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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
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 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.
Another study done by (Ke Li et al, 2010), was to analyze correlations between anthropometric data and
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).
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.
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
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 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.
Another study done by (Ke Li et al, 2010), was to analyze correlations between anthropometric data and
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
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.
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
To determine the association of
dominant hand grip strength with
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
To determine the association of
dominant hand grip strength with
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.
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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.
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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
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Shurrab, M., Mohanna, R., Shurrab, S. and Mandahawi, N. (2015). Experimental design to
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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
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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
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