showing positive relationship with

MGS. Hand circumference showing the highest correlation.

On other cross-sectional study that was performed to compared hand anthropometric measurement

and grip strength among different sports groups. The study done on 145 basketball players, 133

volleyball players and 96 handball players between the age of 9-18. ANOVA for parametric condition and

kruskal-wallis variance analysis for groups which have nonparametric condition was performed. In

17

conclusion, researcher found that hand circumference put effect on hand grip strength across different

sports groups. (Cagatay et al, 2008).






Forearm, wrist joint and palm circumference showing positive correlation with grip strength.

18

2.2.3 Middle finger and hand length

There is a lot of study done to investigate and to find the relationship of middle finger length and hand

length with the hand grip strength. One of it recently done by (Khalid A Alahmari et al, 2017). He had

done cross-sectional descriptive study on 116 healthy adult volunteers in Saudi Arabian males. This

study basically correlates hand grip strength and hand length using Pearson correlation coefficient. For

the results and discussion part showing that hand length was significantly correlated with hand grip

strength. This shows that hand length of an individual plays a major role of influence factor that will

influence the hand grip strength.

Meanwhile in other study there is searching for relationship between hand lengths with hand grip

strength of population in Turkey. A sample of 211 (128 male and 83 female) volunteers aged between 18

and 69 were tested their static hand grip strength using Jamar hand dynamometer and measurement

were took placed. There we divided into different groups based on age, gender, BMI and

anthropometric measurement. In conclusion, they had decided that hand lengths for females has

positively correlated with HGS. On the other hand, the result also similar for males as well, as hand

length is positively correlated with HGS (Mahmud Eksioglu, 2015).

On different study done by (Vengata et al, 2015), is about finding the relationship between hand lengths

with the hand grip strength. This study is one type of longitudinal study. In their result, they come into

conclusion that hand lengths are also an important factor determining the grip strength of Malaysian

population.

On the other study, that conducted on 46 Jordanian college students. They found out that hand length

showing significant with the maximum voluntary contraction (MVC). By using the regression model

formula, researchers come into conclusion that hand length will affect the hand grip strength of an

individual. (Mohammed Shurrab et al, 2015)

19

Study done by (Ibegbu A. O et al, 2014) is to find out the relationship of hand lengths with the



correlation coefficients to find out the correlation between hand length and hand grip strength. It may

be concluded that handgrip strength had strong positive correlation with hand length.

There is also study that done by (Rita S.Guerra et al, 2013) that find relationship between associated

factors and hand grip strength. This study conducted among 688 inpatient of university hospital. Type of

study is cross sectional study that range of aged is between 18-91 years old. In this study one of the

factors is hand length. By using Spearman correlation coefficients, hand length significant value was

calculated. At the end, researchers find out that hand length shows positive association with HGS.

Referring to other study that done by (Ali asghar et al, 2011), to find out effect of middle finger and hand

length on male hand grip strength of athletes and non-athletes. Totally 80 subjects aged between 19

and 29 participated in this study in such a way hand grip related athletes n=40 and non-athletes n=40.

Independent t test was used to compare the means of middle finger and hand length in the two groups.

Pearson correlation test was used to evaluate the correlation between variables. In conclusion, hand

length significantly correlated with hand grip strength for athletes but not correlated for non-athletes.

Meanwhile, middle finger length did not show a significant correlation with hand grip strength for both

groups.


maximal grip strength (MGS) in order to establish a simple model to predict ‘normal’ MGS. The study

done on 100 populations and stepwise multiple linear regression analysis was selected as the data

analysis. In conclusion, hand length showing positive relationship with MGS.

On other cross-sectional study that was performed to compared hand anthropometric measurement

and grip strength among different sports groups. The study done on 145 basketball players, 133

volleyball players and 96 handball players between the ages of 9-18. ANOVA for parametric condition

and kruskal-wallis variance analysis for groups which have nonparametric condition was performed. In

conclusion, researcher found that hand length and middle finger length put effect on hand grip strength

across different sports groups. (Cagatay Barut et al,2008)

20






Hand length showing positive correlation with grip strength.

21

2.3 Conceptual framework

Figure 5 Conceptual framework

The conceptual framework consists of independent variable that is factors that influencing hand grip

strength. The independent variable will affect the dependent variable which is the hand grip strength. As

the outcome, we can find out and determine whether each of the factors list really affects the hand grip

strength.

22

Population

Factors influencing hand grip strength

1. Body mass index (BMI)

2. forearm circumference

3. wrist joint circumference

4. Palm circumference

5. hand length

6. middle finger length

Dominant hand grip strength

Find out each factor will affect the hand grip strength

(Yes / No)

2.4Summary

In conclusion, the literature review had discussed about articles that related and supported the topic

regarding the hand grip strength. Mainly articles being discussed that are related to factors that will

affect the hand grip strength. The articles also being divided into multiple sub topics that are body mass

index (BMI), forearm, wrist joint and palm circumference and middle finger and hand length. Lastly,

conceptual framework shows the relationship between independent, dependent variables and outcome

of the study.

23

CHAPTER III METHODOLOGY

3.1 Introduction

This chapter will discuss about the methodology used to carry out the research. These included research

design, study setting, population and sampling methods, inclusion and exclusion criteria, instruments

used for this study, precision and consistency of the instruments, pilot study, method of data collection,

and data analysis will be discussed in this chapter.

3.2 Research design

This is a quantitative study where cross-sectional design will be adapted. This design is suitable to

examine the correlation between body mass index and anthropometric measurement such forearm,

wrist joint and palm circumference, hand and middle finger length with dominant hand grip strength.

Researchers are going to use this design to understand the relationship between the factors list whether

it can influence the dominant hand grip strength.

3.3 Research setting

The research will be conducted in Asia Metropolitan University. Students that fulfilled the inclusion and

exclusion criteria will be selected as respondent and the entire data collection component will be done.

24

3.4 Population and sampling

3.4.1 Population

The population isactive students from Academic Affairs and Record of Asia Metropolitan University. The

population for this study is 447 students which is summation of the total active students until the month

of November 2017.

3.4.2 Sampling

The sampling method that will be used in this study is convenient sampling. This method is the easiest,

inexpensive, required less time to acquire and most commonly used in medical discipline. To reduce

sample bias, there are several steps to be taken such, inclusion and exclusion criteria of responded and

all the data collection process will be done at the same time for each responded. Besides, all the

measuring process will be taken at physiotherapy laboratory of Asia Metropolitan University at second

floor and in calm and quiet to avoid environmental bias. All the measurement taking process will be

carry out by one researcher to avoid double standard data bias and same measuring instrument will be

carried out along the study purpose to avoid instrument bias.

25

3.4.3 Sample size

This study will be use formula developed by Krejcie &Morgan (1970) to calculate the estimated sample

size. The formula and calculation for the sample size is shown as below:

n = Sample size that are required

X2 = The table value of chi-square for 1 degree of freedom at the desired confident level 0.50 (3.841)

N = The population size (447)

P = The proportion of population (assumed to be 0.50 as this would provide the maximum sample size)

ME2 = The degree of accuracy expressed as a proportion as 0.05

S = (3.841) (447)(0.50)(1-0.50) / [(0.05)(0.05)(447-1)] + [(3.841)(0.50)(1-0.50)]

S = 429.23175 / (1.115) + (0.96025)

S = 429.23175 / 2.07525

S = 206.8338…

S = 207 students

Thus, the sample size for students is 207 if population size, (N=447)

Attrition rate or drop out value for this study is determined by 20% of sample size. But since my study

Involve one time measurement, so the attrition rate will not beconsidered.

26

3.5 Inclusion and exclusion criteria

3.5.1 Inclusion criteria

1. Malaysian citizen

2. Aged between 18 and 30 years old

3. Able to understand and read English or Bahasa Malaysia language

4. Willingness to participate

3.5.2 Exclusion criteria

1. Any hand injury or surgery

2. Hand deformity

3. Any oedematous, vascular or inflammation condition of hand

4. History of neurological deficit

5. Neck related problem

6. Scars on the forearm and palm region

7. Skin related problems such rashes or sensitivity of skin region

27

3.6 Instrument

The instruments for this study are:

1. Jamar hand dynamometer

2. Weighting machine

3. Height measuring scale

4. Measuring tape.

1. For Jamar hand dynamometer, the components are peak-hold needle knob, handle position, handle,

post, guide and handle clip.

Figure 6 Hand dynamometer with features

Figure 7 Hand dynamometer available at physiotherapy lab

28

2. For weighting machine, the features are: Size: 25cm x 25cm x 2.5cm, Maximum capacity: 180kg,

Equipped with 4 high precision weight sensors, LCD digital display and Room temperature reminder.

Figure 8 Weight measuring machine

3. Meanwhile, height measuring scale is consist of 180 cm calibration, white background for easy

determine the value and easily sticker glue at the back.

4. For measuring tape, the components are push button, tape handle, plastic case and centimeter

calibration on the scale blade.The size is 1.5 M x 7.5 mm.

Figure 9 Measuring tape

29

3.7 Accuracy and consistencyAccuracy and consistency of all the instruments used in this study are of utmost importance. The

instrument is calibrated for accuracy. The pilot study has been done by using the instrument and reading

taken three times to check for consistency.

a. For the hand dynamometer, it is calibrated by the product company manufacture that is BASELINE

EVALUATION INSTRUMENT, once a year.

b. Meanwhile, for the weight measuring machine and height measuring scale, it is calibrated by the

company manufacture that is Malaysian Lazada that located at Subang Jaya, Selangor.

c. As for the measuring tape, it is calibrated by the product company manufacture that is DELI, located at

Kuala Lumpur.

3.8 Pilot studyPilot study will be carried out to identify any potential practical problems before carrying out the larger

scale study. It is done to examine the feasibility of the study. The other reasons to perform pilot study

are to evaluate whether the research protocol is workable and followed and the appropriateness of the

instruments used. The numbers of respondents for the pilot study are 10% from the sample size

(Connelly 2008). Pilot study will be carried out to 21 students who fulfilled all the criteria. The

researches will give brief explanation to the respondents before all the measuring taken procedure to be

done. All the value will be recorded and the respondents will be asked whether they are experience any

uncomfortable situation or any difficulty throughout the processes.

3.9 Data collectionResearches will identify eligible respondents according to the inclusion and exclusion criteria. If the

respondent is eligible, researches will approach and a brief explanation will be given to respondent for

their understanding about the research. The respondent will be asked to sign a consent form if they

agree to participate. The respondents need to fill their age, gender and dominant hand test will be done

before undergoing all the data measuring steps. If the responded are not eligible, do not agree to

participate and do not completely provide the data, they will be excluded from this study

30

3.9.1 Flow chart of data collection

YES NO

Figure 10 Flow chart of data collection

31

START

Identify eligible respondent from AMU students

Respondents are not eligible, do not agree to participate and do not

completely provide the data

Respondents will be excluded from the study

END

Height, weight, BMI, forearm, wrist joint and palm circumference, hand

and middle finger length and grip strength measurement of each respondent will be measured

Respondents will be asked to sign a consent form if they agree to

participate and dominant hand test will be done

Brief explanation will be given to respondent for their understanding

about the research

Respondents are eligible

3.10 Data analysisThe data will be analyzed using IBM SPSS STATISTICS (VERSION 21). The variables will be coded and

entered in the SPSS system database and the data will be cleaned. Descriptive and inferential analysis

will be performed to enable researches to obtain the frequencies, percentage, mean and standard

deviation of the major aim of the study. Significant level that will determine the normality of the

population data studied represents by the value p<0.05. Normality test will be carried out to fulfill the

terms for data analysis using parametric statistic to get the Test of normality Kolmogrov-Sminov and

Shapiro-Wilk table. After that, Pearson or Spearman correlation will be used on the data, based on the

normality.

3.10.1 Technique of data analysis

Table 3 Technique of data analysis

Research objectives Types of data Method of analysis Type of stastical

analysis

To determine the association of

dominant hand grip strength with

body mass index (BMI).

Classification of BMI

(categorical data)

Mean and standard

deviation,

Frequency and

percentage

Nominal



anthropometric measurement:

forearm, wrist joint and palm

circumference.

Forearm, wrist joint,

palm circumference

length (continuous

data)

Mean and standard

deviation,

Frequency and

percentage

Pearson / Spearman

Interval



anthropometric measurement: hand

and middle finger length.

.

Hand and middle

finger length

(continuous data)

Mean and standard

deviation,

Frequency and

percentage

Pearson / Spearman

Interval

32

3.10.2 Dummy table

a. Demographic data

Characteristics Variables (n) (%) Mean Standard

deviation

Age

Height

Weight

Gender Male

Female

Handeness Left

Right

Table 4 Demographic data

b. Body Mass Index

Characteristics Variables (n) (%) Mean Standard

deviation

BMI Underweight

Normal

Obese

Table 5 Body mass index

c. Anthropometric measurement

Characteristics Mean Standard deviation

Forearm circumference

Wrist joint circumference

Palm circumference

Hand length

Middle finger length

Table 6 Anthropometric measurement

33

d. Grip strength measurement

Hand grip

strength

Measurement (kg) Average Mean Standard

deviation1 2 3

Hand

dynamometer

Table 7 Hand grip strength measurement

3.11 Ethical consideration

The proposal will be sent to Ethics committee of faculty of health sciences (FOHS) for approval before

conducting the study. Clear explanation will be given to the respondents. Consent form will be given and

sign by the respondents if they are willing to join this study. Respondent can withdraw from the

research at any time. All data collected will be keep anonymous, labeled with numbers and keeps in the

envelope to ensure confidentiality. The study intends to meet the needs of pure academic and all the

information is confidential

3.12 Summary

In this chapter, the methodology for the study is discussed. Sample size for students calculated with

total number of 207 will be required to complete this cross-sectional study. The data will be analyzed

with IBM SPSS version 21 and the result will be present in a table using mean, standard deviation and

correlation analysis. The instrument that will be used for this study had been discussed in this chapter.

34

REFERENCES

Alahmari, K., Silvian, S., Reddy, R., Kakaraparthi, V., Ahmad, I. and Alam, M. (2017). Hand grip

strength determination for healthy males in Saudi Arabia: A study of the relationship with age,

body mass index, hand length and forearm circumference using a hand-held dynamometer.

Journal of International Medical Research, 45(2), pp.540-548.

Alex, D., Antonio, J., Breno. C., Myrin. A.,(2013). The relationship between hand grip strength

and anthropometric parameters in Men. Arch Med deporte. pp.160-164.

Ali. A., Ali. A., (2011). The effects of hand dimensions, Hand shape and some anthropometric

characteristic on handgrip strength in Male grip athletes and non-athletes. Journal of human

kinetic volume 29/2011. Pp.151-159.

Anon, (2017). [online] Available at: http://.Merriam-Webster dictionary [Accessed 5 Nov. 2017].

Anon, (2017). [online] Available at: http://The Free Dictionary By Farlex [Accessed 5 Nov. 2017].

Cagatay. B., Puar. D., Sibel. K.,(2008). Evaluation of hand anthropometric measurement and grip

strength in basketball, volleyball and hand ball players. International journal of Experimental

and clinical anatomy. Pp. 56-59.

Carrasco Poyatos, M., Navarro Sánchez, M., Martínez González-Moro, I. and Reche Orenes, D.

(2016). Daily physical activity impact in old women bone density and grip strength. Nutrición

Hospitalaria, 33(6).

Christian. M., Alexander. B., Marcus. (2008). Grip strength in healthy Caucasian adults:

Reference values. Journal of health sciences. pp.558-565

Deepak, G., Laxmikznt J,. Rasika D., (2014) Study of correlation between dominant hand’s grip

strength and some physical factors in adult males and females. International journal of pharma

research and health sciences, pp.316-323.

35

De Lima, T., Silva, D., de Castro, J. and Christofaro, D. (2017). Handgrip strength and associated

sociodemographic and lifestyle factors: A systematic review of the adult population. Journal of

Bodywork and Movement Therapies, 21(2), pp.401-413.

Dictionary.com. (2017). Dictionary.com - The world’s favorite online dictionary!. [online]

Available at: http://Dictionary.com [Accessed 5 Nov. 2017].

Ekşioğlu, M. (2016). Normative static grip strength of population of Turkey, effects of various

factors and a comparison with international norms. Applied Ergonomics, 52, pp.8-17.

Guerra, R., Fonseca, I., Pichel, F., Restivo, M. and Amaral, T. (2013). Handgrip Strength and

Associated Factors in Hospitalized Patients. Journal of Parenteral and Enteral Nutrition, 39(3),

pp.322-330.

Hemberal, M., Doreswamy, V. and Rajkumar, S. (2014). Study of correlation between hand

circumference and Maximum Grip Strength (MGS). National Journal of Physiology, Pharmacy

and Pharmacology, 4(3), p.195.

Ke. Li., David. J., Jacques. D., Jea-Y., (2010). Predicting maximal grip strength using hand

circumference. Journal of manual therapy. Pp.580-585.

Liao, K. (2016). Hand Grip Strength in Low, Medium, and High Body Mass Index Males and

Females. Middle East Journal of Rehabilitation and Health, 3(1).

Lindblad, A., Dahlin-Ivanoff, S., Bosaeus, I. and Rothenberg, E. (2013). PP022-MON BODY

COMPOSITION AND PHYSICAL FUNCTION IN HEALTHY COMMUNITY-DWELLING OLDER ADULTS

IN SWEDEN, A CROSS-SECTIONAL STUDY. Clinical Nutrition, 32, p.S131.

Manoharan, V., Sundaram, S. and Jason, J. (2015). FACTORS AFFECTING HAND GRIP STRENGTH

AND ITS EVALUATION: A SYSTEMIC REVIEW. International Journal of Physiotherapy and

Research, 3(6), pp.1288-1293.

36

M. G., R.Zyroul., B. P., Pereira., T.Kamarul. (2012). Multiple regression analysis of factors

influencing dominant hand grip strength in an adult Malaysian population. Journal of hand

surgery. Pp.66-70.

Nurul Shahida, M., Siti Zawiah, M. and Case, K. (2015). The relationship between

anthropometry and hand grip strength among elderly Malaysians. International Journal of

Industrial Ergonomics, 50, pp.17-25.

Oseloka, I., Bello, B., Oliver, H., Emmanuel, U. and Abraham, M. (2014). Association Of Handgrip

Strength With Body Mass Index Among Nigerian Students. IOSR Journal of Pharmacy and

Biological Sciences, 9(1), pp.01-07.

Shurrab, M., Mohanna, R., Shurrab, S. and Mandahawi, N. (2015). Experimental design to

evaluate the influence of anthropometric factors on the grip force and hand force exertion.

International Journal of Industrial Ergonomics, 50, pp.9-16.

Silva, D., Pelegrini, A., de Castro, J., de Lima, T., de Sousa, G., de Lima Silva, J. and Petroski, E.

(2017). Low handgrip strength levels among adolescents in a city in southern Brazil. Journal of

Bodywork and Movement Therapies, 21(4), pp.884-889.

Silverman, I. (2014). Age as a moderator of the secular trend for grip strength in Canada and the

United States. Annals of Human Biology, 42(3), pp.201-211.

37

APPENDIX A

GANTT CHART

ACTIVITY

2017 2018SEPT OCT NOV DEC JAN FEB MARCH APRIL MAY JUNE JULY

IDENTIFY TOPIC

REVIEW OF LITERATURE

WRITE RESEARCH PROPOSAL

PROPOSAL PRESENTATION

ETHICAL CLEARANCE

DATA COLLECTION

ANALYSES OF DATA

WRITING THESIS

(DRAFT 1)

WRITING THESIS

(DRAFT 2)

FINAL THESIS PRESENTATION

SUBMISSION OF THESIS

38

APPENDIX B

BUDGET

Items Price (RM) Quantity Total (RM)

Photocopy material 0.30

(10 cent for each pages)

207 62.10

Commitment fee and

goody bags

2.00 207 414.00

Grand total 476.10

39

APPENDIX C

INFORMATION FORM

To Asia Metropolitan University students, my name is Muhammad Razlany Bin Md

Rizam, final year student taking Bachelor of physiotherapy (Hons). In my final year of

study, I need to conduct one research work that is entitled “Association of dominant hand grip strength with anthropometric measurements and Body Mass Index”. My

research will be under supervision Associate Professor Kanaga Kumari Chelliah.

Here is basic information about my studies:

1. Respondent that are chosen for my study, are allowed to withdraw from

the research at any time.

2. All data collected will be keep anonymous, labeled with numbers and

keeps in the envelope to ensure confidentiality.

3. The study intends to meet the needs of pure academic and all the

information is confidential.

Any question regarding my research, can be ask directly from either me or my

supervisor. Thanks for the cooperation.

40

mailto:[email protected]

APPENDIX D

CONSENT FORM

ASIA METROPOLITAN UNIVERSITY CONSENT FORM

Association of dominant hand grip strength with anthropometric measurements and Body Mass Index

I confirm that I have read / been briefed regarding the procedures for the above study

and have had the opportunity to ask questions.

I understand that my participation in this study is voluntary and that I am free to

withdraw at any time, without giving reason

I agree to take part in the above study.

________________ _______________

Signature Date

________________ _______________

Muhammad Razlany Date

41

APPENDIX E

DATA COLLECTION FORM

*Age:

*Gender: Male /Female

BMI measurement:

Weight (kg) Height (m) Weight/height2

Anthropometric measurement:

Area Measurement (cm)

Forearm circumference

Wrist joint circumference

Palm circumference

Hand length

Middle finger length

Dominant hand grip strength:

*Dominant hand: Left / Right

hand grip

strength

Measurement (kg)

1 2 3 average

Hand

dynamometer

42

APPENDIX F

PERMISSION TO USE INSTRUMENT

Muhammad Razlany Bin Md Rizam

259 Lorong kenari 3,

Taman paroi jaya,

70400, Seremban, N.S.

Physiotherapy Lab,

Asia Metropolitan University,

Jalan Kemacahaya 11,

Taman kemacahaya, Batu 9,

43200 Cheras, Selangor.

Dear Sir / Madam,

REQUEST TO USE PHYSIOTHERAPY LAB EQUIPMENT AND PLACE FOR RESEARCH DATA COLLECTION

Referring to the above statement, I Muhammad Razlany Bin Md Rizam (01bf-201403-00006) currently studies for Bachelor of Physiotherapy (Hons), in year 4 semester 1. I would like to conduct my study entitle “Association of dominant hand grip strength with anthropometric measurements and Body Mass Index”.

2. As it is part of my curriculum for completion of my project, I would like to request to use the hand-held dynamometer and physiotherapy laboratory around 3 months for my data collection. Any damage to the facilities, I will take full responsibility.

Sincerely,

___________________________

Muhammad Razlany Bin Md Rizam

43

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