Changes in ability, perceived difficulty and use of assistive devices in everyday life: a 4-year follow-up study in people with late effects of polio

The Influence of Walking Limitations on Daily Life: A Mixed-Methods Study of 14 Persons with Late Effects of Polio

Reduced walking ability is common in persons with late effects of polio (LEoP). Here, we explored how many walking limitations persons with LEoP perceive, and how these limitations influence daily life, by using a mixed-methods design. Fourteen persons (mean age 70 years, whereof 7 women) with LEoP responded to the Walking Impact Scale (Walk-12), and were interviewed individually. Qualitative data were analysed by systematic text condensation, and each quotation was deductively analysed in relation to the items in Walk-12. Running was perceived as most limited, whereas walking indoors without using support was perceived as least limited. A majority (>70%) were moderately to extremely limited in standing or walking, in walking speed and distance, which affected concentration and effort, as well as gait quality aspects. The limited walking ability intruded on many everyday activities, both indoors and outdoors, which affected social participation negatively. To increase safety when walking and reduce the fall risk, various strategies were adopted such as using aids, walking carefully, and avoiding risky activities. In conclusion, LEoP-related walking limitations influence participants’ activity and participation greatly. By using both the Walk-12 scale and face-to-face interviews, an increased understanding of how walking limitations influence everyday life was achieved.

Fall-Related Activity Avoidance among Persons with Late Effects of Polio and Its Influence on Daily Life: A Mixed-Methods Study

Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.

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.

Perceived consequences of ageing with late effects of polio and strategies for managing daily life: a qualitative study

Background

New or increased impairments may develop several decades after an acute poliomyelitis infection. These new symptoms, commonly referred to as late effects of polio (LEoP), are characterised by muscular weakness and fatigue, generalised fatigue, pain at rest or during activities and cold intolerance. Growing older with LEoP may lead to increased activity limitations and participation restrictions, but there is limited knowledge of how these persons perceive the practical and psychological consequences of ageing with LEoP and what strategies they use in daily life. The aim of this qualitative study was therefore to explore how ageing people with LEoP perceive the their situation and what strategies they use for managing daily life.

Methods

Seven women and seven men (mean age 70 years) were interviewed. They all had a confirmed history of acute poliomyelitis and new impairments after a stable period of at least 15 years. Data were transcribed verbatim and analysed using systematic text condensation.

Results

The latent analysis resulted in three categories ‘Various consequences of ageing with LEoP’, ‘Limitations in everyday activities and participation restrictions’, and ‘Strategies for managing daily life when ageing with LEoP’ and 12 subcategories. The new impairments led to decreased physical and mental health. The participants perceived difficulties in performing everyday activities such as managing work, doing chores, partaking in recreational activities and participating in social events, thereby experiencing emotional and psychological distress. They managed to find strategies that mitigated their worries and upheld their self-confidence, for example finding practical solutions, making social comparisons, minimising, and avoidance.

Conclusion

Ageing with LEoP affected daily life to a great extent. The participants experienced considerable impact of the new and increased impairments on their life situation. Consequently, their ability to participate in various social activities also became restricted. Social comparisons and practical solutions are strategies that facilitate adaptation and acceptance of the new situation due to LEoP. This emphasises the need to design rehabilitation interventions that focus on coping, empowerment and self-management for people ageing with LEoP.

Struggling to be part of Swedish society: Strategies used by immigrants with late effects of polio

OBJECTIVE

To explore and describe strategies in daily occupations among immigrants with late effects of polio.

METHOD

The strategies were explored by interviews with 12 immigrants from Eastern Africa with late effects of polio. Sampling and data analysis was carried out according to grounded theory.

RESULTS

The participants struggled for occupational participation and normality in an effort to participate in, and be part of, society. The study identified 14 strategies used by the immigrants in their daily occupations. The strategies can be presented in the following four categories: managing physical capacity; promoting occupational performance; strategies for gaining respect; and preparing the ground for one's existence. The participants struggled to find a balance between physical capacity and meaningful occupations, conception of their own and others' norms and values, and living conditions in Swedish society. The strategies were related to the participants' will to manage daily occupations, maintain social relationships, and be part of society.

CONCLUSIONS

The strategies revealed that the participants strive to participate in occupations and society. This study reinforces the importance of occupation for immigrants with disability. The results highlight the need for adequate health care and rehabilitation but should also alert other social institutions.

Elevated blood lipids are uncommon in patients with post-polio syndrome--a cross sectional study

Background

The post-polio syndrome occurs in people who previously have had poliomyelitis. After the initial recovery, new or increasing neurologic symptoms occur. Inflammation and dyslipidaemia may play an important role in the development of atherosclerotic complications, for example myocardial infarction and angina pectoris. Previous studies on cardiovascular risk factors in the post-polio syndrome have found a higher prevalence of hypertension, ischemic heart disease, hyperlipidaemia, and stroke in these patients. The present study was undertaken in order to evaluate whether post-polio patients have elevated lipid values, and if blood lipid abnormalities could be correlated to signs of inflammation.

Methods

Cross-sectional study of 89 consecutive post-polio patients, (53 women, mean age 65 years) from the Post-Polio Outpatient Clinic, Danderyd University Hospital, Stockholm, Sweden. The lipid profiles of post-polio patients were compared to age and sex matched reference values from two earlier studies. Statistical analyses were performed by the Student’s t-test, and linear regression analyses were assessed by Pearson’s correlation coefficient.

Results

Mean total cholesterol levels (5.7 mmol/L) were low or normal in post-polio patients, whereas low density lipoprotein levels (3.6 mmol/L) were normal, and high density lipoprotein (1.5 mmol/L) and triglycerides (1.4 mmol/L) lower than reference values. The prevalence of diabetes (7%), hypertension (38%), concomitant cardiovascular disease, (including angina pectoris, myocardial infarction, heart failure, atrial fibrillation and stroke) (7%), and calculated 10 year risk of coronary heart disease according to Framingham risk score algorithm (8%) was not increased in post-polio patients.

Conclusions

Compared to reference populations, post-polio patients in Sweden appear to have low or normal total cholesterol and low density lipoprotein levels, whereas high density lipoprotein and triglyceride levels are low. Hence, a possible persisting inflammatory process in post-polio syndrome does not seem to be associated with increased lipids and an increased risk for coronary heart disease events.

Assistive technology and prediction of happiness in people withpost-polio syndrome

PURPOSE

To explore the relationship between level of happiness in people with post-polio syndrome (PPS) and assistive technology (AT) by taking into account confounding factors such as age, gender and house composition.

METHOD

Existing data from 218 adults with PPS, who had completed a cross-sectional survey conducted by the British Polio Fellowship in 2007, were used for a secondary quantitative analysis. Ordinal logistic regression was applied to determine whether ownership of or the need for AT predicted happiness in people with PPS.

RESULTS

Ownership of AT did not predict happiness, whereas the perceived need for AT was a significant predictor of feeling less happy (p = 0.028). Among the different types of AT needed, only need of home adaptations combined with major equipment was close to being significantly associated with less happiness (p = 0.078). Being older (p < 0.001) and living with a partner (p < 0.001) significantly increased the likelihood of feeling happier.

CONCLUSION

The findings indicate the importance of the contribution of need for AT in explaining happiness in people with PPS. The fact that users reported unmet equipment needs urge for increased user decision making and better understanding of why perceived needs are not resolved. [Box: see text].