Coping with a Second Disability: Implications of the Late Effects of Poliomyelitis for Occupational Therapists

Fatigue and Activity Patterns of People with Chronic Fatigue Syndrome

Although fatigue is the central symptom of people with chronic fatigue syndrome (CFS), relatively few reports in the literature examine the severity of this fatigue or the activity patterns of people with CFS. Using the Fatigue Severity Scale, the Nottingham Health Profile, the Human Activity Profile, and the Activity Record, severity of fatigue, health status, and activity patterns were investigated. People with CFS reported significantly higher levels of fatigue, poorer health status, and engagement in less energy-demanding activities ( P<0.001) than people without CFS. Those with CFS spent 16.18% (standard deviation [SD]=9.62) of their time resting compared with only 2.28% (SD=3.26) of the time spent by those without CFS ( P<0.05). Time spent in productive activities (household activities and work) was also significantly different, with the CFS group less involved ( P<0.05). This severity of fatigue and limitations in activity patterns warrant further attention. Frequent rest periods and energy conservation training may benefit these clients.

Coping with illness-related problems in persons with progressive muscular diseases: the Swedish version of the Ways of Coping Questionnaire

One of the most widely used self-assessment inventories of coping is the Ways of Coping Questionnaire. The aims of the study were to describe coping with illness-related problems in persons with muscular diseases and to investigate the influence of demographic variables. Also, the reliability of the Swedish version of the Ways of Coping Questionnaire was to be evaluated. Forty-four persons with muscular dystrophy and 32 persons with postpolio syndrome, along with a comparison group of 214 students, completed the questionnaire. The findings of this study show that there are some different coping patterns in students as compared with persons with chronic disease. The coping strategy Distancing was used more and the strategy Accepting Responsibility used less frequently in the chronic disease groups and may be an expression of the inevitable physical limitations caused by the progressiveness of muscular dystrophy and postpolio syndrome. Furthermore, persons with muscular dystrophy also used less problem-focused coping in the form of Confrontive Coping and Planful Problem Solving when compared with the postpolio and student groups. In addition, women in the three groups employed the strategy of Seeking Social Support more often than did men. Regarding the psychometric properties of the Swedish version of the Ways of Coping Questionnaire, internal consistency was acceptable for the total score, but lower and not acceptable for several of the subscales. In the student group, but not in the chronic disease groups, there were low correlations between subscales, which indicate discriminative ability. More research is necessary to further investigate the reliability and validity of the Swedish version of the Ways of Coping Questionnaire before this instrument can be used routinely to assess coping patterns in patients with chronic disease.

Pain, physical activity, and disability in individuals with late effects of polio

OBJECTIVE

The aim of this study was to provide a description of pain and its relationship to the effects of polio, physical activity, and disability.

DESIGN

Assessment instruments used were: a pain questionnaire, a pain drawing, a visual analogue scale (VAS), a 30-m walk indoors, isokinetic muscle strength, serum creatine kinase concentration, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

SETTING

A university hospital department.

SUBJECTS

Thirty-two consecutive individuals with late effects of polio.

RESULTS

More than 50% of the individuals had pain every day, mostly during physical activity. The mean VAS score for daily pain intensity was 55mm, range 0 to 93mm. In the lower limbs cramping pain was the most common pain characteristic in both polio-affected and non-polio-affected limbs. In the upper limbs and in the trunk, aching pain was the most common pain characteristic, especially in the polio-affected areas. The degree of muscle weakness had no correlation to pain experience. The walking test demonstrated a relatively small difference between spontaneous and maximal walking speed. The NHP questionnaire demonstrated that all six dimensions (energy, pain, physical mobility, sleep, emotional reactions, and social isolation) were affected. The dimensions pain and physical mobility both strongly correlated with energy.

CONCLUSIONS

There is a relationship between physical activity in daily life and experience of pain. In many postpolio individuals who experience a high level of pain, spontaneous and maximal walking speed are approximately the same. It is strongly recommended that individuals with late effects of polio, experiencing aching and especially cramping pain, modify their level of physical activity.

Fatigue secondary to chronic illness: postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis

Estimates of the percentage of patients with postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis who experience fatigue range from approximately 75% to 100%. In this study we describe the severity of fatigue and its impact on subjects with these three diagnoses. The Fatigue Severity Scale, the Human Activity Profile, and the Nottingham Health Profile were used to measure fatigue, activity, and health status respectively of each diagnostic group as well as a control group. Using a Kruskal-Wallis one-way analysis of variance followed by a Bonferroni-adjusted Mann Whitney U test all diagnostic groups reported significantly higher levels (p = .0000 to p = .002) of fatigue and lower perceived health status than the control group. Subjects with chronic fatigue and multiple sclerosis also had significantly reduced activity levels (p = .002 to p = .01) compared with the control group. Further attention should be directed toward understanding the relationship between fatigue and ability to engage in activities as well as strategies for remediation and/or compensation of the fatigue.