The risk of post-polio syndrome among immigrant groups in Sweden.

To examine the risk of post-polio syndrome (PPS) in immigrant groups using native Swedish-born individuals as referents. This is a retrospective study. The study population included all individuals aged 18 years and older registered in Sweden. PPS was defined as having at least one registered diagnosis in the Swedish National Patient Register. The incidence of post-polio in different immigrant groups, using Swedish-born individuals as referents, was assessed by Cox regression, with hazard ratios (HRs) and 99% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, co-morbidities, and neighbourhood socioeconomic status. In total 5300 post-polio cases were registered, 2413 males and 2887 females. Fully adjusted HRs (99% CI) in immigrants versus Swedish-born were 1.77 in men (1.52-2.07) and 1.39 (1.19-1.62) in women. Statistically significant excess risks of post-polio were found in the following subgroups: men and women from Africa, HRs (with 99% CI) 7.40 (5.17-10.59) and 8.39 (5.44-12.95), respectively, and Asia, HRs 6.32 (5.11-7.81) and 4.36 (3.38-5.62) respectively, and in men from Latin America, HR 3.66 (2.17-6.18). It is of importance to be aware of risks of PPS in immigrants settled in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. Patients with PPS need treatment and proper follow-up until polio has been eradicated through global vaccination programs.

Coexistence of fibromyalgia and post-polio syndrome in persons with prior poliomyelitis in Turkey: the relations with symptoms, polio-related impairments, and quality of life.

PURPOSE: To investigate the prevalence of fibromyalgia(FM) and to show its relations with symptoms, polio-related impairments (PRI), and quality of life (QoL) in persons with prior paralytic poliomyelitis (PsPP) with and without post-polio syndrome (PPS). MATERIALS AND METHODS: The study included 74 PsPP under 60 years of age, 60 of whom met the criteria for PPS. Presence and severity of FM were assessed by the American College of Rheumatology (ACR) 1990, 2010, and 2016 criteria, and Fibromyalgia Severity Score. PPS symptoms, PRI, and QoL were evaluated using the Self-Reported Impairments in Persons with Late Effects of Polio Rating Scale, Fatigue Severity Scale, and Nottingham Health Profile. Frequency, comparison, and correlation analyses were performed. RESULTS: While 15% of PsPP with PPS met the criteria of ACR 1990, 32% of ACR 2010, and 35% of ACR 2016, none of those without PPS met any of the criteria for FM. Severity of PPS symptoms and PRI were significantly higher, and QoL was significantly lower in those with co-existing FM. FM severity was found to be significantly associated with severity of PPS symptoms, PRI and reduced QoL. CONCLUSIONS: FM frequently coexists in PsPP with PPS and may increase the burden of PPS.Implications for RehabilitationFibromyalgia (FM) is commonly seen in patients with post-polio syndrome (PPS).Co-existing FM may increase the burden of PPS, as it is associated with more severe symptoms, more polio-related impairments, and worse quality of life.Recognition, appropriate referral, and successful management of co-existing FM may allow for reduced symptoms or symptom severity and improved quality of life in persons with PPS.

Describing post-polio syndrome.

INTRODUCTION: Patients presenting sequelae of poliomyelitis may present new symptoms, known as post-polio syndrome (PPS). OBJECTIVE: To identify the clinical and functional profile and epidemiological characteristics of patients presenting PPS. PATIENTS AND METHODS: We performed a retrospective study of 400 patients with poliomyelitis attended at the Institut Guttmann outpatient clinic, of whom 310 were diagnosed with PPS. We describe patients' epidemiological, clinical, and electromyographic variables and analyse the relationships between age of poliomyelitis onset and severity of the disease, and between sex, age of PPS onset, and the frequency of symptoms. RESULTS: PPS was more frequent in women (57.7%). The mean age at symptom onset was 52.4 years, and was earlier in women. Age at primary infection > 2 years was not related to greater poliomyelitis severity. The frequency of symptoms was: pain in 85% of patients, loss of strength in 40%, fatigue in 65.5%, tiredness in 57.8%, cold intolerance in 20.2%, dysphagia in 11.7%, cognitive complaints in 9%, and depressive symptoms in 31.5%. Fatigue, tiredness, depression, and cognitive complaints were significantly more frequent in women. Fifty-nine percent of patients presented electromyographic findings suggestive of PPS. CONCLUSIONS: While the symptoms observed in our sample are similar to those reported in the literature, the frequencies observed are not. We believe that patients' clinical profile may be very diverse, giving more weight to such objective parameters as worsening of symptoms or appearance of weakness; analysis of biomarkers may bring us closer to an accurate diagnosis.

Describiendo el síndrome pospolio / Describing post-polio syndrome

Introducción: Las personas con secuelas de poliomielitis pueden presentar nuevos síntomas que constituirían el síndrome pospolio (SPP). Objetivo Identificar el perfil clínico y funcional, y las características epidemiológicas de personas que padecen SPP. Pacientes y métodos: Estudio retrospectivo de 400 pacientes afectados de poliomielitis visitados en consulta externa del Institut Guttmann, de los cuales a 310 se les diagnosticó SPP. Se describieron variables epidemiológicas, clínicas y electromiográficas. Se analizó la relación entre edad de adquisición de la polio y gravedad de la misma, así como entre el sexo y la edad de aparición del SPP y la frecuencia de síntomas. Resultados: Se observó mayor frecuencia de SPP en mujeres (57,7%). La edad media de inicio de la clínica fue 52,4 años, más precoz en mujeres. Edad de primoinfección mayor de 2 años no se relacionó con mayor gravedad de la polio. La frecuencia de síntomas fue: dolor 85%, pérdida de fuerza 40%, fatiga 65,5%, cansancio 57,8%, intolerancia al frío 20,2%, disfagia 11,7%, quejas cognitivas 9%, síntomas depresivos 31,5%. La fatiga, el cansancio, la depresión y las quejas cognitivas fueron significativamente más frecuentes en mujeres. El 59% de los pacientes presentaban hallazgos electromiográficos sugestivos de SPP. Conclusiones: El tipo de sintomatología que presentaba nuestra muestra es similar a la publicada, no así en la frecuencia de la misma. Creemos que el perfil clínico de los pacientes podría ser muy diverso, y dar mayor peso a parámetros objetivos como el empeoramiento o la aparición de debilidad y el estudio de biomarcadores podría acercarnos más a un diagnóstico preciso. (AU)

Introduction: Patients presenting sequelae of poliomyelitis may present new symptoms, known as post-polio syndrome (PPS). Objective: To identify the clinical and functional profile and epidemiological characteristics of patients presenting PPS. Patients and methods: We performed a retrospective study of 400 patients with poliomyelitis attended at the Institut Guttmann outpatient clinic, of whom 310 were diagnosed with PPS. We describe patients’ epidemiological, clinical, and electromyographic variables and analyse the relationships between age of poliomyelitis onset and severity of the disease, and between sex, age of PPS onset, and the frequency of symptoms. Results: PPS was more frequent in women (57.7%). The mean age at symptom onset was 52.4 years, and was earlier in women. Age at primary infection > 2 years was not related to greater poliomyelitis severity. The frequency of symptoms was: pain in 85% of patients, loss of strength in 40%, fatigue in 65.5%, tiredness in 57.8%, cold intolerance in 20.2%, dysphagia in 11.7%, cognitive complaints in 9%, and depressive symptoms in 31.5%. Fatigue, tiredness, depression, and cognitive complaints were significantly more frequent in women. Fifty-nine percent of patients presented electromyographic findings suggestive of PPS. Conclusions: While the symptoms observed in our sample are similar to those reported in the literature, the frequencies observed are not. We believe that patients’ clinical profile may be very diverse, giving more weight to such objective parameters as worsening of symptoms or appearance of weakness; analysis of biomarkers may bring us closer to an accurate diagnosis. (AU)

[Post-polio Syndrome in the Perioperative Phase]. / Das Post-Polio-Syndrom in der perioperativen Phase.

Due to the numerous poliomyelitis epidemics that have continued over the last decades and the post-polio syndrome (PPS) that occurs 10 - 30 years after poliomyelitis infection, the prevalence of PPS is also expected to increase in Europe. At the same time, due to the musculoskeletal disorders associated with the underlying disease, PPS patients often require surgery for which special anaesthetic requirements must be taken into account. In this analysis we summarise the current evidence and recommendations.

Usefulness of Neuromuscular Co-morbidity, Left Bundle Branch Block, and Atrial Fibrillation to Predict the Long-Term Prognosis of Left Ventricular Hypertrabeculation/Noncompaction.

The prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT) is assessed controversially. LVHT is associated with other cardiac abnormalities and with neuromuscular disorders (NMD). Aim of the study was to assess cardiac and neurological findings as predictors of mortality rate in adult LVHT-patients. Included were patients with LVHT diagnosed between 1995 and 2019 in 1 echocardiographic laboratory. Patients underwent a baseline cardiologic examination and were invited for a neurological investigation. In January 2020, their survival status was assessed. End points were death or heart transplantation. LVHT was diagnosed by echocardiography in 310 patients (93 female, aged 53 ± 18 years) with a prevalence of 0.4%/year. A neurologic investigation was performed in 205 patients (67%). A specific NMD was found in 33 (16%), NMD of unknown etiology in 123 (60%) and the neurological investigation was normal in 49 (24%) patients. During follow-up of 84 ± 71 months, 59 patients received electronic devices, 105 patients died, and 6 underwent heart transplantation. The mortality was 4.7%/year, the rate of heart transplantation/death 5%/year. By multivariate analysis, the following parameters were identified to elevate the risk of mortality/heart transplantation: increased age (p = 0.005), inpatient (p = 0.001), presence of a specific NMD (p = 0.0312) or NMD of unknown etiology (p = 0.0365), atrial fibrillation (p = 0.0000), ventricular premature complexes (p = 0.0053), exertional dyspnea (p = 0.0023), left bundle branch block (p = 0.0201), and LVHT of the posterior wall (p = 0.0158). In conclusion, LVHT patients should be systematically investigated neurologically since neurological co-morbidity has a prognostic impact.

Sense of Coherence and the Association with Sociodemographics and Disability Related Factors in Persons with Late Effects of Polio.

BACKGROUND: Sense of Coherence (SOC) is important for successful adaptation in persons with life-long disabilities. A previous study has shown that persons with Late Effects of Polio (LEoP) have a level of SOC indicating that they generally have the ability to understand, handle, and have the motivation to deal with stressful events and problems arising in their lives. However, no study has explored the associations between SOC, sociodemographics, and disability-related factors in persons with LEoP. OBJECTIVE: To explore the associations between SOC, sociodemographics, and disability-related factors in persons with LEoP. DESIGN: A cross-sectional design. SETTING: University hospital outpatient clinic. STUDY PARTICIPANTS: Ninety-three persons (mean age 74 years, 52% women) with LEoP. MAIN OUTCOME MEASUREMENTS: Swedish versions of the Sense of Coherence scale (SOC-13), Self-reported Impairments in Persons with Late Effects of Polio (SIPP) scale, Reintegration to Normal Living Index (RNL-I) (subscales "Daily Functioning" and "Perceptions of Self"), and Satisfaction With Life Scale (SWLS). METHODS: The participants responded to a postal survey with background information and the four rating scales. To determine factors associated with SOC, a hierarchical regression analysis was performed with SOC as the dependent variable. RESULTS: Higher age, less bothered by symptoms of LEoP, better perceptions of self, and higher life satisfaction were significantly associated with a greater SOC score. The final model explained 60% of the variance in the SOC (R2 Adj = 0.60, P < .001). CONCLUSIONS: The strong association between SOC, higher age, and disability-related factors is important to consider in the rehabilitation of persons with LEoP. This knowledge can assist rehabilitation professionals to plan interventions that enable people with LEoP to develop strategies to better manage their daily life. LEVEL OF EVIDENCE: III.

Polio and post-polio syndrome in non-Western immigrants: A new challenge for the healthcare system in Norway.

OBJECTIVE: To explore the health situation and identify specific health challenges in non-Western immigrants with polio in Norway, by comparing their status with Western immigrants with polio and native Norwegians with polio. DESIGN: A questionnaire covering demographics, polio history, life satisfaction, medical, psychological and social conditions was answered by 1,408 persons with polio, among them 34 immigrants from non-Western countries and 32 immigrants from Western countries. RESULTS: The non-Western immigrant polio group had a mean age of 46 years, were highly educated, reported high frequency of mental health problems and only one-third was working. Mean age for contracting polio was 2.8 years. Only 30% was hospitalized in the acute phase and 80% reported severe leg weakness. Use of a powered wheelchair was reported by 72%. Post-polio symptoms had started at a mean age of 31 years. The non-Western immigrant group reported more fatigue, pain and loneliness, and a high proportion reported insufficient assistance from the public health system. CONCLUSION: The group of non-Western immigrants with polio in Norway reported more health and social problems than the group of Western immigrants with polio or the native Norwegian group with polio, even though they were younger and more highly educated. Their complex psychological and social situation requires active intervention from the health system, and health professionals need extra skills to deal most effectively with their situation.

Polio survivors perceptions of a multi-disciplinary rehabilitation programme.

PURPOSE: Post-polio syndrome refers to a late complication of the poliovirus infection. Management of post-polio syndrome is complex due to the extensive symptomology. European and United Kingdom guidelines have advised the use of rehabilitation programmes to manage post-polio syndrome. There is a paucity of research in relation to the effectiveness of rehabilitation interventions. The objective of this study is to explore polio survivor's perceptions of an in-patient multi-disciplinary rehabilitation programme. METHODS: Semi-structured interviews of community dwelling polio survivors who attended in-patient rehabilitation programme in the United Kingdom. Thematic analysis was used to describe and interpret interview data. RESULTS: Participants' experiences were influenced by past experiences of polio and their self-concept. Participants generally had a positive experience and valued being with other polio survivors. Positive strategies, such as pacing and reflection changed their mind-sets into their lives after the programme, though they still faced challenges in daily living. Some participants supported others with post-polio syndrome after completing the programme. CONCLUSIONS: Our research identified that participants experienced long term positive benefits from attending a rehabilitation programme. Strategies that users found helpful that explored the effectiveness of interventions to manage polio are not cited within a Cochrane review. If we are to recognise the lived experience and service user empowerment within a model of co- production it is essential that patient preferences are evaluated and used as evidence to justify service provision. Further research is required with polio survivors to explore how best rehabilitation programmes can adopt the principles of co-production. Implications for Rehabilitation The patients' expertise and lived experience must be at the centre of a rehabilitation programme. Strategies such as pacing and reflection are perceived as important strategies to enable self-management of polio and post-polio syndrome despite the limited evidence base to support these interventions. Polio rehabilitation programmes should not be time limited and commissioners and therapists need to ensure that follow up support is provided. When measuring outcomes patient preferences and views must be evaluated.

Anxiety, depression, and function in individuals with chronic physical conditions: A longitudinal analysis.

OBJECTIVE: This longitudinal study examined the unique relationship between anxiety, symptoms (pain intensity, sleep disturbance, fatigue severity), and function domains (self-reported cognitive function, physical function, satisfaction with social roles) in individuals with chronic physical conditions, independent of depressive symptoms. METHOD: Three surveys were mailed on an approximately yearly basis to community-dwelling adults with one of four chronic physical conditions (spinal cord injury, multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome). The first survey was completed by 1594 individuals (T1). Of these, 1380 completed the second survey (T2), and 1272 completed the third survey (T3). RESULTS: Mixed growth curve models evidenced significant concurrent and longitudinal associations between anxiety and each symptom and function domain, independent of depression severity. The largest unique association found was between anxiety and self-reported cognitive function; inclusion of the measure of anxiety in the model improved model fit substantially over depression alone, χ²[2] = 104.40, p < .001. Both anxiety and depression exhibited similar effect sizes in their unique relationships with each symptom and function domain measure. However, depression was more strongly associated with satisfaction with social roles and physical function than was anxiety. CONCLUSIONS: The findings showed that anxiety assessed at one point in time demonstrated significant and unique associations with concurrent and subsequent symptom and function domains. Given that anxiety has been inadequately studied (and perhaps evaluated and treated) in rehabilitation populations, the current findings suggest that researchers and clinicians should broaden their scope when assessing and treating psychological distress to incorporate anxiety and related disorders. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Neurological Symptoms in Danes with a History of Poliomyelitis: Lifelong Follow-Up of Late Symptoms, their Association with Initial Symptoms of Polio, and Presence of Postpolio Syndrome.

BACKGROUND: Previous studies suggest that patients with a history of poliomyelitis (PM) later in life experience a variety of symptoms. These studies were carried out in patients who later in life were admitted to hospital or became members of polio societies and may therefore not be representative of all polio patients. Little data have been published concerning patients actually discharged from hospital with a diagnosis of acute paralytic PM. OBJECTIVES: The aim of this study was to compare the prevalence of late symptoms in individuals with a history of paralytic PM with that of controls, and to study whether late symptoms in individuals with a history of PM were associated with symptoms at the acute stage of polio, and finally to compare the prevalence of symptoms in polio patients with postpolio syndrome (PPS) with the prevalence of symptoms in polio patients without PPS. METHODS: A questionnaire concerning various symptoms was sent to a previously established cohort of patients, who during the polio epidemics were discharged from the Department of Infectious Disease at Blegdamshospitalet, Copenhagen, with a diagnosis of paralytic PM, and to age- and gender-matched controls without PM. Information about symptoms at the acute stage of disease was obtained from hospital records. Logistic regression analysis with adjustment for age and gender was applied to compare the occurrence of late symptoms in cases and controls and within the above-mentioned groups of individuals with a history of PM. RESULTS: (i) Compared with controls, individuals with a history of polio significantly more often reported muscle symptoms, pain, neuropathic sensory symptoms, and bulbar symptoms; (ii) the occurrence of symptoms did not seem to be related to symptoms of the initial PM; and (iii) symptom prevalence was significantly higher in individuals with a history of polio who reported PPS as compared with those who did not. CONCLUSION: Our data indicate that individuals with a history of PM late in life experience a variety of symptoms that cannot be attributed to lesions of the anterior horn. Furthermore, late symptoms do not seem to be related to initial symptoms of the acute stage of PM but to reported PPS. The last finding supports the perception that the cause of PPS is not just normal ageing.

Polio y postpolio. Visión de pacientes y profesionales en atención primaria / Polio and post-polio syndrome, viewed by patients and health professionals in primary care

Fundamentos: La polio afecta a la calidad de vida de las personas que la han padecido y ocasiona problemas de salud entre los que se encuentra el síndrome postpolio. Los objetivos de este estudio fueron conocer la perspectiva de pacientes sobre cómo les ha afectado la enfermedad y describir el conocimiento sobre el síndrome postpolio de pacientes y profesionales de atención primaria. Métodos: Investigación cualitativa interpretativa basada en la Teoría Fundamentada, realizada en dos centros de salud de la ciudad de Málaga, uno de ellos con consultorios rurales. Se realizaron cuatro grupos focales con participación de trece pacientes y dos grupos focales con veintiséis profesionales participantes. Muestreo intencional hasta saturación. El análisis siguió una estrategia inductiva con ayuda del programa Atlas Ti 5.2. Resultados: Los pacientes relataron una historia personal de sufrimiento, contrarrestada por un fuerte apoyo familiar y afrontamiento activo (categoría central), marcado por el sobreesfuerzo, la superación y una alta resiliencia. Realizaron una valoración positiva de sus vidas, minimizando las limitaciones. Presentaron síntomas compatibles con el síndrome postpolio, no identificado por el gran desconocimiento de pacientes y profesionales. La atención sanitaria fue considerada deficitaria (falta de implicación y problemas de comunicación). Conclusiones: La vivencia de la polio está centrada en la superación personal, con gran relevancia del apoyo familiar, las difíciles relaciones con el sistema sanitario y el desconocimiento del síndrome postpolio

Backgrounds: Polio affects the quality of life of those who have suffered from it and causes health problems including the post-polio syndrome. The main goals of this work were to know the patients perspective of how they have been affected by the disease and establish the knowledge of post-polio syndrome among patients and primary health care professionals. Methods: Interpretive qualitative research based on the Grounded Theory carried out in two health-care centers in the city of Malaga, one of them with care-rural clinics. Four focal groups were established with the participation of thirteen patients and two focus groups with twenty-six professional participants. Intentional sampling is performed until saturation. The analysis follows an inductive strategy using the Atlas Ti5.2 software. Results: The people affected by polio reports their personal histories of suffering counteracted by strong family support and an active coping attitude, marked by great effort exertion, willpower and endurance. These people made a positive assessment of their lives minimising the limitations. They presented compatible symptoms with post-polio syndrome, which remain unidentified due to the lack of knowledge of it among patients and health-care professionals. The health care provided was considered deficient due to several causes as for instance lack of involvement, communication problems. Conclusions: The day-to-day polio experience is focused on personal overcoming with major roles played by family support, difficult relationships with the healthcare system and lack of knowledge of the post-polio syndrome

Restless legs syndrome is highly prevalent in patients with post-polio syndrome.

OBJECTIVE: Few studies have quantified the prevalence of restless legs syndrome (RLS) in patients with post-polio syndrome (PPS). Our objective was to assess the prevalence and severity of RLS in patients with PPS and to examine the demographic characteristics of this population. METHOD: This was a cross-sectional study conducted from April 2010 to May 2012 at the outpatient Neuromuscular Disorders clinic of Universidade Federal de São Paulo, São Paulo, Brazil. We evaluated 119 patients with PPS, consecutively recruited, and investigated for RLS based on the diagnostic criteria established by the International Restless Legs Syndrome Study Group (IRLSSG). Patients were evaluated with the Brazilian version of the IRLSSG severity scale. RESULTS: The prevalence of RLS was 36% (n = 43; 32 women and 11 men). The ages at onset of RLS (median = 41 years) and PPS (median = 41 years) were concurrent, and the correlation between onset of symptoms of RLS and onset of symptoms of PPS was positive and very strong (Spearman r = 0.93, p = 0.01). The median RLS severity was 23 (range, 20-28). Low educational achievement and depression were predictive of RLS development. CONCLUSION: In the largest population of patients with PPS studied to date, our results indicate a high prevalence of RLS, marked disease severity, and concomitant onset of both conditions in many patients with PPS. Further studies are needed to elucidate a possible pathophysiologic mechanism linking these two conditions. We suggest that all post-polio patients with sensory and motor complaints in the legs be investigated for RLS.

Relationship of depression and medications on incidence of falls among people with late effects of polio.

The purpose of this study was to determine if falls in polio survivors, with or without post-polio syndrome (PPS), are related to number of medications taken, use of anti-depressant or psychoactive medications, or self-report of depression. A survey was sent to 300 members of a regional polio support group, asking them to document their fall history, medications used, and the presence of depression. Depression was measured by self-report and with the Geriatric Depression Scale, short form (GDS-15). One hundred and seventy-two usable surveys were returned with 146 of those completing the medication list. Sixty-two percent reported at least one fall in the past year. The multiple logistic regression was significant (p = 0.023), and it indicated depression to be a significant predictor (p = 0.012) of falls in polio survivors with and without PPS. The number of total medications or anti-depressant or psychoactive medications used was not related to fall incidence. Routine screening and treatment for depression may be one aspect of fall prevention which can be implemented through primary care.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning.

OBJECTIVE: To determine the impact of postpolio-syndrome on quality of life in polio survivors. METHODS: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. RESULTS: Total manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. CONCLUSIONS: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning / Qualidade de vida relacionada com a saúde em sobreviventes turcos da pólio: impacto pós-pólio na saúde relacionada com a qualidade de vida em termos de estado funcional, gravidade da dor, fadiga e funcionamento social e emocional

ABSTRACT Objective: To determine the impact of postpolio-syndrome on quality of life in polio survivors. Methods: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. Results: Total manual muscle testing score was 26.19 ± 13.24 (median: 29) in postpolio-syndrome group and 30.08 ± 8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

RESUMO Objetivo: Determinar o impacto da síndrome pós-pólio na qualidade de vida nos sobreviventes da pólio. Métodos: Quarenta sobreviventes da pólio foram incluídos no estudo. Participaram do grupo de síndrome pós-pólio 21 pacientes que atenderam aos critérios de síndrome pós-pólio de Halstead. Os 19 restantes formaram o grupo não síndrome pós-pólio. O grupo controle foi composto por 40 indivíduos saudáveis. A qualidade de vida foi avaliada pelo Nottingham Health Profile, a depressão pela Escala de Depressão de Beck e a fadiga pelo Inventário de Sintomas de Fadiga. A força muscular isométrica foi medida por teste muscular manual. Resultados: O escore total do teste muscular manual foi 26,19 ± 13,24 (mediana: 29) no grupo de síndrome pós-pólio e 30,08 ± 8,9 (mediana: 32) no grupo não síndrome pós-pólio. Escores totais de teste muscular manual de grupo não síndrome pós-pólio foram significativamente maiores do que os do grupo de síndrome pós-pólio. Os pacientes com síndrome pós-pólio relataram níveis significativamente maiores de fadiga e qualidade de vida reduzida em termos de mobilidade física, dor e energia quando comparados com pacientes sem síndrome pós-pólio e grupo controle. Não se relatou uma diferença estatisticamente significativa no funcionamento social e emocional e na qualidade do sono entre grupos de síndrome pós-pólio, não síndrome pós-pólio e controle. Além disso, não se encontrou diferença estatisticamente significativa nos escores da Escala de Depressão de Beck entre os grupos. Conclusões: A síndrome pós-pólio tem um impacto negativo na qualidade de vida em termos de estado funcional, gravidade da dor e energia. A identificação, o reconhecimento precoce e a reabilitação dos pacientes com síndrome pós-pólio podem resultar em uma melhoria da qualidade de vida.

Outcomes of total hip replacement in limbs affected by poliomyelitis.

INTRODUCTION: The outcomes of total hip replacement in patients suffering from residual poliomyelitis are poorly covered in the literature. In this retrospective study we posed the question of whether total hip replacement performed for degenerative hip diseases in limbs with residual poliomyelitis could determine satisfactory mid-term clinical and radiographic results, with a reasonable complication rate. METHODS: A retrospective study was carried out to assess the results of 14 total hip replacements performed on 14 patients with residual poliomyelitis on the involved limb from June 1999 to September 2011. Average age at the time of surgery was 51 years (range 26-66 years). Mean duration of follow-up was 92 months (range 52-156 months). Surgery was performed through a direct lateral approach on all hips. All but one were cementless implants. RESULTS: 2 implants failed, 1 due to traumatic acetabular fracture 6 days after surgery, and 1 due to aseptic cup loosening 13 years after surgery. Surgery was uneventful in all patients except 1 (7%), who experienced a transient sensory sciatic nerve palsy. At the latest follow up Harris Hip Score was 83.3 (range 72-91) with a marked improvement when compared to preoperative score (average 52, range 32-78). No dislocations had occurred. CONCLUSIONS: Total hip replacement can be considered a feasible option for hip osteoarthritis in patients with limbs affected by residual poliomyelitis. Longer follow-up studies are needed to assess the effectiveness of unconstrained total hip replacement in polio patients.