Morbidity, mortality and long-term sequelae of West Nile virus disease in Québec.

We aimed to describe the clinical characteristics of West Nile patients reported in Québec in 2012 and 2013 and to document physical, mental and functional status 24 months after symptom onset according to illness severity. The cases were recruited by a public health professional. Data were collected from public health files, medical records and two standardised phone questionnaires: the Short Form-36 and the Instrumental Activities of Daily Living. In all, 92 persons participated in the study (25 had West Nile fever (WNF), 18 had meningitis and 49 had encephalitis). Encephalitis participants were older, had more underlying medical conditions, more neurological symptoms, worse hospital course and higher lethality than meningitis or WNF participants. Nearly half of the surviving hospitalised encephalitis patients required extra support upon discharge. At 24-month follow-up, encephalitis and meningitis patients had a lower score in two domains of the mental component: mental health and social functioning (P = 0.0025 and 0.0297, respectively) compared with the norms based on age- and sex-matched Canadians. Physical status was not affected by West Nile virus (WNV) infection. In addition, 5/36 (15%) of encephalitis, 1/17 (6%) of meningitis and 1/23 (5%) of WNF participants had new functional limitations 24 months after symptom onset. In summary, mental and functional sequelae in encephalitis patients are likely to represent a source of long-term morbidity. Preventive measures should target patients at higher risk of severe illness after WNV infection.

A postural adaptation test for stroke patients.

PURPOSE: To explore the interrater reliability of the Advanced Mobility and Balance Scale (AMBS) and to determine its discriminative capacity in stroke patients. METHODS: Twelve hemiparetic patients and six healthy elderly volunteers were videotaped while: (1) executing rapid head motions during standing and walking; and (2) standing and walking on a slope. Five physical therapists viewed the videotapes to establish interrater reliability. RESULTS: Interrater reliability: Intraclass correlation ratios ranged from 0.93-0.97 for the AMBS global as well as slope and head turn subscores. Construct validity: One-way ANOVAs and post-hoc pairwise comparisons were performed to determine whether there was a difference in scores between high (HFL) and low functional-level (LFL) stroke patients (based on gait speed) and healthy subjects. Mean (+/-SD) global scores were 45 +/- 3 for healthy subjects, 40 +/- 9 for HFL stroke patients and 25 +/- 1 for LFL stroke patients (p < 0.05 for HFL versus LFL patients and LFL patients versus healthy subjects). The AMBS slope subscores were 22 +/- 2, 19 +/- 5, 9 +/- 7 for healthy, HFL and LFL subjects respectively (p < 0.05 for HFL versus LFL patients and LFL patients versus healthy subjects). CONCLUSION: The AMBS has excellent interrater reliability and good discriminative capacities.