Characteristics of Patients at First Visit to a Polio Clinic in Sweden

Is Intervention to Prevent Falls Necessary in Prior Polio Patients?

Objective

To investigate whether intervention to prevent falls is necessary in prior polio patients, by identifying the frequency, circumstances and consequences of falls among patients in Sweden with prior polio.

Subjects

Patients with prior polio diagnosis.

Methods

A falls history questionnaire was completed by patients with prior polio visiting the outpatient clinic at the Department of Rehabilitation Medicine, Danderyd University Hospital, Stock-holm, Sweden, or participating in group activities organized by the patient organization.

Results

A total of 80 patients answered the questionnaire; 32 men and 48 women. Eighty-one percent (n = 63/77) of respondents walked outdoors, but rarely more than 1 km, or only inside and near the house. Three-quarters of patients had fallen one or more times over the past year and one-quarter of patients had fallen 5 times or more. The falls often occurred during daytime in an environment known to the patient. Sixty-nine percent (n = 40/58) of respondents had been injured due to falling during the past year. The most common injuries were minor injuries.

Conclusion

Falls are common in patients in Sweden with prior polio. Interventions to prevent falls in people with prior polio are therefore clinically relevant.

A very long-term longitudinal follow-up of persons with late effects of polio

BACKGROUND

As many as 60-80% of persons with a history of polio myelitis develop new symptoms, such as new or increased muscle weakness, muscle and joint pain, and fatigue several decades later, called postpolio syndrome (PPS). This may affect their ability to perform activities of daily living (ADL). It is still unclear if the patient's symptom is getting worse and in that case how much/fast the decline is.

AIM

The aim of the present study was to evaluate long-term changes in disability in community dwelling patients with prior poliomyelitis, in contact with a polio clinic 14-16 years post their first assessment.

DESIGN

A cross sectional longitudinal study.

SETTING

Polio clinic.

POPULATION

Fifty-two persons recruited from an earlier 4-year follow-up participated in the study.

METHODS

A questionnaire was mailed prior to the visit at the polio clinic. Physical testing was performed by measuring muscle strength, walking speed and handgrip force.

RESULTS

Overall there was a small change in muscle strength. A significant reduction in the right leg was found for flexion 60° and in dorsal flexion. For the left leg a significant reduction was found for plantar flexion. In the walking tests, a significant reduction was seen for spontaneous walking speed. No significant interaction between decrease in spontaneous walking speed and the variables age, BMI and flexion 60° and dorsal flexion in the right leg was seen.

CONCLUSIONS

This cross-sectional longitudinal study shows small changes in muscle strength and disability. The results may imply that symptoms associated with late effects of polio are not progressing as fast as we had previously thought.

CLINICAL REHABILITATION IMPACT

When health care professionals meet persons with late effects of polio the knowledge of long-term consequences of deterioration is important. Knowing that the deterioration is not as fast as previously thought, can help us to support the person in having a healthy lifestyle, stay active and encourage to perform adapted physical training.

Sunnerhagen K. "The car is my extra legs" - Experiences of outdoor mobility amongst immigrants in Sweden with late effects of polio

BACKGROUND

The aim of the study was to describe the experience of outdoor mobility among immigrants with late effects of polio living in Sweden. There is a need to understand more about this young group of persons since they often have problems with mobility and gait, but they may also face participation restrictions due to issues associated with integration into a new community and culture.

METHOD

A total of 14 young immigrants with late effects of polio participated and were interviewed individually. The study used a qualitative method to explore personal experiences and the interviews were analyzed through an inductive approach, using qualitative content analysis.

RESULTS

The analysis led to a major theme; self-image and acceptance, that comprised a changeable process and experiences of cultural, social, and gender-specific barriers, but also of environmental and personal factors that impacted their outdoor mobility. By using a car, the participants felt they could come across as normal which also increased their self-esteem.

CONCLUSIONS

Independent mobility is a major enabler for ongoing employment and being able to use a car increases the chances for integration into society for young immigrants with late effects of polio. Public transport is not considered to be adequate or efficient enough due to the participants' mobility impairments, but driving can prevent involuntary isolation and facilitate participation. A car can increase quality of life but may also be a facilitator for work and reduce the demand for societal support.

Self-perceived mobility in immigrants in Sweden living with the late effects of polio

Purpose: To investigate outdoor mobility of immigrants in Sweden who are living with the late effects of polio.Materials and methods: A total of 145 patients with late effects of polio born outside the Nordic region were identified at an outpatient polio clinic. Of these, 74 completed a questionnaire about their mobility and independence in daily life, self-perceived pain and depression, vocational status, mobility assistive devices/aids, transportation modes and driving. Patient characteristics were based on medical records supplied by physicians.Results: Twice as many patients had lower extremities that were affected by polio than upper extremities. This affected their use of different transport modes and caused mobility and transfer problems. Indeed, 39% needed mobility aids and help from another person to move outdoors. Those who reported dependence for outdoor mobility were more often unemployed and more often depressed.Conclusions: Many respondents reported having difficulties with transport mobility, but a large proportion, 57%, were independent and active drivers. It is important to consider outdoor mobility when planning rehabilitation for patients with late effects of polio and foreign backgrounds. In addition to psychosocial factors, dependence on mobility-related activities can lead to dependency and isolation.Implications for rehabilitationOutdoor mobility and access to transport modes are important for independence and an active life and need to be included in the rehabilitation process.Both personal and environmental factors, can contribute to mobility problems of people with foreign backgrounds, who are living with the late effects of polio.Factors such as cultural, social and gender aspects are important when planning suitable and individualized rehabilitation.

The extent of using mobility assistive devices can partly explain fatigue among persons with late effects of polio - a retrospective registry study in Sweden

Background

Fatigue is reported as one of the most disabling symptoms and is common among persons living with late effects of polio. Although fatigue has been studied in the context of people living with late effects of polio, there is a lack of knowledge concerning the association of fatigue and variables of importance for participation in daily life. Therefore, the aim of this study was to explore possible factors associated with fatigue among persons with late effects of polio in Sweden.

Methods

This retrospective registry study consisted of 89 persons with late effects of polio living in Sweden. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20) scale, Swedish version. Pearson’s correlation coefficient was used to analyse the correlation between the factors and fatigue, and a multiple linear regression was carried out to explore factors for fatigue.

Results

Fatigue statistically significantly correlated with age (r = 0.234, p < 0.05) and the use of mobility assistive devices (r = 0.255, p < 0.05). The multiple linear regression model showed that the factors age (β = 0.304, p < 0.019) and mobility assistive devices (β = 0.262, p < 0.017) were associated with fatigue among persons living with late effects of polio, and the model partly explained 14% of the variation of fatigue.

Conclusions

Fatigue could partly be explained by the extent of using mobility assistive devices and age. Healthcare professionals should provide and demonstrate the importance of assistive devices to ensure management of fatigue in persons living with late effects of polio.