Co-Relation of Bmi and Specific Anthropometry On

RESEARCH PROPOSAL

CO-RELATION OF BMI AND SPECIFIC ANTHROPOMETRY ON

GRIP AND PINCH STRENGTH IN YOUNG ADULTS IN DAKSHINA KANNADA DISTRICT-A CROSS -SECTIONAL STUDY

MASTER OF PHYSIOTHERAPY IN MUSCULOSKELETAL DISORDERS AND SPORTS

(MPT)

MS. SNEHA BALAKRISHNAN

DEPARTMENT OF PHYSIOTHERAPY

FR. MULLER MEDICAL COLLEGE

MANGALORE-575002

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF CANDIDATE: / MS.SNEHA BALAKRISHNAN
DEPARTMENT OF PHYSIOTHERAPY
FATHER MULLER MEDICAL COLLEGE
MANGALORE-575002
2. / NAME OF INSTITUTION / FATHER MULLER MEDICAL COLLEGE (DEPARTMENT OF PHYSIOTHERAPY) MANGALORE
3. / COURSE OF STUDY AND SUBJECT / MASTER OF PHYSIOTHERAPY IN MUSCULOSKELETAL DISORDERS AND SPORTS.(MPT-MSS)
4. / DATE OF ADDMISSION TO COURSE / 01-06-2011
5. / TITLE OF TOPIC: / CO-RELATION OF BMI AND SPECIFIC ANTHROPOMETRY ON GRIP AND PINCH STRENGTH IN YOUNG ADULTS IN DAKSHINA KANNADA DISTRICT-
A CROSS -SECTIONAL STUDY
6.
7
8 / BRIEF RESUME OF THE INTENDED WORK.
6.1 NEED FOR THE STUDY:
Hand is an intricate part of upper extremity. It is a structure consisting of four digits and a thumb each functioning significantly different from each other. There is a good interplay of muscle groups-flexors and extensors. Functions of hand consist of Grasp, support, free movements, dexterity, expression and orientation.
Strength is a good indicator of hand function. Grip strength and pinch strength becomes an important part of hand assessment for estimation of hand function and proper integrity of the muscles.It is imperative to assess for grip and pinch strengths for rehabilitation of upper extremity work related musculoskeletal disorders, to diagnose and evaluate the level of indicating hand function for sports like wrestling, baseball, football ,tennis, badminton, boxing ,judo as well as to document ADL activities like eating and lifting heavy things.
Normative data for grip and pinch strength is important so as to predict strength in normal population in order to quantify the severity of hand injury and direct goal on specific rehabilitation and compare the deviations from the normal. A data on normative grip strength in india by Bansal.Nreported an average of 29.7900 kgs and 27.88 kgs for the dominant and the non dominant hands respectively This was however done on an age group of 18-25 years.1. In a given population there are many factors which may influence these measures of hand function .
The above said factors can be grouped in to basic body anthropometry and specific anthropometry.
1.Basic body anthropometry includes age ,gender ,hand dominance2, BMI,posture 3of shoulder,elbow,wrist angle.
A study by Hanten W.P., Chen W.Y.et al reveals that prediction equations –for
maximum grip strength were developed for the right and left hands on the basis of variables of
gender, height, weight, age and hand dominance4. According to their study men in the age group 55-59 and 60-64 had weaker grip strength when compared to men between the age group 20-54. Thus a high co-relation of grip strength is found in the age group 20-40 yrs.4,5,6
Body height and weight are directly co-related to grip strength.1,7Body mass index was found the strongest predictor of grip strength 7,8,9,10 .Higher BMI is seen under 25 and over 70 yrs age group and is weakly positively co-related to higher grip strength and higher BMI between the age group 25-70 yrs shows a low co-relation to grip strength. Westropp N.M., Gill T.K. et al 9 however could not fully explore the relationship of BMI and grip strength .
Researchers have found that there is geographical variation in body mass index in Africa,India,China,Australia,America,Carribean,Asia . Thus becomes the need to find a co-relation of grip strength to BMI in the Indian population.
2.Specific anthropometry- Anthropometry is a branch of ergonomics that deals with study of human body measurements which includes body variations like shape ,size,circumference,length,breadth and depth and related to head, arms,hands,leg, foot.It includes skinfolds,body composition(fat mass,bone mineral content, lean mass). Specific anthropometry in the hand is more related to hand dimensions like ,hand span, hand length,palm length and hand width .
Researchers have over the ages explored the influence of specific anthropometry on grip strength .Palm length is the lowest in 3 yr olds and 5 yr olds had stronger and larger hands.11.Hand length which is a combined length of the palm as well as the digit length has also shown a co-relation to grip strength.12.
In women age 20-80 yrs optimal grip span (position where maximum grip strength is
obtained) is influenced by hand span13,14,15 . The handle span affect the submaximal and maximal grip force.16.Significant differences in height,weight,BMI,hand length,hand breadth
in right dominant and left dominant female labourers between the age group 18-40 yrs have been found 10 signifying that these factors play a major role in the middle age group.
A study by Gunther CM, Burger A, Rickert M and Schulz C.U. shows a positive co-relation of hand span with key pinch strength in the age group 20-95 yrs.17 . A study by Shivers C.L. ,Mirka G.A. and Kaber D.B. shows effect of lateral pinch grip span with maximum effort of lateral pinch grip strength.18.Thus there exist a relationship between lateral pinch grip span and lateral pinch strength.
Hand dimensions behave similarly like BMI and are linked to ethnicity,12 which shows differences within the same population. Thus becomes the need to find a co-relation of grip and pinch strength to specific anthropometry .
There is a dearth of literature to explore the effects of these factors on grip and pinch strength in an indian population.The information regarding the grip strength ,pinch strength and various variables is minimal from india and to be more specific in dakshina Karnataka.. Thus becomes the need to find grip and pinch strength and its co-relation on body mass index and specific anthropometry in dakshina Karnataka.
OPERATIONAL DEFINITION:
Young adults would include subjects in the age group of 20-40 years from Dakshina Kannada District.
RESEARCH QUESTION:
Is there any co-relation of BMI and specific anthropometry on grip and pinch strength in young adults in Dakshina Kannada District ?
HYPOTHESIS:
There is co-relation of BMI and specific anthropometry on grip and pinch strength in young adults in Dakshina kannada District.
NULL HYPOTHESIS
There is no co-relation of BMI and specific anthropometry on grip and pinch strength in young adults in Dakshina Kannada District.
6.2 AIMS AND OBJECTIVES OF THE STUDY :
1.To find out co-relation of BMI on grip and pinch strength.
2. To find out co-relation of specific anthropometry on grip and pinch strength.
6.3 REVIEW OF LITERATURE :
Grip strength means the ability of the hand to hold the objects , Pinch strength is the maximimum voluntary contraction force between the thumb and index finger.Functions of hand consists of Grasp ,support, free movements ,dexterity ,expression and orientation.Grasp (prehension) means taking objects in hand and it will vary with size,shape,weight and solidity of the object.There are two types of grip-power grip and precision grip.
A Power grip
In this there is forceful flexion of finger joints with maximum voluntary force that the subject is able to exert.Full contact with palm and thumb adducted, there are 4 types of power grip-cylindrical ,spherical,hook and lateral prehension.19
B. precision grasp
Includes fine movements .which includes contact between thumb and finger.Three varieties of precision grip-pad to pad prehension,tip to tip prehension and pad to side
prehension.In hand assessment power grip is determined by grip strength and precision grip by pinch strength.
There are many predictors of grip strength like age , body mass index,hand dominance,gender,position of shoulder elbow wrist angle,hand length,hand span, hand breadth, palm length.
Basic body anthropometry includes body mass index,age,gender ,position of
shoulder,elbow and wrist angle. A study by Hanten W.P., Chen W.Y. et al reveals that prediction equations –for maximum grip strength were developed for the right and left hands on the basis of variables of gender, height, weight, age and hand dominance4 .55-59 and 60-64 year age groups of men shows a low co-relation of grip strength than in the younger age groups-20-54 yrs.Thus a high co-relation of grip strength is found in the age group 20-40 yrs.4,5.,6.
Semproli S, Brasili P, Toselli S et al investigated the relationships between hand grip strength and pinch strength with basic body (height,body mass,BMI)) and with specific hand anthropometric parameters (fingers spans, lengths and perimeters) in prepubertal children 6-10 yr old.BMI was found the strongest predictor of grip strength.In children, the basic anthropometric parameters (body height and BMI) contribute more to the prediction of handgrip strength than the specific anthropometric parameters. With increasing age the contribution of basic and specific hand anthropometry increases and the relation between anthropometry and handgrip strength is stronger in boys compared with girls.8
Westropp N.M. et al proved that higher hand grip strength was weakly related to higher BMI in adults under the age of 30 and over the age of 70, but inversely related to higher BMI between these ages.9
Specific anthropometry includes hand dimensions like hand length,hand breadth,palm
length , hand span. Koley.S and Kaur.N showed association of grip strength with five
anthropometric traits like height,weight,body mass index,hand breadth and hand length on 100 women as labrourers and 100 sedentary women in the age group 18-40 yrs.Significant differences in height,weight,BMI,hand length,hand breadth in right dominant and left dominant female labourers between the age group 18-40 yrs have been found.10
Bear L.J, Kafko M, Mah L et al performed a study on hand grip strength and hand size among preschoolers.This study consist of 81 preschool children and tested using standard conditions for grip strength ,pinch strength and hand size.(hand span) Hand size and hand strength were found to increase with each age.The 5 yr olds have strongest grip and pinch ability and larger hands than the 3yr olds and 4 yr olds.11
Castillo M.J., Ruiz J.R. et al investigated which position (grip span) on the standard grip dynamometer results in maximum grip strength in the age group 20-80 yrs.This occurs for both men and women. In men the optimal grip span is a fixed value (5.5 cm) and is not influenced by hand size. In women the optimal gripspan is influenced by hand size; this implies the need of adapting the dynamometer grip span to the handsize.13
A study on key pinch in healthy adults and normative values was done by Gunther C.M, Rickert M et al in the age group- 20-95 yrs. Variables such as forearm length,forearm circumference and hand size showed a positive co-relation with key pinch strength.Since the correlation between age and key pinch was similar in both genders, showing a continuous decrease of strength from the fifth decade of life on, key pinch seems independent from gender-specific hormonal changes17.Hager-Ross C and Rosbald b provided norms for grip strength in children aged 4-16 yrs and shows that strong co-relations exist between grip strength and anthropometric measures in particular height,weight and hand length.20
Hand assessment is important part of hand rehabilitaion and performed with various
instruments like MartinVigorimeter21,Jamar dynamometer and Pinch gauge. Bravo.G,Dutil E et al compared Martin Vigorimeter and Jamar Dynamometer for grip strength measurements
in the adult population 60-94 yrs. It showed high co-relation between the two measures.Grip strength measured by Jamar Dynamometer is even more dependent on specific anthropometry than measurements with Martin Vigorimeter.22 .Jamar Dynamometer and Pinch gauge demonstrate the highest accuracy of the instruments tested for evaluation of grip and pinch strength23,24
Mathiowetz V,Weber K,Volland G and Kashman N 23 shows high interrater reliability (r=0.99) and test retest reliability(r=0.82-0.91) and high co-relation when mean of three trials was used for jamar dynamometer and pinch gauge. Jamar dynamometer consists of a dial and kept at second handle position .The above study shows reliability and validity of four tests of hand strength-palmar pinch,grip,tip pinch and key pinch. Stegink C.W., Simper V.K., Stuart H.G. and Pinkerton H.M. shows low co-relation of key pinch strength in supinated position, finger tip pinch low co-relation in pronation position and three jaw chuck shows no statistical significance in any of the forearm position.26
MATERIALS AND METHODS :
7.1 SOURCE OF DATA : Community dwelling young adults in the age group 20-40 yrs will be recruited from colleges, bank and shopping malls.
7.2 METHODS OF COLLECTING DATA :
STUDY DESIGN :A cross sectional study design
SAMPLE PROCEDURES: Purposive sampling
SAMPLE SIZE: Subjects will be divided in to 4 interval of 5 yrs of each in the age group 20-40 yrs. 18 is the minimum required sample size of males and females .Thus 36 is the sample
size of each interval according to 80% power and 0.05 level of significance. For this
study we will have 25 subjects of males and females in every interval, thus 50 from each class
interval will be taken,Therefore the entire study would be recruiting 200 subjects.
INCLUSION CRITERIA :

• Normal healthy subjects(20-40 yrs ,both male and female)

• Right and left dominant individuals

EXCLUSION CRITERIA :

• Work related musculoskeletal disorder affecting the upper limb.
• Ambidextrous individuals
• Pain in the upper extremity
• Any restriction in the range of motion of upper limb especially shoulder,elbow and wrist that interferes with position of grip strength
• Neuromuscular disorders or system pathology that affects grip strength.

OUTCOME MEASURES :

• Body weight measured by weighing scale.

• Body height measured by stadiometer,

• Hand span measured by ruler .

• Digit length,palm length and hand width by inch tape.

• Hand grip strength by Jamar Dynamometer.

• Pinch strength by Pinch gauge

METHOD OF THE STUDY:








Weight:
Subject will be asked to stand on the weighing scale without shoes and heavy garments.Facing forward with both feet solidly on the scale and the weight is evenly distributed between the feet. The balance bar will be aligned and thus calibration of weighing scale will be done before each measurement and maintain the neutral at zero. The subject’s weight will be recorded in kg.
Height
The height will be measured by stadiometer which is taped vertically to the hard flat wall surface with the base at floor level.Participants will be asked to remove their shoes and wiil be measured in cm.The participant will be asked to stand with his/her back to the height rule. The back of the head, back, buttocks, calves and heels should be touching the upright, feet together.
Body mass index
Body mass index will be calculated by weight (kg)/height2(m).
Hand span
Hand span will be measured by the linear distance between thumb and little finger with stretched hand placed on metric ruler.
Digit length
Digit length will be measuredby inch tape from the proximal flexion crease at the base of every digit to the tip of that digit.
Palm length
Palm length is the distance between distal flexion crease at the wrist and proximal flexion crease of middle finger.
Hand length
Hand length calculated by summation of the palm length and digit length of 3rd metacarpal.
Hand width
Hand width defined as the distance between the radial side of the second metacarpal joint to the ulnar side of fifth metacarpal joint.
Grip strength
Grip strength will be tested in fundamental testing position with Jamar Dynamometer as recommended by American Society of hand therapist-Seated with shoulder adducted neutral rotation,elbow flexed to 900 and forearm in neutral position,wrist between 00 and 300 dorsiflexion and between 00 and 150 ulnar deviation.25 Subjects will be asked to give their maximum force in one single effort when tested thrice. Grip strength will be recorded in kgs.Hand will be choosen alternately .Demonstrations will be given and then instructed holding it properly – and say” squeeze as hard u can” .As the subject begin to squeeze the
examiner will say ” harder ….harder and then stop”.Three trials will be performed alternating
one hand to the other and 15 secs rest will be given between each trial. Thus average of the three trials will be taken.
Pinch strength
Pinch gauge will be the instrument to find an accurate measure of pinch strength. Three pinch strength –key pinch,three fingered pinch and finger tip pinch will be tested with the instrument in a standard position.Standard position of testing will be followed with shoulder adducted neutral rotation,elbow flexed to 900 and forearm in midprone position and wrist between 00 and 300 dorsiflexion and 00 and 15 0 ulnar deviation. . Thus all pinches will be tested in forearm midprone position. Three trials will be given and average of the three trials will be taken.
DATA ANALYSIS:
1.Demographic data will be summarized using descriptive statistics
2.Co-relation of BMI and specific anthropometry on grip strength will be done using multivariate analysis of variance.
7.3 Does the study require any investigation or intervention to be conducted on patients or animals ?
Yes
7.4 Has ethical clearance been obtained from your institution in case of 7.3 ?
Yes
LIST OF REFERENCES :
1.Bansal N.Hand grip strength:Normative data for young adults. Indian journal of physiotherapy and occupational therapy.2008;2(2):29-33.
2.Koley S.and Singh A.P.Effect of hand dominance in Grip strength in Collegiate population of Amritsar,Punjab,India.The Anthropologist.2010;12(1):13-16.
3.Kattel B. P.,FredericksT. K., Fernandez J.E.and Lee D.C.The effect of upper-extremity posture on maximum grip strength.The international Journal of industrial ergonomics.1996;18:423-429.
4.Hanten W.P.,Chen W.Y.,Austin A.A.,Brooks R.E. et al. Maximum grip strength in normal subjects from 20-64 years of age. J Hand Ther.1999;12(3):193-200.
5.Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M and Rogers S: Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil .1985;66:69-72.
6.Crosby C.A.,Wehbe M.A. and Mawr.B.Hand Strength: Normative Values.J Hand Surg. 1994;19:665-670.
7.Koley.S and Melton.S.Age –related changes in handgrip strength among healthy Indian males and females aged 6-25 yrs. J Life Sci .2010;2(2):73-80.
8.Semproli S,Brasili P,Toselli S,Ventrella AR et al.The influence of anthropometric characteristics to the handgrip and pinch strength in 6-10 yr old children.Anthropol Anz.2007;65(3):293-302.
9.Westropp.N.M. ,Gill T.K. ,Hill.C.L. et al. Hand Grip Strength: age and gender stratified normative data in a population-based study.BMC Research Notes. 2011;4:127.
10.Koley.S and Kaur.N. A Study on Hand Grip Strength in Female Labourers of Jalandhar, Punjab, India.J Life Sci.2009;1(1):57-62.
11.Bear L.J,Kafko M ,Mah L,MosqueraL and Reilly B.An exploratory look at hand strength and hand size among preschoolers.J Hand Ther .2002;15(4):340-6.
12.Clerke A.M.,Adams.R.D. and Clerke J.P. Effects of Hand Shape on Maximal Isometric Grip Strength and its Reliability in Teenagers. J Hand Ther. 2005;18:19–29.
13.Ruiz J.R., Mesa J.L., Gutiérrez A and Castillo M.J. Hand size influences optimal grip span in women but not in men.J Hand Surg .2002;27:897-901.
14.Ruiz J.R., Romero V.E., Ortega F.B., Sjöström M, Castillo M.J. and Gutierrez.A.Hand Span Influences Optimal Grip Span in Male and Female Teenagers.J Hand Surg. 2006;31:1367–1372.
15.Romero V.E, Artero E.G., Pasias A.S., Gutierrez.A, Castillo M.J. and Ruiz J.R. Hand Span Influences Optimal Grip Span in Boys and Girls Aged 6 to 12 Years. J Hand Surg .2008;33:378 – 384.
16.Oh S,Radwin RG.Pistol grip power tool handle and trigger size effects on grip exertions and operator preference.Hum Factors.1993;35(3):551-69.
17.Günther C.M,Bürger A,Rickert M and Schulz C.U. Key pinch in healthy adults:normative values.J Hand Surg .2008;33(2):144-8.
18.Shivers C.L., Mirka G.A., Kaber D.B..Effect of grip span on lateral pinch strength. Hum Factors. 2002;44(4):569-77.
19.LinK ,Lukens S,Bush MA.Spherical grip strength in children 3-6 yrs of age.Am J Occup Ther.1995;49:318-26.
20.Häger-Ross C and Rösblad B.Norms for grip strength in children aged 4-16 years.Acta Paediatr. 2002;91(6):617-25.
21.Backman C and Daniels L.E.A descriptionof grip and pinch strength in children aged 6 to 11 years using the Martin Vigorimeter. Canadian journal of occupational therapy.1996;63(4):235-244.
22.Hebert R,Bravo G,Dutil E and Desrosiers J.Comparison of the jamar dynamometer and the martin vigorimeter for grip strength measurements in a healthy elderly population.ScandJ Rehabil Med. 1995;27(3):137-43.
23.Mathiowetz V. ,Weber K, Volland G and Kashman N.Reliability and validity of hand strength evaluation. J Hand Surg. 1984;9(2):222-6.
24.Hazel D.L.,Laura Bix and Kratt.A.Interrater reliability of students using hand and pinch dynamometers. Journal of Occupational Therapy .2002 ;63(2):193-7.
25.Balogun JA,Akomolafe CT and Amusa LO.Grip strength: effects of testing posture and elbow position.Arch Phys Med Rehabil.1991;72(5):280-3.
26.Stegink C.W.,Simper V.K.,Stuart H.G.and Pinkerton H.M. Measurement of maximum voluntary pinch strength:effects of forearm position and outcome score.J Hand Ther .2003;16:326-336.
APPENDIX 1
CONSENT FORM
I______hereby agree to provide my fullest consent and cooperation a subject for the dissertation work of Ms. Sneha Balakrishnan titled
“ Co-relation of BMI and specific anthropometry on grip and pinch strength in young adults in Dakshina Kannada District-a cross –sectional study” as a part of her post graduation in physiotherapy.The question and queries I have posed have been answered to my satisfaction and I am aware that my identity will be kept confidential. I am also aware that I can discontinue the study at any time I wish to do.
Date:
Place Signature:
APPENDIX 2
PROFORMA
Name Age Gender
Hand dominance :
Date of birth Date of evaluation
Body height ( CM): Body weight( KG):
BMI=
RIGHT HAND / LEFT HAND
Grip Strength / Trial 1 / Trial 2 / Trial 3 / Trial 1 / Trial 2 / Trial 3
Average
Pinch Strength / Trial 1 / Trial 2 / Trial 3 / Trial 1 / Trial 2 / Trial 3
1.Finger Tip
Pinch
2.Key Pinch
3.Three Fingered Pinch
Average
Specific Anthropometry / Right / Left
TRIAL 1 / TRIAL 2 / TRIAL 3 / AVERAGE / TRIAL 1 / TRIAL 2 / TRIAL 3 / AVERAGE
Hand Span
Palm Length
Digit Length
1.Thumb
2.Index Finger
3.Middle Finger
4.Index Finger
5.Little Finger
Hand Length
Hand Breadth