INTERNATIONAL ISLAMIC UNIVERSITY

KULLIYAH OF SCIENCE
BIO-MEDICAL SCIENCE
CLINICAL AND PHARMACEUTICAL RESEARCH CONCENTRATION
S

RESEARCH PARTICIPATION CONSENT FORM

Project Title :- “Electromyography study of different rubber tapper tools”

Student Investigator :- Mohammed Sarfraz Ahmed

Project Supervisor :- Br. Ibrahim Adham bin Taib

Introduction/Purpose:
The objective of this study is to assess the comfort and efficiency of the various rubber tapper
tools that are being used today employing the use of the Electromyography.

You are being requested to participate in this research study:-

 The participant would represent the rubber tapper worker.

 To perform the same procedure of rubber tapping in a laboratory conditions.

The purpose of this study :-

 Is to determine whether the tools used by rubber tappers are contributing to any
problems of the hand , wrist , and forearm .
 To identify which muscles of the forearms are being used during the actual rubber
tapping process.
 To provide information that may aid in the designing of more ergonomically designed
tools for carrying out the rubber tapping process.

The Number of people involved in this research :-

 10 Male and 10 Females randomly selected.

Procedures :-

As a participant of this study you will be requested to come to the physiology lab in the bio-
labs building on the first floor. Your participation in this study would last approximated 20 to
30 minutes and will require just one visit to the lab.

1. Before conducting the experiment you will be asked to fill out a questionnaire that has
questions of a non personal nature such as -

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 a. You will be required to fill out your full name.
b. You will be required to indicate whether you are right or a left handed person.
c. You will be asked about your height and weight.
d. You will be required to explain your occupation.

2. You will be asked to perform the rubber tapping process after an explanation from the
student investigator.
3. Electrodes that are attached to an electromyography device would be placed on
certain muscles of the forearm.
4. Once the electrodes are attached you will perform the rubber tapping process using
the rubber tapping tools on two surfaces that would represent the tree.
5. As you are performing the process the readings shall be recorded and documented for
later data analysis.

At any time in the study, you may decide to withdraw from the study. If you withdraw no
more information will be collected from you. When you indicate you wish to withdraw the
investigator will ask if the materials already collected in the study can be used.

Risks & Discomfort

 You may get tired while performing the process and get rest at any time.
 You may feel a little bit awkward when holding the rubber tapping tool , you will be
instructed on how to minimize this.
 The student investigator shall inform you any risks or complications if any associated
with your participation in this research.

You have the right to withdraw from the study at any time.

Research Related Injuries

Immediate necessary medical care is available at the IIUM CLINIC in the event that you are
injured as a result of participation in this project. However , there is no commitment by
International Islamic University, Student Investigator and his supervisor to provide monetary
compensation to you in the event of a project-related injury.

For questions about the study or research related injury please contacts the student
investigator Sarfraz at 019-974-2770 during regular business hours including weekends and
holidays.

Benefits

There will be no direct benefit to you as a result of participating in this study

Your participation in this study may :-

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  The data gathered as a result of your participation will help identify the risks
associated with using the common rubber tapper tools in the Rubber Tapping industry
in Malaysia.
 This data will assist in the future designing of more comfortable and ergonomic tools.
 This data will help alleviate the risk of injury for approximately 100,000 rubber
tappers in Malaysia.

Alternatives

You have the alternative to choose not to participate in this study.

Confidentiality

Participation in this study may result in a loss of privacy , since persons other than the
investigators might view the data gathered from this experiment. Unless required by law ,
only the student investigator and his supervisor will have the right to review the data
gathered from the experiment. They are required to maintain the confidentiality regarding
your identity.

Results of this study may be used for teaching , research , publications or presentations at
scientific meetings. If your individual results are to be discussed , your identity will be
protected by giving a code rather that your name or other identifying information.

Financial Information

Your participation in this study will involve no costs to you. You will not be paid for your
participation in this study.

Participation and Withdrawal

You can choose whether to be in this study or not. If you volunteer to be in this study, you
may withdraw at any time without consequences of any kind. You may exercise the option
of removing your data from the study. You may also refuse to answer any questions you
don’t want to answer and still remain in the study. The investigator may withdraw you
from this research if circumstances arise that warrant doing so.

Rights of Research Participations

You may withdraw your consent at any time and discontinue participation without penalty.
You are not waiving any legal claims or rights because of your participation in this
research study. If you have questions regarding your rights as a research participant,
contact

Student Investigator: - Mohammed Sarfraz Ahmed at 019 – 974 – 2770

Supervisor:- Br. Ibrahim Adham bin Taib at 019 – 370 – 4778

At regular business hours including weekends and holidays.

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Contact:-

Student Investigator :- Mohammed Sarfraz Ahmed at 019 – 974 – 2770 room number
Mahallah Zahrawi boys hostel F 2.7.

Research Supervisor :- Br. Ibrahim Adham bin Taib at 019 – 370 – 4778 Lecturers room
_____________

On regular business hours including holidays and weekends.

Consent :-

I have read this form and the research study has been explained to me. I have been given the
opportunity to ask questions and my questions have been answered. If I have additional
questions, I have been told whom to contact. I agree to participate in the research study
described above and will receive a copy of this consent form. I will receive a copy of this
consent form after I sign it.

__________________________________________________ _______________
Subject’s Name (printed) and Signature Date

__________________________________________________
Name (printed) and Signature of Person Obtaining Consent

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 RESEARCH PARTICIPANT DETAILS

“Electromyography of Rubber Tapper Tools”

1 Name

2 Age

3 Sex

4 Height

5 Weight

6 Hand Dominance

7 Occupation
Details.

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