Effect of wrist posture, rate of force development/relaxation, and isotonic contractions on finger force independence

PhysIOpathology of NEuromuscular function rElated to fatigue in chronic Renal disease in the elderly (PIONEER): study protocol

BACKGROUND

Chronic Kidney Disease (CKD) is associated with reduced muscular strength resulting in profound fatigue. The physiopathology of these changes, their prevalence and evolution are still debated. Moreover, we have little data on elderly CKD patients. The present study protocol aims to 1) quantify the prevalence of low muscle strength (dynapenia) in a cohort of elderly patients with advanced CKD and to 2) characterize their force production coupled with electromyographic features and the symptoms of fatigue compared to a matched control group.

METHODS

This is a case-control, prospective, interventional study.

INCLUSION CRITERIA

age ≥ 60 years; CKD Stage 3b-5; clinical stability (i.e. no hospitalization and ≤ 25% in creatinine increase in the previous 3 months). Controls with normal kidney function will be matched in terms of age, gender and diabetes mellitus (requisite: estimated glomerular filtration rate ≥ 60 ml/min/1.73m² available in the last 6 months). Exclusion criteria for cases and controls: neuromuscular disease, life expectancy < 3 months. The handgrip strength protocol is an intermittent test consisting in 6 series of 9 repetitions of 3-s sub-maximum contractions at 40% of the maximum voluntary contraction (MVC) and 2 s of resting time between contractions. Each series is separated by one fast sub-maximum contraction and one MVC. Strength is assessed with a high-frequency handgrip dynamometer paired with surface electromyography. Symptoms of fatigue are assessed using MFI-20 and FACIT-F questionnaires. In order to reach a statistical power of 96%, we plan to enroll 110 subjects in each group.

DISCUSSION

The novelty of this study resides in the application of an already validated set of tests in a population in which this combination (dynamometer, electromyography and questionnaires) has not previously been explored. We expect a high prevalence of dynapenia and a higher fatigability in CKD patients. A positive correlation is expected between reported fatigue and fatigability. Better appreciation of the prevalence and the relationship between fatigability and a sensation of fatigue can help us target interventions in CKD patients to improve quality of life and survival.

TRIAL REGISTRATION

The study was approved by Ethical Committee EST III n°20.03.01 and was recorded as a Clinical Trial (NCT04330807) on April 2, 2020.

Wrist Posture Does Not Influence Finger Interdependence

A task involving an instructed finger movement causes involuntary movements in the noninstructed fingers of the hand, also known as finger interdependence. It is associated with both mechanical and neural mechanisms. The current experiment investigated the effect of finger interdependence due to systematic changes of the wrist posture, close to neutral. Eight right-handed healthy human participants performed submaximal cyclic flexion and extension at the metacarpophalangeal joint at 0° neutral, 30° extension, and 30° flexion wrist postures, respectively. The experiment comprised of an instruction to move one of the 4 fingers-index, middle, ring, and little. Movements of the instructed and noninstructed fingers were recorded. Finger interdependence was quantified using enslavement matrix, individuation index, and stationarity index, and it was compared across wrist postures. The authors found that the finger interdependence does not change with changes in wrist posture. Further analysis showed that individuation and stationarity indices were mostly equivalent across wrist postures, and their effects were much smaller than the average differences present among the fingers. The authors conclude that at wrist postures close to neutral, the finger interdependence is not affected by wrist posture.