Received: 15 January 2019 | Revised: 23 August 2019 | Accepted: 26 September 2019

DOI: 10.1002/hfm.20820

Upper extremity muscular strength in wrist‐twisting tasks:

Model approach towards task design

Joydeep Majumder1 | Sanjay M Kotadiya2 | Lokesh Kumar Sharma3 | Sunil Kumar4

1
Division of Physiology & Ergonomics,
ICMR‐National Institute of Occupational Abstract
Health, PhD Scholar, Gujarat University, Frequent wrist‐twisting operations of hand tools results in wrist injuries, loss of
Ahmedabad, India
2 control, localized discomfort and muscular fatigue. The aim was to investigate upper
Division of Physiology & Ergonomics,
ICMR‐National Institute of Occupational extremity strength in generic wrist‐twisting modes while using hand tools and
Health, Ahmedabad, India
forecasting the limits while in frequent or continuous operation. Hundred men were
3
Division of Information Technology,
ICMR‐National Institute of Occupational recruited (Group 1: 18‐39 years and Group 2: 40‐60 years). Upper extremity
Health, Ahmedabad, India isometric muscular strength testing of the preferred hand during wrist‐twisting type
4
Division of Reproductive & Cyto‐toxicology,
of manual hand‐tool operations was carried out for 60 s. Forecasting of strength to
Former Director‐in‐Charge, ICMR‐National
Institute of Occupational Health, Ahmedabad, generate predictions for future events (60 s) based on measured 60 s was carried out
India
using Holt‐Winters time series model. Descriptive statistics was used for analysis. For
Correspondence prediction model evaluation, WEKA 3.8.2 was used. Anthropometric parameters of
Joydeep Majumder, Division of Physiology &
both groups were similar, having minimal effect on generated strength. The strength
Ergonomics, ICMR‐National Institute of
Occupational Health, Ahmedabad 380016, generated by Group 2 workers were slightly higher than their younger counterparts.
Gujarat, India.
The mean clockwise strength for both groups were recorded to be higher than the
Email: majumder.j@gov.in
anticlockwise strength. Also, standing posture generated higher strength than in
seated posture. During last 5 s of trial, participants could sustain only three‐fifth of
strength generated in the first 5 s for anticlockwise trials. Whereas, for clockwise
trial, the strength sustainability during the last 5 seconds was around three‐fourth of
initial 5 seconds. Uniformly decreasing plateau of strength over time support
clockwise torque application for increase efficiency, reduced fatigue, and muscu-
loskeletal disorders. Strength data generated would assist in re‐engineering the
design of tools at workplace and suggest functional limits of work.

KEYWORDS
isometric strength, model forecasting, time‐series analysis, upper extremity, wrist‐twisting.

1 | INTRODUCTION tenosynovitis, carpal tunnel syndrome with continuous or frequent

While performing a manual task involving hand tool operation, wrist‐
twisting activity is a common postural modulation. For example, while
opening or closing a container lid, use of screwdrivers, and so forth it
requires variable workspace and strength allowance of shoulder, arm,
whole hand as well as finger manipulations. Further depending on the
type of operation, torque application during this wrist‐twisting activity
may be clockwise as well as anticlockwise. Literature in the recent past
reports association of upper limb disorders like epicondylitis,
50 | © 2019 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/hfm
wrist‐twisting operations (Aublet‐Cuvelier, Aptel, & Weber, 2006;
Leclerc, Landre, Chastang, Niedhammer, & Roquelaure, 2001). Further,
inappropriate selection or use of hand tools such as manual drill,
spanner, rod bender, screwdriver, maize sheller and so forth
demanding force beyond an operator’s capacities may result in
loss of control, muscle fatigue, or localized discomfort and injury
(Lin, Radwin, Fronczak, & Richard, 2003). Repetitive forceful exertions
in endurance are also associated with increased risk for musculoske-
letal disorders and injury (Bureau of Labor Statistics, 2016).
Hum. Factors Man. 2020;30:50–58.
MAJUMDER ET AL.
During an activity in wrist‐twisting mode, power grip force exertion
on the tool is followed by wrist twisting. Thus, physical exertion is
dependent on the torque applied on hand tool as well as the thrust
force along the shaft of the tool handle (Freund, Takala, & Toivonen,
2000). Eventually, literature reports ample studies on grip strengths,
expressing the functional limits of the population (De, Sengupta,
Maity, Pal, & Dhara, 2011; Gite, Majumder, Mehta, & Khadatkar,
2009; Tietjen‐Smith et al., 2006). However, research on wrist strength
exertion while performing a twisting task are limited. In addition, it is
recognized that, wrist strength may be influenced by finger flexor
muscle activities (Seo, Armstrong, Ashton‐Miller, & Chaffin, 2008) that
is grip force may influence wrist‐twisting force application. Thus, in
operations involving rotational motions, though the risk of tripping/
slipping is less (common in activities involving straight translation
motions), muscular loading of the upper extremities is nearly inevitable.
While some studies on torque application during screwdriver
operation reported 1–19 Nm torque during isometric experimenta-
tion (Gite et al., 2009; Kim & Kim, 2000), studies primarily focused on
one‐way torque application. However, as stated earlier, the work-
space may demand power grip force followed by wrist exertion in
both clockwise as well as the anticlockwise direction of the wrist.
This may have a significant effect on the force generation and
sustainability, in endurance. Seo et al. (2008) reported maximum
clockwise torque as 45% higher than maximum anti‐clockwise
torque. Ciriello, Webster, and Dempsey (2002) also reported torque
of 0.33–0.65 Nm during wrist‐twisting activity and 1.08–1.13 Nm for
ulnar deviation. Although, it is recognized that the wrist‐twisting task
may not require a voluminous strength, however, variability in work
stretch, endurance, and awkward posture can affect productivity
(Ciriello et al., 2002) besides musculoskeletal overloading.
Although strength databases in Western countries are available
(Xiao, Lei, Dempsey, Lu, & Liang, 2005), wrist‐twisting data on Indian
population are scanty and scattered, except for Indian agricultural
workers during intermittent work (De et al., 2011; Tiwari, Gite,
Majumder, Pharade, & Singh, 2010). In the case where a task
demands longitudinal time of force application of the grip and wrist,
model forecasting would be a standard tool in the predication of the
sustainable strength on time scale based on the observation data.
This would also assist in determining the muscular strength
sustainability limits of the workforce. Forecasting models have been
reported to be applied successfully in time‐series research in the
literature. The Holt‐Winters time series forecasting has been
reportedly used in medical research (Buczak et al., 2018; Medina,
Findley, Guindo, & Doumbia, 2007); productivity as well as produc-
tion planning. In this study, Holt‐Winter's time series forecasting is
used for the upper extremity strength prediction on the time scale.
This model uses univariate simple exponential smoothing to forecast
(Newberne, 2006), wherein more weights are assigned to recent
time‐series observations than older observations. The Holt‐Winters
model builds upon the simplest form of exponential smoothing and
takes into account the possibility of a time series exhibiting some
form of trend or seasonality, both of which are updated by simple
exponential smoothing (Walters & Chai, 2008).
| 51
It is imperative that the determination of human strength
capabilities is an important consideration in the development of
ergonomic guidelines for pre‐employment screening of workers
performing manual hand tool operation. Therefore, the present
study was attempted to systematically investigate the upper
extremity strength in generic wrist‐twisting modes and forecasting
the limits of the workers while performing the frequent or
continuous operation.
2 | M A T E R I A L S AN D M E T H O D S
The experiment was conducted on 100 male healthy and physically
active workers (18–60 years age) who voluntarily agreed to
participate in the laboratory‐simulated strength testing experiment
during the wrist‐twisting type of manual hand‐tool operations. The
ethical consideration of the study was obtained from the Human
Ethics Committee of the Institute. A written informed consent form
was also obtained from all the participants.
The participants were then categorized into two groups as per
their age (Group 1: 18–39 years (N = 74) and Group 2: 40–60 years
(N = 26)). This was done based on earlier literature which revealed
that muscular strength increases till the middle age and then
decreases with the further progressive age (DiDomenico &
Nussbaum, 2003; Keller & Engelhardt, 2019; Rantanen et al., 2012).
The height, weight and anthropometric dimensions of the hand
were measured for all the participants, using stadiometer, weighing
scale and vernier caliper, as per standard protocol. Isometric strength
testing of the preferred hand was carried out on Humac Norm–Test-
ing and Rehabilitation System (CSMi). A wrist‐twisting handle coupler
was fabricated with a grip diameter of 32 mm and a grip length of
125 mm for the power‐precision grip. For both concentric as well as
eccentric movement, the dynamometer of the instrument was set at
0 Nm torque. The wrist‐twist handle coupler was affixed to the
dynamometer shaft at the preset anatomical zero position. The
mechanical stops were fixed at +2° (concentric) and −2° (eccentric)
position of the dynamometer to ensure that in case of any
mechanical failure of the instrument, there remains no chance of
any injury to the participant.
The participants were allowed to apply the torque at the neutral
position of the wrist, by adjusting the height of the dynamometer at
the level of trochanterion height, at standing posture. In the case of
seated operation, the height of the seat was adjusted so that the foot
gets an optimal grip on the floor perpendicular to the tibia (Figure 1).
The torque was allowed to be applied with the arm at a neutral
position beside the axillary folds of armpit. The other arm was
instructed to be kept over the patella with an open palm. Back
support was not provided during the seated operation as the study
focused on the maximum voluntary strength of the hand‐arm‐
shoulder complex only. This also restricted thus the inadvertent
exertion of the muscular load from other body parts or allowing the
body weight to influence greater strength. The experiment was
performed in one single trial for 60 s without any verbal
52 | MAJUMDER ET AL.

FIGURE 1 Wrist‐twisting strength testing in standing and seated postures

encouragement, wherein each participant was instructed to generate The strength data recorded was not normally distributed (p < .05).
maximum voluntary strength and maintain it till the next instruction Hence, to normalize the data, the box‐cox transformation was
(i.e., after 60th s). Every participant was given a practice trial of 5 s applied, and after transformation the strength data were normally
before the start of the experimentation process. The rest interval distributed and was used for further analysis.
between practice trial and the start of the experiment was set as As observed in Table 2, the strength generated by the Group 2
2 min as adopted earlier by several investigators (Kumar, Narayan, & participants was slightly higher (~2% to 14%) while statistically not
Bacchus, 1995; Tiwari et al., 2010). However, a gap of 4 hr was given significantly different than their younger counterparts. The mean
between two endurance (clockwise and anticlockwise) experiments. anti‐clockwise strength for both the groups during the first 5 s of the
Data obtained from the instrument software were recorded as trial was recorded to be higher than the clockwise strength, except
torque in Newton‐meter (Nm). The data were entered in the excel for anticlockwise wrist‐twisting in a standing posture for Group 2
sheet and descriptive statistics were used to analyze the data using participants. However, during the last 5 s (55–60 s) of the trial,
SPSS 16.0 (Chicago, IL). The normality of the data was tested by clockwise strength in seated and standing postures were recorded
Shaipro‐Wilk test. Repeated measures ANOVA was used to examine higher for both the groups. The percentage decrease in strength from
the difference in the rate of strength reduction from the first 5 the first 5 s to the last 5 s varied between 15.3% and 44% for all
seconds and the last 5 seconds of exertion. Factorial ANOVA was conditions. Overall for the 60 s trial, the younger age group men
used to measure the main interaction effects on the strength generated higher strength during anticlockwise wrist‐twisting in
generated with three factors (age group, the direction of torque, and standing posture, and for older age group men, meagerly higher
posture) with Bonferroni adjustment. strength was generated in standing posture than in seated posture.
Time series forecasting was carried out using the Holt‐Winters Further, repeated measures analysis of variance (RMANOVA)
model, for 60 s after the observed 60 s trial bout. This was done was applied to assess the difference in strength generated during the
considering wrist‐twisting as an intermittent task and may not first five and the last 5 seconds of the measurement across age
require continuous exertion for more than 120 s. The forecast group, direction and posture. The Box test of equality of covariance
modeling was performed on WEKA 3.8.2 environment (Hall et al.,
2009). Time was considered as the periodic attribute, and sit T A B L E 1 Anthropometric parameters of Group 1 (18–39 years)
clockwise, stand clockwise, sit anti‐clockwise, and stand anti‐clock- and Group 2 (40–60 years) male workers participating in the study
wise strength was selected as the target attributes. For the analysis, Group 1 Group 2 95% Confidence
it was hypothesized that the strength generated for performing any Parameters mean (SD) mean (SD) interval
activity gradually decreases with the progression of time in Age (years)*** 29.1 (5.7) 51.9 (6.1) −25.47 to −20.24
application of torque. The forecasting time was set as for 60 s, with Height (cm)* 171.7 (7.4) 168.5 (5.6) 0.03 to 6.37
periodicity in milliseconds. The modeling was based on the group Weight (Kg) 69.2 (14.3) 68.8 (10.0) −4.72 to 5.55
mean time series strength data. The model was evaluated using the BMI (Kg/m2) 23.4 (4.1) 24.2 (3.3) −2.64 to 0.91
mean absolute error (MAE), root mean square error (RMSE) of the
BSA (m2) 1.8 (0.2) 1.8 (0.1) −0.07 to 0.09
predictions, direction accuracy, and relative absolute error.
Hand length (cm) 18.8 (1.4) 18.5 (0.9) −0.24 to 0.90
Palm length (cm) 11.0 (0.6) 10.9 (0.5) −0.17 to 0.33
Hand breadth across 8.3 (0.5) 8.3 (0.4) −0.15 to 0.26
3 | RES U LTS metacarpal III (cm)
Hand breadth across 10.0 (0.5) 10.0 (0.5) −0.19 to 0.28
Table 1 presents the mean, standard deviation and 95% confidence thumb (cm)
interval of the anthropometric parameters for both groups of
*<.05.
participants. It is observed that all the parameters for both the ***<.001.
group of participants were similar. Abbreviations: BMI, body mass index; BSA, body surface area.
MAJUMDER ET AL. | 53

T A B L E 2 Isometric clockwise and anticlockwise wrist‐twisting strength for first 5 s and last 5 s and percentage decrease in strength (Nm)
among Group 1 and Group 2 male workers in seated and standing postures
Isometric test Group 1 0‐5 s Group 1 55‐60 s % strength decrease Group 2 0‐5 s Group 2 55‐60 s % Strength decrease
Sit clock 2.3 (0.17) 1.79 (0.02) 20.9 (5.7) 2.38 (0.11) 1.96 (0.03) 15.3 (4.2)
Sit anticlock 2.56 (0.13) 1.42 (0.02) 43.5 (1.9) 2.63 (0.18) 1.49 (0.05) 40.6 (2.7)
Stand clock 2.33 (0.14) 1.72 (0.02) 24.6 (4.1) 2.6 (0.14) 2.01 (0.02) 21.7 (5.2)
Stand anticlock 2.71 (0.12) 1.48 (0.03) 44.0 (2.4) 2.46 (0.12) 1.62 (0.02) 33.2 (3.6)
Note: All values are in Mean (SD)

was met (p > .05). Further, as there were only two repeated measures
of the dependent variables, no test of sphericity was assumed. The
results revealed that there was a significant difference in strength
generated during the first 5 s and the last 5 s of the measurement
(F(1,32)= 2259.296; p < .001). The difference in rate of strength
reduction between the two times (first 5 and last 5 s) has a significant
interaction with the age group (F(1,32)= 45.581; p < .001) and direction
of torque (clockwise–anticlockwise twisting; F(1,32)= 338.767;
p < .001). However, posture was not observed to have significant
interaction with the difference in the rate of strength reduction
(F(1,32)= 0.103; p = .75), implying that the reduction rate over time is
consistent for seated and standing strength exertion.
For the total participants, pairwise comparison of torque during all
conditions are shown in Table 3. Factorial ANOVA revealed that there
was significant main effect of age group (F(1,472) = 32.412; p < .001),
direction of torque (F(1,472) = 41.984; p < .001), posture (F(1,472) = 8.979;
p = .003) on the normalized strength values. Further, age group and
direction showed significant interaction effect (F(1,472) = 9.948; p = .002),
while age group and posture (F(1,472) = 0.240; p = .624), and direction
and posture (F(1,472) = 0.874; p = .350), did not show significant
interaction effect on the normalized strength values. However, age
group, direction and posture showed significant interaction effect
(F(1,472) = 6.652; p = .010) on the normalized strength values.
Figure 2 depicted the observed (60 s) and forecasted (60 s) trend
of wrist‐twisting strength in seated and standing postures. Figure 2a
shows a sharp decline in generated strength and thereafter a
decreasing plateau in wrist‐twisting operation in the seated posture,
although the deteriorating trend was more prominent in anticlockwise
twisting. As seen in the graph, preferred hand clockwise wrist‐twisting
activity for men below 40 years of age was more productive and safer
wrist‐twisting strength could not be sustained for more than 40% of
the maximum generated strength and there was a steep decline in the
wrist‐twisting strength during the 60 s forecasted period.
Figure 3 depicts the observed (60 s) and forecasted (60 s) trend of
upper extremity wrist‐twisting strength among Group1 and Group 2
participants. For clockwise strength in the seated posture, participants
from both age groups reflected a similarly steep decline trend, and
thereby a plateau after 15 s of strength application. The participants in
Group 2 were also seen to have higher strength than their Group 1
counterparts. However, the prediction trend for the next 60 s reveals
that participants in Group 1, though produce lesser strength, match up to
the Group 2 participants during endurance performance (Figure 3a). In
case of anticlockwise performance, both the groups were observed as
identical (~50% of the maximum generated was maintained till 60th s),
which was even similar in the forecasting model, wherein approximately
25% of the maximum generated was maintained by the end of 60th
second of prediction (Figure 3b). The standing clockwise exertion (Figure
3c) also followed the similar trend of Group 2, generating higher strength
uniformly till the forecasted period. However, the standing strength was
recorded to be higher than the seated strength. Figure 3d depicted a
similar pattern of a decremental trend in strength application by both
groups during anticlockwise operation. As observed in Figure 3, the
prediction model revealed steady strength values only during clockwise
application with increasing duration of the trial.
T A B L E 3 Pairwise comparison of wrist‐twisting strength for all
participants
Normalized
strength mean
Age group Direction Posture (SD) N

than anticlockwise motion. Figure 2b shows that a similar decreasing Group 1 Clockwise Sit 0.475 (0.158) 60
(20–39 years) Stand 0.474 (0.183) 60
plateau as in Figure 2a. Although the Group 1 participants could
Anticlockwise Sit 0.31 (0.38) 60
maintain around two‐third of the maximum strength generated in
Stand 0.479 (0.384) 60
clockwise operation till the 60th s, for anticlockwise operation, they
Group 2 Clockwise Sit 0.638 (0.117) 60
could hold upon the same till 30th second only. In the case of Group 2 (40–60 years) Stand 0.738 (0.135) 60
participants, till 25th second of continuous activity, the seated Anticlockwise Sit 0.445 (0.313) 60
Stand 0.466 (0.279) 60
clockwise–anticlockwise strength was similar (~70% of the maximum),
Total Clockwise Sit 0.556 (0.161) 120
thereafter it was maintained only for clockwise operation till the
Stand 0.606 (0.208) 120
forecasted 60th s (Figure 2c). In Figure 2d, the pattern was similar to Anticlockwise Sit 0.378 (0.353) 120
Figure 2c, the exception being the generation of slightly higher Stand 0.472 (0.334) 120
strength in both clockwise and anticlockwise operation. This was even Total Sit 0.467 (0.288) 240
a little higher in the case of Group 2 participants in comparison to their Stand 0.539 (0.286) 240
Total 0.503 (0.289) 480
younger counterparts. For all the four conditions, the anticlockwise
54 | MAJUMDER ET AL.

F I G U R E 2 Measured and forecasted trend of wrist‐twisting strength in seated and standing postures. Figure 2a: sit clockwise and sit anti‐
clockwise among Group 1; Figure 2b: stand clockwise and stand anticlockwise among Group 1; Figure 2c: sit clockwise and sit anticlockwise
among Group 2; Figure 2d: stand clockwise and stand anticlockwise among Group 2

Table 4 shows the evaluation of the prediction model. Absolute reached to 100% accuracy except in the case of Group 2 sit clockwise
error, as mentioned is the absolute value of the difference between and anti‐clockwise strength. The values for RAE and RMSE also
forecasted value and observed value. As seen, the range of MAE is shows the forecasted value adaptability, overall revealing model
0.094−0.305, the predictor is near to observed value. The model forecasted with high accuracy.
MAJUMDER ET AL. | 55

F I G U R E 3 Measured and forecasted trend wrist‐twisting strength among Group1 and Group 2 participants. Figure 3a: sit clockwise
strength; Figure 3b: sit anticlockwise strength; Figure 3c: stand clockwise strength; Figure 3d: stand anticlockwise strength

4 | D IS C U S S IO N
Wrist‐twisting activity is a common task at home and workplace.
Although the strength generated during such activity is less, increased
frequency and longitudinal strength application during a task instigate
fatigue and probability of injury (Ciriello et al., 2002). Many studies
reported that isometric pronation torque during a repeated task like
screw driving would increase the discomfort level (Khan, O'Sullivan, &
Gallwey, 2009; Mukhopadhyay, O'Sullivan, & Gallwey, 2009).
Literature reports that anthropometric parameters is directly
correlated to muscular strength. However, in the present study,
wrist‐twisting strength may not be influenced by anthropometric
variables. This may be due to the optimal size of the handle grip and
position of the force application. The other possible reasons may be
56 | MAJUMDER ET AL.

T A B L E 4 Prediction model evaluation for Group 1 (18–39 years) Further, as we tried to comprehend the influence of age on the
and Group 2 (40–60 years) workers (60 s) in seated and standing strength generated, we see that Group 2 depicted marginally higher
postures strength in clockwise as well as in anticlockwise operation under both
Results MAE DA RMSE RAE seated and standing postures except stand anticlockwise activity,
Group 1 Sit clockwise 0.134 100 354.3 383.87 although statistically not significantly different. The results of the
Sit anti‐clockwise 0.08 100 37.95 39.61 present study were not in line with the results of earlier studies
Stand clockwise 0.257 100 272.66 280.28
reported that muscular strength increases till the middle age and then
Stand anti‐clockwise 0.094 100 33.8 32.51
decreases with further progressive age (DiDomenico & Nussbaum,
Group 2 Sit clockwise 0.261 33.33 1337.74 13.6
2003; Karavirta et al., 2011; Keller & Engelhardt, 2019; Rantanen
Sit anticlockwise 0.305 100 133.47 134.45
Stand clockwise 0.117 68 0.123 361.83 et al., 2012). In the case of the present study, the Group 2 participants
Stand anticlockwise 0.064 100 0.09 75.31 were working professionals and physically more trained and experi-
Abbreviations: DA, direction accuracy; MAE, mean absolute error; RAE, enced than their Group 1 counterparts. This was also supported by the
relative absolute error; RSME, root mean squared error.
previous study iterating skilled workers who have longer endurance
time than nonskilled workers (Rose, Örtengren, & Ericson, 2001).
the static postures adopted and isometric strength protocol in the It is imperative that operations at a workplace may demand a
present study to comprehend the maximum strength that a participant variety of postural orientations (seated or standing). We found that
can develop and sustain that is generic strength of the upper extremity the strength profile in observed, as well as a model prediction in
muscles, as well as when dynamic posture could not be adopted, viz, standing posture, were more than in seated posture. However,
confined space. Workability under restricted condition would need the despite the postural differences, it is worth considering that wrist‐
involvement of the upper extremity muscles only, wherein a work bout twist activity is a precision‐power activity. Such activity is productive
may also demand longitudinal time. Therefore, this study focused only only when the upper extremities are close to the site of force
on the wrist‐twisting strength of the group of muscles of the upper application (Huysmans, De Looze, Hoozemans, Van Der Beek, & Van
extremity. For both operations, the strength took the peak within the Dieen, 2006), iterating that difference between standing and seated
first few seconds, and thereafter a sharp decline was observed till the posture has little relevance. Therefore, clockwise–the anticlockwise
end of the bout at 60 s. This is in consistence with the previous study difference in variable posture was tested (Figure 2a–d). In all
reporting an exponential decline in exertion force with endurance time anticlockwise trials, there has been a steep decline in the generated
(Lee, 2016). Evidently, for clockwise twisting for 60 s, the strength strength, and the participants could not sustain more than 40% of the
during the last 5 s was reduced up to one‐fourth of the first 5 s, while maximum generated strength. Whereas, for clockwise trials, a
for anticlockwise twisting, the reduction was even higher (33–44%), uniform plateau was recorded; supporting clockwise torque applica-
although the reduction rate was consistent for seated and standing tion for increase efficiency, reduced fatigue and risks of musculoske-
strength exertion. Further, to comprehend the sustainability of letal disorders (Ng, Jee, & Choong, 2016; Seo et al., 2008).
strength in endurance, the model approach was applied to the Further, we tried to comprehend the age difference in the model
observed data so as to understand the pattern of strength that can be prediction of strength for 60 s beyond the observed 60 s trial bout
sustained with an increase in the duration of force exertion at work. (Figure 3a–d). Although the decremental graph in anticlockwise
Our study depicted marginally higher mean clockwise strength vis‐ operation for both groups was observed, Group 2 participants
à‐vis the observed anti‐clockwise strength as approximately 1.99 N depicted higher stability in sustained strength, after an initial steep
and 1.96 N, respectively, in standing posture, although statistically not decline. An exception as observed in Group 2 seated clockwise
significantly different. In the forecasted data, the clockwise torque was strength application. During the last 10 s of the measured strength,
approximately 45%–64% higher than the anticlockwise torque. Earlier the trend of holding on the strength was observed which modulated
study on Indian agricultural workers reported preferred handgrip the forecasting on the time scale. This might have affected the trend
isometric torque as 7 Nm (Gite et al., 2009). A higher data in the as seen in Figure 3a–d. The effectiveness of the models is observed in
reported study was because of variability in grip size, which was Table 3, revealing the accuracy in the model forecasts.
specifically for opening lids. The difference in observed maximum From the engineering guidelines point of view for the hand tool
clockwise–anticlockwise strength was approximately 17%. An earlier design, percentile values of wrist‐twisting strength may be of direct
study reported maximum clockwise torque as 45% greater than relevance to the designers for the optimal point of application to the
maximum anticlockwise torque (Seo et al., 2008). Such results may also tools. This would allow the workers to generate maximum strength
have influenced the gravity and anti‐gravity muscle of the upper with relatively less static loading on the muscles, even when the work
extremity. Roman‐Liu and Tokarski (2002) reported that the muscles demand is frequent and in endurance. On the task design
of the upper limb influence the force generation. Finneran and perspective, the pattern of strength generation and sustainability
O'Sullivan (2013) also mentioned that although flexors and extensors with time would help in estimating the work–rest schedule for the
were involved during strong power grips, such repetitive actions may workers involved in manual tool operations.
accentuate forearm extensors related to upper limb injuries like The trend in strength observed was mostly consistent, until the
epicondylitis and carpal tunnel syndrome. work is prolonged beyond the capacity, or any disease/disorder
MAJUMDER ET AL.
restricting physical performance. Thus, this is one of the strengths of
the study, as the current study only recruited healthy participants
having unrestricted physical performance. Further, participants with
any recent (within 1 month) disease/disorder restricting physical
performance were also excluded from the study, thus limiting recall
bias. Although, recall bias of the self‐reported symptoms is
recognized; self‐report is a reliable source for determining work‐
related hazards (Majumder, Shah, & Bagepally, 2016). However, the
present study has certain limitations. Women participants were not
considered in the study, so greater variability in age group
classification could be considered. In addition, cause and effect could
not be addressed in this cross‐sectional study, in which the trends
associated with age may simply be due to the individual capability of
the participants participated. Variability in strength generation and
sustainability may also be affected by any number of environmental
and developmental factors. Although out of the scope of the present
study, future studies may consider the effect of gravity and
antigravity muscles influencing wrist‐twisting activities in variable
postures as well as clinical occupational symptoms like epicondylitis
or tenosynovitis and so forth.
Upper extremity strength in clockwise and anticlockwise modes
while using hand tools is an important criterion for hand tool design.
Further, forecasting of strength data suggests the limits of the
workers while frequent or continuous operation. In addition to
developing engineering guidelines in the design of tools at the
workplace, the job task or equipment may be reengineered in the
event of physical limitations of the worker.
A C K N O W L E D GE M E N T
The authors thank the Director, ICMR‐National Institute of Occupa-
tional Health, Ahmedabad, for permitting to conduct this study. The
authors are indebted to Mrs. BG Shah and Mr. DS Kshirsagar for the
recruitment of participants and assistance during the study.
CO NFLICT OF I NTERE STS
The authors declare that there are no conflict of interests.
E TH I C S A P P R O V AL
Institutional Human Ethics Committee, ICMR‐National Institute of
Occupational health, Ahmedabad
OR CID
Joydeep Majumder http://orcid.org/0000-0001-8138-9940
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How to cite this article: Majumder J, Kotadiya SM, Sharma LK,
Kumar S. Upper extremity muscular strength in wrist‐twisting
tasks: Model approach towards task design. Hum. Factors Man.
2020;30:50–58. https://doi.org/10.1002/hfm.20820