International Journal of Occupational Safety and

Ergonomics

ISSN: 1080-3548 (Print) 2376-9130 (Online) Journal homepage: http://www.tandfonline.com/loi/tose20

Impact of posture and upper–limb muscle activity

on grip strength

Rahul Jain, Makkhan Lal Meena, Manoj Kumar Sain & Govind Sharan
Dangayach

To cite this article: Rahul Jain, Makkhan Lal Meena, Manoj Kumar Sain & Govind Sharan
Dangayach (2018): Impact of posture and upper–limb muscle activity on grip strength, International
Journal of Occupational Safety and Ergonomics, DOI: 10.1080/10803548.2018.1501972

To link to this article: https://doi.org/10.1080/10803548.2018.1501972

Accepted author version posted online: 19

Jul 2018.

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Publisher: Taylor & Francis & Central Institute for Labour Protection – National Research Institute
(CIOP-PIB)
Journal: International Journal of Occupational Safety and Ergnomics
DOI: 10.1080/10803548.2018.1501972

Impact of posture and upper–limb muscle activity on grip strength

Rahul Jain*1, Makkhan Lal Meena2, Manoj Kumar Sain2, 3, Govind Sharan Dangayach2
1
Department of Mechanical Engineering, University Teaching Department, Rajasthan Technical
University Kota, Rawatbhata Road, Akelgarh, Kota, Rajasthan, India–(324010)
2
Department of Mechanical Engineering, Malaviya National Institute of Technology Jaipur, JLN
Marg, Malaviya Nagar, Jaipur, Rajasthan, India–(302017)
3
Department of Mechanical Engineering, Swami Keshvanand Institute of Technology,
Management & Gramothan, Jagatpura, Jaipur, Rajasthan, India–(302017)

SHORT TITLE: “Grip strength in manual working”

*Corresponding author: Rahul Jain, Assistant Professor (Temporary faculty), Department of

Mechanical Engineering, University Teaching Department, Rajasthan Technical University
Kota, Rawatbhata Road, Akelgarh, Kota, Rajasthan, India–(324010)
Telephone: +91–9460568520, E–Mail: rjmahesh207@gmail.com

Abstract:
Purpose: The current research was carried out to determine the grip strength (GS) with change
in posture and upper–limb muscle activity of manual workers and find out the impacts of these
changes.
Methods: For the current research, 120 male and 80 female participants were selected and GS
was assessed using digital hand grip dynamometer in various conditions.
Results: The outcomes showed that male participants had higher GS as compared to female
participants. Maximum GS was found in standing posture with the fixed forward shoulder in 45°,
elbow at 90° and neutral position of wrist and forearm for all participants.

1
Conclusions: Higher values of GS attained in standing postures which may results in attainment
of higher performance levels by the workers. The outcomes justify the importance of correct
postures during manual work in the industries employing traditional methods.

Keywords: agriculture; grip strength; manual workers; posture; upper limb–muscle activity.
WORD COUNT (Excluding tables and figures): 3599

ABSTRACT COUNT: 138

NUMBER OF FIGURES: 2

NUMBER OF TABLES: 6

1. Introduction
Consistent and effective assessment of grip strength (GS) is of great importance for the
evaluation of arm muscle strength [1]. Grip strength or grip force is the outcome of powerful
effort or maximum exertion applied by the human hand. The movement of extensor and flexor
muscles, and interaction in groupings of these muscles play a major role in the resultant GS [2].
GS is not only an indicator of the performance of worker, but it may also be utilized in
reduction/prevention of persistent illnesses, as muscular difficulty is strongly linked to practical
restrictions and physical incapacity [3]. GS is frequently used for checking the capacity/strength
level of hand in various practices like rehabilitation, therapy, etc. The principle/measure of these
practices includes identification of sickness level, assessment of the treatment process regarding
strength (pre– and post– condition of worker) and evaluation of muscle strength progress for
checking the risk in working of hand [4]. It can be utilized to assess the degree of exhaustion
faced by workers, hand function failure in elderlies and performance level in workers [5, 6].
Volaklis [7] recommends GS as a self–governing element of physical health. Various features
affecting GS include age, fatigue, nutritional status, controlled action, and discomfort [8–14].
Workers are not aware about the effects of force/power they use during work. Power is muscle’s
capability to apply maximum exertion or the capability for opposing a conflicting force to a
maximum extent. GS is associated with the power of the upper–limb muscle activity and some
anthropometric dimensions [14]. It is also frequently implemented in an extensive variety of
scientific practices for assessing upper–limb muscles behaviour [15, 16], amount of upper–limb

2
muscle deficiency [17], musculoskeletal problems [18–21] and nerve/stroke settings [22]. The
dissimilarity of GS among different dominance has been testified by Eksioglu et al [23]. Beside
hand dominance, GS may differ with variation in the upper–limb muscles [24].
The GS may similarly fluctuate with the variation in body sites when various angles of upper–
limb muscles (wrist, elbow, forearm, etc.) are changed [8, 25–26]. A standard procedure for GS
examination has been outlined by the American Society of Hand Therapists (ASHT) [27]. By
utilizing the ASHT principles, Richards [28] conducted a GS measurement study and found no
significant variation among sitting and supine postures. Kattel et al [24] discovered that GS had a
strong association with posture variation and the peak value of the muscle power found at zero
degrees shoulder abduction and elbow flexed at 135°. Zhang et al [29] noticed that male
participants exhibited significantly higher GS in both hands than females. Some researchers had
evaluated GS for various upper–limbs muscles variations at two body postures (standing and
sitting) in laboratories or advanced sector industries. Although various aspects have been tested
in previous investigations; yet relevant aspects cannot be streamlined for workers belonging to
less advanced sectors or less technically developed sectors (agriculture, construction, etc.) where
the place of working is not same as operating circumstances in advanced sectors. As per reported
literature, there is very less research pertaining to the investigation of GS giving due
consideration to the specific conditions of less advanced sector workers. Therefore, to overcome
this research gap, following objectives have been targeted in the current research:
a. To measure GS with variation of postures and upper–limb muscles (i.e., wrist, forearm, and
elbow) among young participants belonging to less advanced sectors (i.e., agriculture,
construction, etc.).
b. To find out the impact of these variations on GS values.

2. Methods
2.1 Research design
Data was collected from three districts of eastern Rajasthan state of India. Moreover, from every
district, 10–12 villages were nominated based on the healthy working population found in our
previous studies [30–31]. From each village, 17–18 participants were selected with the help of
village representatives. As GS relies on age, and in general, young adults have higher values of
GS [32–33], the current research was conducted on 200 younger manual workers (age 18–40

2
years) to assess their GS. Participants found suitable for inclusion were briefed about the
processes and techniques. The anthropometric details of the participants are presented in Table 1.

<Insert Table 1 here>

All participants signed consent for the data collection process which was carried out as per the
guidelines given by World Medical Association [34].
2.2 Apparatus and settings
Baseline hand evaluation kit (Lafayette Instrument, Lafayette, IN) was utilized for assessing the
GS (Figure 1). The kit is user–friendly and suitable for measuring strength in kilograms or
pounds. In the current research, all GS measurements were logged in kilograms and further
converted into Newton. The kit offers a flexible handle to support several dimensions of hands
enabling the researchers to evaluate GS for various sized objects. The handle is adjustable at
various grip positions (i.e., 2nd, 3rd, and 4th) according to the participant’s comfort. In the current
research, the maximum number of participants felt more comfortable with the 2nd position of the
handle. This fact also corroborates with the findings of Trampisch et al [35].

<Insert Figure 1 here>

Measurement of GS was done for the variations of upper–limb muscles associated with shoulder,
elbow, wrist and forearm flexion angles in standing and sitting postures (Figure 2). In both
sitting and standing postures, each participant held the hand–grip dynamometer firmly for nearly
3s, and then continued the process in three intervals for three wrist and forearm conditions:
relatively neutral, flexion 45° and expansion 45°. Participants took a 10s break between
subsequent processes. Only the dominant hand of participants was tried in all situations and
mean value of all measurements was recorded for further investigations. A break of one or more
minutes according to the requirement of candidates among processes was provided to avoid
excessive muscular fatigue.

<Insert Figure 2 here>

3
2.3 Data analysis
SPSS version 22.0 was used for analysis of data. The age–group and gender–wise descriptive
analysis for mean and standard deviation (SD) values was done for evaluation of GS in various
conditions. Significant effects of various conditions on GS (total 6 exertions per participant)
were tested by repeated measures analysis of variance (ANOVA) method for checking variation
within groups and significance level (p). Post–hoc analysis was performed further for monitoring
the significance level among various group comparisons.

3. Results
The GS values (Table 2) were logged in for various conditions of three age–groups of both
genders.

<Insert Table 2 here>

According to the findings of the current research, GS for male participants was highest in
standing posture with the wrist/forearm in neutral flexion followed by GS for sitting posture with
the neutral wrist/forearm flexion. However, some values of GS in the forearm extension were
close to the values of GS in the neutral flexion. A good decrement in GS values was seen for
forearm flexion in standing posture.
The outcome of ANOVA as given in Table 3–4 shows that there is no significant impact of
different variations (error in variations) in upper–limb muscles for sitting as well as standing
postures.

<Insert Table 3 and 4 here>

The data was tested by Mauchly's examination of sphericity, and found to be violated (ε < 0.75)
for sitting (χ2 = 105.9, df = 14, p < 0.001) and standing postures (χ2 = 63.8, df = 14, p < 0.001).
Therefore, huynh–Feldt estimations of sphericity were utilized for modifications in degrees of
freedom in sitting and standing postures. These outcomes indicated that no variations in upper–
limb muscles were considerably healthier posture except neutral wrist in both postures.

4
Post–hoc analysis of different variations in upper–limb muscle activity brought to light
requirement of significant changes among all variations except wrist 45° extension and neutral
forearm in sitting posture (p = 0.169), and wrist 45° extension and forearm 45° flexion (p =
0.959) in standing posture (Table 5–6).

<Insert Table 5 and 6 here>

4. Discussion
4.1 Impact of gender and age–group on grip strength
The result related to GS analysis showed that GS of males in various body postures was higher
than the GS of females. The apparent justification for this outcome was a dissimilarity in the
variety of tasks done by both genders. Males are usually more adept at physically intensive tasks.
Also, usually males are more associated with weight handling activities as compared to females.
GS among the age group 18–40 years was tested in the current research and higher GS values
were found as compared to the values obtained by previous Indian studies [32–33]. Furthermore,
a broader exploration of the three age groups (18–25, 26–32, and 33–40 years) was also done in
the current research. The analysis of different age–groups showed that participants in the age
group of 26–32 years have higher GS as compared to the other two groups. These results
conform to the results reported by previous researchers [36–37].
4.2 Impact of various conditions on grip strength
The outcomes concerning the impact of posture on GS in male and female participants clarified
that there was no substantial difference of GS among various conditions. However, the mean GS
was marginally higher in standing posture than in sitting posture. Richards [28], who
investigated the effect of various body postures on GS, also established that GS computed in
standing posture was the highest, whereas GS computed in supine posture was the lowest.
However, there is no significant difference. Liao et al [38] also verified that GS was higher in
standing posture with elbow flexed at 90° as matched with the GS values in supine and sitting
postures. The outcomes of the current research are also in line with these findings.
In the current research, the highest GS value for males in various standard limb postures was
found to be 399 ± 41.8 N; which is closer to the maximum GS value (436 ± 97.7 N) found in an
earlier meta–analytic review carried out by Roman–Liu [39]. The maximum GS values for both

5
postures in wrist and forearm neutral conditions were determined for male participants in the
current research also complied with the equation generated by Roman–Liu [39] which is used for
obtaining maximum GS value for the male using GS value of female.
Liao [11] noticed in his research that GS is extreme when the wrist and forearm are in neutral
flexion, which was also sustained by Shih et al [40]. However, research carried out by Kong [8]
expounds that shoulder extension at 90° is more influential in the development of maximum GS
than 45° flexion and neutral flexion. As per the tests of current research, GS in 45° flexed
wrist/forearm with a fixed orientation of two body postures has been categorically found to fall
in an intermediary strength range. A cursory comparison with relevant literature indicates this
finding to be novel. Furthermore, the participants were comfortable in two body postures with
the shoulder in 45° forward flexion and elbow at 90° during all upper–limb muscle activity. In
the existing research, fairly neutral forearm was discovered to generate quite good GS values as
compared to flexion and extension of upper–limb muscles. The increase in various angles of
upper–limb muscles was found to be directly associated with the GS values as stiffness was
increased in upper–limb muscles with an increase in angle.
The wrist variation was also found to be affecting parameter for GS value. It was detected in the
current research that the neutral wrist angle resulted in considerably higher GS than ulnar
deviation. A decrement in GS was recorded with wrist flexion at various angles as depicted in
the previous findings [10–11, 16, 21, 39, 41] also.
4.3 Limitations of the research
The main constraint of the current research was the shortage of time to explore the impact of
various conditions on GS. However, a stepwise method was applied to gather unique data for
Indian workers in various conditions, which has not been explored previously. Also, it was
difficult to investigate the biomechanical aspects of the participants, as continuous video
recording for a reasonable time was not possible due to the remote location of their residences.
The outcome would have been more fruitful if a camp was organized in a particular village.
4.4 Implications for future research
From the current research, it became apparent that some issues, especially biomechanical aspects
require more attention in future research. The electromyography investigation of the muscles
also holds proper scope for future research. Also, developing a framework for the specific
manual operations like lifting, pushing, pulling, etc. will be more helpful.

6
5. Conclusions
GS determined at standing posture was higher than that at sitting posture. Although there was no
significant variation in GS among two angles of the forearm, viz., –45° and +45°, the value was
higher at the neutral variation. The GS was significant in a neutral situation of wrist and forearm
than flexion and extension of the wrist and forearm. From outcomes, it can be suggested that
manual working should be done as per the optimal posture with higher GS values which is good
for health and safety at work. The outcomes also recommend suitable working manner as well as
GS data for equipment/task design for manual workers of less advanced sectors.
ACKNOWLEDGEMENTS:

The corresponding author is thankful to the Ministry of Human Resource Department

(MHRD) India for providing a fellowship for this research work and is also grateful to the

co–authors for their suggestions at every stage of this study. The authors are very

pleased with the favorable comments of the reviewers and duly grateful for the support

and encouragement they have afforded.

FUNDING:

There is no specific funding from any provider source for this study.

CONFLICTS OF INTEREST:

The authors declare that they have no conflict of interest.

References:
[1.] Roberts H C, Denison H J, Martin H J, et al. A review of the measurement of grip
strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing.
2011;40(4):423–429.

7
[2.] Ketchum L D, Thompson D, Pocock G, et al. A clinical study of forces generated by the
intrinsic muscles of the index finger and the extrinsic flexor and extensor muscles of the hand. J
Hand Surg Am. 1978;3(6):571–578.
[3.] Kroemer K E. Human strength: terminology, measurement, and interpretation of data.
Hum Factors. 1970;12(3):297–313.
[4.] Vanpee G, Hermans G, Segers J, et al. Assessment of limb muscle strength in critically ill
patients: a systematic review. Crit Care Med. 2014;42(3):701–711.
[5.] Mijnarends D M, Meijers J M, Halfens R J, et al. Validity and reliability of tools to
measure muscle mass, strength, and physical performance in community–dwelling older people:
a systematic review. J Am Med Dir Assoc. 2013;14(3):170–178.
[6.] Rantanen T, Guralnik J M, Foley D. Midlife hand grip strength as a predictor of old age
disability. JAMA. 1999;281(6):558–560.
[7.] Volaklis K A, Halle M, Meisinger C. Muscular strength as a strong predictor of
mortality: A narrative review. Eur J Intern Med. 2015;26(5):303–310.
[8.] Kong Y K. The effects of co–ordinating postures with shoulder and elbow flexion angles
on maximum grip strength and upper–limb muscle activity in standing and sitting postures. Int J
Occup Saf Ergon. 2014;20(4):595–606.
[9.] Singh J, Khan A A. Effects of position of the handles and feed force on discomfort score
and grip strength during hand drilling. Int J Hum Factors Ergon. 2012;1(2):148–166.
[10.] Khan A A, Khan Z, Mukarram M. Effect of elbow flection on grip strength in vertical
and horizontal directions. J Hum Ergol (Tokyo). 2013;42(1–2):13–22.
[11.] Liao K H. Experimental study on gender differences in hands and sequence of force
application on grip and hand–grip control. Int J Occup Saf Ergon. 2014a;20(1):77–90.
[12.] Liao K H. The effect of wrist posture and forearm position on the control capability of
hand–grip strength. Int J Indus Eng: Theory, Appl Pract. 2014b;21(6):295–303.
[13.] Jain R, Meena M L, Dangayach G S, et al. The effect of different hand positions on
capability of hand–grip strength. Presented at 18th Conference of Industrial Engineering, held at
Hotel President, Seoul, South Korea, October 10–12, 2016.
[14.] Kong Y K, Kim D M. The relationship between hand anthropometrics, total grip strength
and individual finger force for various handle shapes. Int J Occup Saf Ergon. 2015;21(2):187–
192.

8
[15.] Roman–Liu D, Tokarski T. Upper limb strength in relation to upper limb posture. Int J
Indus Ergon. 2005;35(1):19–31.
[16.] Ahmed T. The effect of upper extremity fatigue on grip strength and passing accuracy in
junior basketball players. J Hum Kinet. 2013;37(1):71–79.
[17.] Tokarski T, Roman–Liu D, Kamińska J. The influence of age and type of force on muscle
strength capabilities in women. Int J Occup Saf Ergon. 2012; 18(1):47–57.
[18.] Dale A M, Addison L, Lester J, et al. Weak grip strength does not predict upper extremity
musculoskeletal symptoms or injuries among new workers. J Occup Rehabil. 2014;24(2):325–
331.
[19.] Sung P C, Hsu C C, Lee C L, et al. Formulating grip strength and key pinch strength
prediction models for Taiwanese: a comparison between stepwise regression and artificial neural
networks. J Ambient Intell Humaniz Comput. 2015;6(1):37–46.
[20.] Jain R, Meena M L, Dangayach G S. Ergonomic Intervention for manual harvesting in
agriculture: a review. In Ray G G, Iqubal R, et al, editors. Ergonomics in caring for people.
Singapore: Springer Nature; 2018. pp. 183–191.
[21.] Roman–Liu D, Tokarski T, Kowalewski R. Decrease of force capabilities as an index of
upper limb fatigue. Ergonomics. 2005;48(8):930–948.
[22.] Bertrand A M, Fournier K, Brasey M G W, et al. Reliability of maximal grip strength
measurements and grip strength recovery following a stroke. J Hand Ther. 2015;28(4):356–363.
[23.] Eksioglu M. Normative static grip strength of population of Turkey, effects of various
factors and a comparison with international norms. Appl Ergon. 2016;52:8–17.
[24.] Kattel B P, Fredericks T K, Fernandez J E, et al. The effect of upper–extremity posture
on maximum grip strength. Int J Indus Ergon. 1996;18(5–6):423–429.
[25.] La Delfa N J, Langstaff N M, Hodder J N, et al. The interacting effects of forearm
rotation and exertion direction on male and female wrist strength. Int J Indus Ergon.
2015;45:124–128.
[26.] Lee J A, Sechachalam S. The effect of wrist position on grip endurance and grip strength.
J Hand Surg Am. 2016;41(10):367–373.
[27.] American Society of Hand Therapists. Clinical Assessment Recommendations. Chicago
(IL): American Society of Hand Therapists; 1992.

9
[28.] Richards L G. Posture effects on grip strength. Arch Phy Med Rehabil.
1997;78(10):1154–1156.
[29.] Zhang Z, Li K W, Zhang W, et al. Muscular fatigue and maximum endurance time
assessment for male and female industrial workers. Int J Indus Ergon. 2014;44(2):292–297.
[30.] Jain R, Meena M L, Dangayach G S, et al. Association of risk factors with
musculoskeletal disorders in manual working farmers. Arch Environ Occup Health. 2018;
78(1):19–28.
[31.] Jain R, Meena M L, Dangayach G S, et al. Risk factors for musculoskeletal disorders in
manual harvesting farmers of Rajasthan. Ind Health. 2018;56(3):241-248.
[32.] Dewangan K N, Gogoi G, Owary C, et al. Isometric muscle strength of male agricultural
workers of India and the design of tractor controls. Int J Indus Ergon. 2010;40(5):484–491.
[33.] Patel T, Sanjog J, Kumar P, et al. Isometric muscular strength data of Indian agricultural
workers for equipment design: Critical analysis. Agric Eng Int: CIGR Journal. 2014;16(2):70–
79.
[34.] World Medical Association. World Medical Association Declaration of Helsinki Ethical
principles for medical research involving human subjects. Bull World Health Org.
2001;79(4):373–374.
[35.] Trampisch U S, Franke J, Jedamzik N, et al. Optimal Jamar dynamometer handle position
to assess maximal isometric hand grip strength in epidemiological studies. J Hand Surg Am.
2012;37(11):2368–2373
[36.] Massy–Westropp N M, Gill TK, Taylor A W, et al. Hand grip strength: age and gender
stratified normative data in a population–based study. BMC Res Notes. 2011;4(1):127–131.
[37.] Werle S, Goldhahn J, Drerup S, et al. Age–and gender–specific normative data of grip
and pinch strength in a healthy adult Swiss population. J Hand Surg (Eur Vol). 2009;34(1):76–
84.
[38.] Liao W C, Wang C H, Yu S Y, et al. Grip strength measurement in older adults in
Taiwan: A comparison of three testing positions. Australas J Ageing. 2014;33(4):278–282.
[39.] Roman–Liu D. Maximum handgrip force in relation to upper limb posture—a meta–
analysis. Am Indus Hyg Assoc J. 2003;64(5):609–617.

10
[40.] Shih Y C, Lo S P, Huang W S. The effects of wrist splints on when females reach the
peak grip strength under different wrist and forearm positions. J Chinese Institute Indus
Engineers. 2006;23(5):435–442.
[41.] Claudon L. Evaluation of grip force using electromyograms in isometric isotonic
conditions. Int J Occup Saf Ergon. 1998;4(2):169–184.

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 Tables
Table 1: Anthropometrics of the participants (N = 200)
Variable M (SD)
Age (years) 28.5 (6.9)
Weight (kg) 57.2 (6.4)
Height (mm) 1543.5 (80.2)
Note– M: Mean, SD: Standard deviation
Table 2: Grip strength (in N) in various conditions among different age–groups and gender (N = 200)
Condition M (SD)
Posture with fixed Upper–limb muscles Males (n = 120) Females (n = 80)
upper–limb muscle with angles 18–25 26–32 33–40 Total 18–25 26–32 33–40 Total
angles
Sitting (shoulder Wrist neutral 379 380 369 420 249 262 264 257
forward flexed at 45 (32.1) (37.4) (38.3) (35.8) (33.7) (41.4) (32.5) (34.6)
and elbow at 90 ) Wrist 45 flexion 324 326 326 325 209 214 211 210
(19.3) (18.4) (20.8) (19.3) (16.3) (11.8) (18.1) (16.1)
Wrist 45 extension 348 348 353 350 228 218 214 230
(21.5) (21.9) (22.4) (21.8) (22.8) (19.8) (20.7) (21.6)
Forearm neutral 358 354 356 377 229 224 231 229
(28.7) (31.0) (36.1) (31.4) (35.3) (33.7) (31.5) (33.1)
Forearm 45 flexion 314 316 311 314 195 193 194 294
(21.1) (20.6) (19.1) (20.3) (20.7) (17.7) (20.0) (19.3)

12
 Forearm 45 extension 345 342 346 344 220 223 214 218
(33.6) (30.3) (29.7) (31.2) (31.0) (29.2) (29.4) (29.8)
Standing (shoulder Wrist neutral 385 382 386 406 242 246 256 248
forward flexed at 45 (35.8) (39.3) (35.3) (36.6) (27.9) (22.1) (26.0) (26.9)
and elbow at 90 ) Wrist 45 flexion 338 336 339 338 219 211 211 214
(21.2) (20.7) (23.4) (21.5) (21.2) (17.0) (23.5) (21.2)
Wrist 45 extension 355 357 362 358 225 221 220 223
(26.2) (23.2) (27.1) (25.4) (23.2) (20.5) (22.0) (22.6)
Forearm neutral 405 391 402 427 259 273 261 262
(40.7) (43.9) (40.3) (41.8) (31.4) (31.3) (30.5) (31.3)
Forearm 45 flexion 356 359 344 354 229 221 233 229
(24.3) (24.5) (24.6) (24.9) (26.3) (22.3) (23.4) (24.3)
Forearm 45 extension 366 367 363(27.9) 366 242 254 244 245
(28.4) (26.2) (27.3) (27.1) (24.6) (27.5) (26.9)
Note– M: Mean, SD: Standard deviation

13
 Table 3: Test of within subject effects for sitting posture
Source SS df MS F p
Variation
Sphericity assumed 478381.4 5 95676.3 128.1 <0.001*
Huynh–Feldt 478381.4 4.49 111570.6 128.1 <0.001*
Error (Variation)
Sphericity assumed 743279.8 995 747.1
Huynh–Feldt 743279.8 853.3 871.1
Note– df: degree of freedom, F: F–test statistics, MS: mean square, SS: sum of squares
*significant at p <0.001
Table 4: Test of within subject effects for standing postures
Source SS df MS F p
Variation
Sphericity assumed 409034.6 5 81806.9 97.1 <0.001*
Huynh–Feldt 409034.6 4.5 90387.3 97.1 <0.001*
Error (Variation)
Sphericity assumed 838747.3 995 842.9
Huynh–Feldt 838747.3 900.6 931.4
Note– df: degree of freedom, F: F–test statistics, MS: mean square, SS: sum of squares
*significant at p <0.001
Table 5: Result of post–hoc comparisons for sitting postures
Post–hoc comparisons of GS
Group#
1 2 3 4 5 6
1 <0.001** <0.001** <0.001** <0.001** <0.001**
2 <0.001** <0.001** <0.001** <0.001** <0.001**
3 <0.001** <0.001** 0.169 <0.001** <0.001**
4 <0.001** <0.001** <0.001** <0.001** <0.001**
5 <0.001** <0.001** <0.001** <0.001** <0.001**
6 <0.001** <0.001** 0.004* <0.001** <0.001**
Note– GS: grip strength.
#1: GS in neutral wrist, 2: GS in wrist 45° flexed, 3: GS in wrist 45° extended, 4:
GS in neutral forearm, 5: GS in forearm 45° flexed, 6: GS in forearm 45°
extended
**Significant at p < 0.001, *Significant at p < 0.01

14
 Table 6: Result of post–hoc comparisons for standing postures
Post–hoc comparisons of GS
Group#
1 2 3 4 5 6
1 <0.001** <0.001** <0.001** <0.001** <0.001**
2 <0.001** <0.001** <0.001** <0.001** <0.001**
3 <0.001** <0.001** <0.001 0.959 <0.001**
4 <0.001** <0.001** <0.001** <0.001** <0.001**
5 <0.001** <0.001** <0.001** <0.001** <0.001**
6 <0.001** <0.001** 0.004* <0.001** <0.001**
Note– GS: grip strength.
#1: GS in neutral wrist, 2: GS in wrist 45° flexed, 3: GS in wrist 45° extended, 4: GS in
neutral forearm, 5: GS in forearm 45° flexed, 6: GS in forearm 45° extended
**Significant at p < 0.001, *Significant at p < 0.01
Figure captions

Figure 1: Baseline hand evaluation kit used in current research

Figure 2: Setting for grip strength measurement in (a) sitting posture (b) standing posture

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