Outcomes of Research or Clinical Trials Activity Levels Acute Flaccid Paralysis Ageing Anaerobic Threshold Anaesthesia Assistive Technology Brain Cardiorespiratory Cardiovascular Clinical Evaluation Cold Intolerance Complementary Therapies Continence Coping Styles and Strategies Cultural Context Diagnosis and Management Differential Diagnosis Drugs Dysphagia Dysphonia Epidemiology Exercise Falls Fatigue Fractures Gender Differences Immune Response Inflammation Late Effects of Polio Muscle Strength Muscular Atrophy Orthoses Pain Polio Immunisation Post-Polio Motor Unit Psychology Quality of Life Renal Complications Respiratory Complications and Management Restless Legs Syndrome Sleep Analaysis Surgery Vitality Vocational Implications

Title order Author order Journal order Date order
Category: Activity Levels

Title: A Brief Questionnaire to Assess Post-Exertional Malaise
Author: Joseph Cotler, Carly Holtzman, Catherine Dudun and Leonard A. Jason
Affiliation:
Journal: Diagnostics
Citation: 11 September 2018
Publication Year and Month: 2018 09

Abstract: Post-exertional malaise (PEM) is a key symptom of myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Currently, five PEM-items from the DePaul Symptom Questionnaire (DSQ) were recommended as a first step in measuring this symptom for patients with ME and CFS by the National Institutes of Health/Centers for Disease Control and Prevention (NIH/CDC) Common Data Elements’ (CDE) working group. The second step in this process, as recommended by the NIH/CDC CDE working group, involves assembling information from various sources to confirm the presence of PEM. There have not been any efforts, to date, to standardize this second-step process in the assessment of PEM. The current study examined whether five supplementary items on the DSQ could be used to operationalize the second step of the recommendations made by the NIH/CDC CDE working group. The five supplementary DSQ PEM duration items correctly categorized patients with ME or CFS 81.7% of the time, while incorrectly categorizing multiple sclerosis (MS) and post-polio syndrome (PPS) as ME or CFS only 16.6% of the time. The findings suggested that a PEM second-step process could be operationalized using supplementary DSQ items.

Conclusions:

Outcome of Research: More research required

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Category: Activity Levels

Title: Actual and perceived activity levels in polio survivors and older controls: a longitudinal study
Author: Klein MG, Braitman LE, Costello R, Keenan MA, Esquenazi A
Affiliation: Moss Rehabilitation Research Institute, Philadelphia, PA; Thomas Jefferson University, Philadelphia 19141, USA – [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2008 Feb; 89(2):297-303
Publication Year and Month: 2008 02

Abstract: OBJECTIVE: To examine factors associated with daily step activity, perceived activity, maximum walking speed, and walking speed reserve over time in polio survivors and older adults with no history of polio.

DESIGN: Longitudinal study.

SETTING: A research clinic and the community.

PARTICIPANTS: Polio survivors (n=96; 65 in postpolio syndrome [PPS] group, 31 in non-PPS group) and older adults (n=112) with no history of polio.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Daily step activity, perceived activity, maximum walking speed, and walking speed reserve.

RESULTS: Results showed decreases in perceived activity over time in the PPS group. However, there was no change in average daily walking activity. Overall, polio survivors walk less and have a smaller walking speed reserve than controls. Knee strength was positively associated with maximum walking speed and walking speed reserve in all groups. Weight and age were associated with daily step activity in controls but not polio survivors.

Conclusions: Daily walking activity did not change statistically over the 3-year study period, although perceived activity and the walking speed reserve decreased among polio survivors with PPS. On average, polio survivors appear to function with minimal functional reserve, as their preferred walking speed was close to their maximum speed.

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Category: Activity Levels

Title: Change in physical mobility over 10 years in post-polio syndrome
Author: Bickerstaffe A (1), Beelen A (2), Nollet F (2)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands; (2) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
Journal: Neuromuscular Disorders
Citation: Neuromuscul Disord. 2015 Mar;25(3):225-30. doi: 10.1016/j.nmd.2014.11.015
Publication Year and Month: 2015 03

Abstract: Post-polio syndrome is characterised by progressive muscle weakness and other symptoms which can limit physical mobility. We assessed the rate of decline in mobility over 10 years in relation to strength decline; and investigated potential predictors for the rate of decline of walking capacity, a measure of mobility, in 48 patients with post-polio syndrome and proven quadriceps dysfunction at baseline. Average walking capacity and self-reported physical mobility declined over 10 years, by 6 and 14%, respectively. Concomitantly people lost an average of 15% of isometric quadriceps strength. Significantly more people used walking aids offering greater support at follow-up. Notably, there was much individual variation, with 18% of participants losing a substantial amount of walking capacity (27% decline) and concomitant self-reported physical mobility (38% decline). Loss of quadriceps strength only explained a small proportion of the variance of the decline in walking capacity (R = 11%) and the rate of decline could not be predicted from baseline values for strength, walking capacity, self-reported physical mobility or basic demographics. The individual variability, yet lack of predictive factors, underscores the need for personally tailored care based on actual functional decline in patients with post-polio syndrome.

Conclusions: • The majority of post-polio patients experienced modest declines in physical mobility in 10 years.
• One-fifth of patients experienced substantial declines in walking capacity.
• The rate of decline in walking capacity could not be predicted from baseline quadriceps strength.
• These findings underscore the need for personally tailored care based on actual functional
decline.

Outcome of Research: Not applicable

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Category: Activity Levels

Title: Energy conservation, occupational therapy, and the treatment of post-polio sequelae
Author: Young GR
Affiliation: Department of Occupational Therapy, Kaiser-Permanente Medical Center, Downey, California 90242
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1233-9
Publication Year and Month: 1991 11

Abstract: Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.

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Category: Activity Levels, Psychology

Title: Exercise therapy and cognitive behavioural therapy to improve fatigue, daily activity performance and quality of life in postpoliomyelitis syndrome: the protocol of the FACTS-2-PPS trial
Author: Koopman FS (1), Beelen A (1), Gerrits KH (2), Bleijenberg G (3), Abma TA (4), de Visser M (5), Nollet F (1)
Affiliation: (1) Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; (2) Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Expert Centre Chronic Fatigue Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;(4) Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands; (5) Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands - [email protected]
Journal: BioMed Central Neurology
Citation: BMC Neurol. 2010 Jan 18;10:8. doi: 10.1186/1471-2377-10-8
Publication Year and Month: 2010 01

Abstract: BACKGROUND: Postpoliomyelitis Syndrome (PPS) is a complex of late onset neuromuscular symptoms with new or increased muscle weakness and muscle fatigability as key symptoms. Main clinical complaints are severe fatigue, deterioration in functional abilities and health related quality of life. Rehabilitation management is the mainstay of treatment. Two different therapeutic interventions may be prescribed (1) exercise therapy or (2) cognitive behavioural therapy (CBT). However, the evidence on the effectiveness of both interventions is limited. The primary aim of the FACTS-2-PPS trial is to study the efficacy of exercise therapy and CBT for reducing fatigue and improving activities and quality of life in patients with PPS. Additionally, the working mechanisms, patients' and therapists' expectations of and experiences with both interventions and cost-effectiveness will be evaluated.

METHODS/DESIGN: A multi-centre, single-blinded, randomized controlled trial will be conducted. A sample of 81 severely fatigued patients with PPS will be recruited from 3 different university hospitals and their affiliate rehabilitation centres. Patients will be randomized to one of three groups i.e. (1) exercise therapy + usual care, (2) CBT + usual care, (3) usual care. At baseline, immediately post-intervention and at 3- and 6-months follow-up, fatigue, activities, quality of life and secondary outcomes will be assessed. Costs will be based on a cost questionnaire, and statistical analyses on GEE (generalized estimated equations). Analysis will also consider mechanisms of change during therapy. A responsive evaluation will be conducted to monitor the implementation process and to investigate the perspectives of patients and therapists on both interventions.

DISCUSSION: A major strength of the FACTS-2-PPS study is the use of a mixed methods design in which a responsive and economic evaluation runs parallel to the trial. The results of this study will generate new evidence for the rehabilitation treatment of persons with PPS.

TRIAL REGISTRATION: Dutch Trial Register NTR1371.

Conclusions:

Outcome of Research: Not applicable.

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Category: Activity Levels, Late Effects of Polio, Muscle Strength, Psychology, Quality of Life

Title: Health-related quality of life, self-reported impairments and activities of daily living in relation to muscle function in post-polio syndrome
Author: Vanya Gocheva,corresponding author1 Patricia Hafner,1 Anna-Lena Orsini,1,2 Simone Schmidt,1,3 Sabine Schaedelin,4 Nicole Rueedi,1 Daniela Rubino-Nacht,1 Peter Weber,1 and Dirk Fischer1
Affiliation: 1Division of Neuropediatrics and Developmental Medicine, University Children’s Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056 Basel, Switzerland
2Division of Neurology, University Hospital Basel, Basel, Switzerland
3Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
4Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
Vanya Gocheva, Email: [email protected].
corresponding author.
Journal: Journal of Patient-Reported Outcomes
Citation: 4(1), 59. https://doi.org/10.1186/s41687-020-00226-5
Publication Year and Month: 2020 12

Abstract: Background
The symptoms of post-polio syndrome (PPS) and its resulting disabilities can affect quality of life and the ability to perform daily activities. No study has comprehensively analysed how various patient-reported outcome measures (PROMs) are associated with objectively assessed physical function in patients with PPS.

Aim
To investigate health-related quality of life (HRQOL), self-reported impairments and activities of daily living during 6 months and evaluate their association with clinical muscle function outcomes in individuals with PPS.

Methods
Twenty-seven patients with PPS were included in the study. At baseline and 6 months, patients were administered PROMs measuring HRQOL (WHOQOL-BREF), self-reported impairments related to PPS (SIPP-RS) and activities of daily living (IBM-FRS). Clinical muscle function outcomes included 6 min walking distance (6MWD) and motor function measure (MFM).

Results
There were no changes in self-reported impairments (25.52 to 24.93, p = 0.40), activities of daily living (33.89 to 33.30, p = 0.20), 6MWD (391.52 to 401.85, p = 0.30) and MFM (83.87 to 85.46, p = 0.14) during 6 months, while the HRQOL psychological health decreased during this period (76.85 to 72.38, p = 0.05). A strong association was found between activities of daily living and clinical muscle function outcomes (6MWD: ß = 0.02, 95% CI: 0.02;0.03, t = 6.88, p < 0.01; MFM: ß = 0.25, 95% CI: 0.17;0.33, t = 6.69, p < 0.01). Self-reported impairments and HRQOL domains were not associated with the clinical muscle outcomes.

Conclusions
Study findings indicate that objectively measured walking and motor abilities do not reflect patient’s perspectives of their HRQOL and impairment due to PPS. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.

Conclusions: Self-reported impairments, HRQOL domains, activities of daily living and muscle function outcomes remained stable during 6 months in patients with PPS, except for the HRQOL psychological health domain which declined during this period. Clinical muscle outcomes had no statistically significant relationship with HRQOL and self-reported impairments of PPS patients while a significant relationship was observed with the activities of daily living. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.

Outcome of Research: More research required

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Category: Activity Levels

Title: Neuromuscular function in polio survivors
Author: Agre JC, Rodriquez AA
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin - Madison Medical School 53792
Journal: Orthopedics
Citation: Orthopedics. 1991 Dec; 14(12):1343-7
Publication Year and Month: 1991 12

Abstract: Although there is no documented, objective evidence that symptomatic post-polio subjects are rapidly losing strength, they have a number of neuromuscular deficits related to a more severe poliomyelitis illness that may explain why they complain of problems with strength, endurance, and local muscle fatigue. Symptomatic post-polio subjects were hospitalized longer during the acute poliomyelitis, recovered more slowly, and had electromyographic evidence of greater loss of anterior horn cells. Additionally, recent assessment demonstrated that they were weaker, had a reduced work capacity, and recovered strength less readily after activity in the quadriceps muscles as compared to asymptomatic subjects. Of great clinical importance, rating of perceived exertion in the muscle during exercise was the same in symptomatic and asymptomatic post-polio and control subjects, indicating that symptomatic subjects have a mechanism to monitor local muscle fatigue that could be used to avoid exhaustion. A study of pacing (interspersing activity with rest breaks) showed that symptomatic subjects had less local muscle fatigue and greater strength recovery when they paced their activity than when they worked at a constant rate to exhaustion. We recommend that post-polio individuals pace their daily activity to avoid excessive fatigue.

Conclusions:

Outcome of Research:

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Category: Activity Levels, Psychology,

Title: No reduction of severe fatigue in patients with postpolio syndrome by exercise therapy or cognitive behavioral therapy: results of an RCT
Author: Koopman FS (1), Voorn EL (1), Beelen A (1), Bleijenberg G (2), de Visser M (1), Brehm MA (1), Nollet F (1)
Affiliation: (1) University of Amsterdam, Amsterdam, The Netherlands; (2) Radboud University Medical Centre, Nijmegen, The Netherlands
Journal: Neurorehabilitation & Neural Repair
Citation: Neurorehabil Neural Repair. 2015 Aug 7. pii: 1545968315600271
Publication Year and Month: 2015 08

Abstract: BACKGROUND: People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL).

OBJECTIVES: To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS.

METHODS: We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months.

RESULTS: A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = -2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = -2.24 to 5.98, for CBT versus UC), activities, or HRQoL.

Conclusions: Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.

Outcome of Research: More research required

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Category: Activity Levels

Title: Physical activity in persons with late effects of polio: a descriptive study.
Author: Winberg C, Flansbjer UB, Carlsson G, Rimmer J, Lexell J.
Affiliation: 1 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden. Electronic address: [email protected].
2 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden; Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
3 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden.
4 University of Alabama, Birmingham, USA.
Journal: Disability and Health Journal
Citation: 2014 Jul;7(3):302-8. doi: 10.
Publication Year and Month: 2014 07

Abstract: BACKGROUND:
To promote a healthy and active lifestyle there is a need to increase our knowledge of the level of physical activity (PA) among people with late effects of polio.

OBJECTIVES:
To examine PA in people with late effects of polio and to assess the relationship between PA, life satisfaction and various sociodemographic factors.

METHODS:
PA was assessed in 81 persons with late effects of polio using the Physical Activity and Disability Survey (PADS) and by a pedometer. Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11).

RESULTS:
The amount of PA varied considerably but on average the participants were physically active almost 3 h per day, mostly in household activities. The mean value of the pedometer counts was 6212 steps per day (SD = 3208). Sixty-nine percent of the participants rated themselves as satisfied with life as a whole. The sum of PADS was positively and significantly related to the number of steps (r = 0.39, p < 0.001), increasing age (r = 0.26, p < 0.05) and to the level of global satisfaction with life (rho = 0.23, p < 0.05). The number of steps was also positively and significantly associated with level of global satisfaction with life (rho = 0.37, p < 0.001).

Conclusions: Despite a progressive physical disability, people with late effects of polio are physically active, but much of the activities are performed as part of their household activities and not as traditional exercise. The relationship between PA, life satisfaction and age further supports the general contention that an active lifestyle is an important factor for perceived well-being among older people.

Outcome of Research: More research required

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Category: Activity Levels

Title: Reproducibility of walking at self-preferred and maximal speed in patients with postpoliomyelitis syndrome
Author: Horemans HL (1), Beelen A (2), Nollet F (2), Lankhorst GJ (1)
Affiliation: (1) Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; (2) Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2004 Dec;85(12):1929-32
Publication Year and Month: 2004 12

Abstract: OBJECTIVE:
To assess the reproducibility of walking performance, heart rate, and perceived exertion at self-preferred speed and maximal walking speed in patients with the postpoliomyelitis syndrome (PPS).

DESIGN: Repeated measurement at a 3-week interval.

SETTING: University hospital.

PARTICIPANTS: Convenience sample of 65 patients with PPS.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Walking performance: the distance walked in 2 minutes at a self-preferred speed and the time needed to walk 75 m at maximal speed, heart rate, and rating of perceived exertion (RPE) on an 11-point scale.

RESULTS: Test-retest reliability of walking performance was excellent for both tests (intraclass correlation coefficient [ICC] range, .94-.97). No systematic differences existed between test and retest. The smallest detectable change for an individual was 15% for both tests. Test-retest reliability for heart rate was good (ICC=.86) but moderate for RPE (Spearman rho range, .67-.70). The smallest detectable change for RPE was between 4 and 6 scale points. The variability in walking performance was significantly correlated with the variability in heart rate at self-preferred speed (r =.36, P <.01) but not with the variability in RPE (r =.20, P =.11).

Conclusions: Both walking tests showed good reproducibility and may be appropriate to monitor (individual) changes in walking capacity in patients with PPS. Because of its moderate reproducibility, RPE does not seem to be suitable to monitor physical exertion. The usefulness of an objective measure such as heart rate for this purpose needs further investigation.

Outcome of Research: More research required

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Category: Exercise, Activity Levels

Title: The Postpolio Syndrome: An Overuse Phenomenon
Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08

Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.

Conclusions:

Outcome of Research: Not applicable

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Comments (if any): Paul Cavendish
(Clinical Health Educator):
This article discusses manual muscle testing and gait dynamics with EMG, demonstrating excessive muscle use during gait, demonstrating increased fatigue for this sample of people with a history of polio.

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Category: Activity Levels

Title: Walking in postpoliomyelitis syndrome: the relationships between time‐scored tests, walking in daily life and perceived mobility problems
Author: Horemans HL, Bussmann JB, Beelen A, Stam HJ, Nollet F
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):142-6.
Publication Year and Month: 2005 05

Abstract: OBJECTIVE: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome.

SUBJECTS: Twenty-four ambulant patients with post-poliomyelitis syndrome.

METHODS: Walking tests were performed at self-preferred and maximal speed. Walking activity was measured with an ambulatory activity monitor. Heart rate, step cadence and walking speed in the test and in daily life were compared. Walking speed in daily life was represented by the intensity of walking. Perceived mobility problems were assessed with the Nottingham Health Profile.

RESULTS: Heart rate during walking was lower in the test at self-preferred speed than in daily life (mean difference: 11.3+/-10.4; p=0.001). Self-preferred walking speed in the test and in daily life correlated significantly (r=0.55; p=0.04). In a sub-group with a test performance below the median value, test performance correlated significantly with walking activity. No significant correlation was found between perceived mobility problems and walking activity.

Conclusions: Walking in daily life may be more demanding than walking under standardized conditions. Patients with post-poliomyelitis syndrome with the lowest test performance walked less in daily life. Patients do not necessarily match their activity pattern to their perceived mobility problems.

Outcome of Research: Not applicable.

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There are currently 12 papers in this category.

Category: Activity Levels

Title: Neuromuscular function in polio survivors
Author: Agre JC, Rodriquez AA
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin - Madison Medical School 53792
Journal: Orthopedics
Citation: Orthopedics. 1991 Dec; 14(12):1343-7
Publication Year and Month: 1991 12

Abstract: Although there is no documented, objective evidence that symptomatic post-polio subjects are rapidly losing strength, they have a number of neuromuscular deficits related to a more severe poliomyelitis illness that may explain why they complain of problems with strength, endurance, and local muscle fatigue. Symptomatic post-polio subjects were hospitalized longer during the acute poliomyelitis, recovered more slowly, and had electromyographic evidence of greater loss of anterior horn cells. Additionally, recent assessment demonstrated that they were weaker, had a reduced work capacity, and recovered strength less readily after activity in the quadriceps muscles as compared to asymptomatic subjects. Of great clinical importance, rating of perceived exertion in the muscle during exercise was the same in symptomatic and asymptomatic post-polio and control subjects, indicating that symptomatic subjects have a mechanism to monitor local muscle fatigue that could be used to avoid exhaustion. A study of pacing (interspersing activity with rest breaks) showed that symptomatic subjects had less local muscle fatigue and greater strength recovery when they paced their activity than when they worked at a constant rate to exhaustion. We recommend that post-polio individuals pace their daily activity to avoid excessive fatigue.

Conclusions:

Outcome of Research:

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Category: Activity Levels

Title: Change in physical mobility over 10 years in post-polio syndrome
Author: Bickerstaffe A (1), Beelen A (2), Nollet F (2)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands; (2) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
Journal: Neuromuscular Disorders
Citation: Neuromuscul Disord. 2015 Mar;25(3):225-30. doi: 10.1016/j.nmd.2014.11.015
Publication Year and Month: 2015 03

Abstract: Post-polio syndrome is characterised by progressive muscle weakness and other symptoms which can limit physical mobility. We assessed the rate of decline in mobility over 10 years in relation to strength decline; and investigated potential predictors for the rate of decline of walking capacity, a measure of mobility, in 48 patients with post-polio syndrome and proven quadriceps dysfunction at baseline. Average walking capacity and self-reported physical mobility declined over 10 years, by 6 and 14%, respectively. Concomitantly people lost an average of 15% of isometric quadriceps strength. Significantly more people used walking aids offering greater support at follow-up. Notably, there was much individual variation, with 18% of participants losing a substantial amount of walking capacity (27% decline) and concomitant self-reported physical mobility (38% decline). Loss of quadriceps strength only explained a small proportion of the variance of the decline in walking capacity (R = 11%) and the rate of decline could not be predicted from baseline values for strength, walking capacity, self-reported physical mobility or basic demographics. The individual variability, yet lack of predictive factors, underscores the need for personally tailored care based on actual functional decline in patients with post-polio syndrome.

Conclusions: • The majority of post-polio patients experienced modest declines in physical mobility in 10 years.
• One-fifth of patients experienced substantial declines in walking capacity.
• The rate of decline in walking capacity could not be predicted from baseline quadriceps strength.
• These findings underscore the need for personally tailored care based on actual functional
decline.

Outcome of Research: Not applicable

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Comments (if any):

Link to Paper (if available): Click here to view Abstract


Category: Activity Levels

Title: Reproducibility of walking at self-preferred and maximal speed in patients with postpoliomyelitis syndrome
Author: Horemans HL (1), Beelen A (2), Nollet F (2), Lankhorst GJ (1)
Affiliation: (1) Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; (2) Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2004 Dec;85(12):1929-32
Publication Year and Month: 2004 12

Abstract: OBJECTIVE:
To assess the reproducibility of walking performance, heart rate, and perceived exertion at self-preferred speed and maximal walking speed in patients with the postpoliomyelitis syndrome (PPS).

DESIGN: Repeated measurement at a 3-week interval.

SETTING: University hospital.

PARTICIPANTS: Convenience sample of 65 patients with PPS.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Walking performance: the distance walked in 2 minutes at a self-preferred speed and the time needed to walk 75 m at maximal speed, heart rate, and rating of perceived exertion (RPE) on an 11-point scale.

RESULTS: Test-retest reliability of walking performance was excellent for both tests (intraclass correlation coefficient [ICC] range, .94-.97). No systematic differences existed between test and retest. The smallest detectable change for an individual was 15% for both tests. Test-retest reliability for heart rate was good (ICC=.86) but moderate for RPE (Spearman rho range, .67-.70). The smallest detectable change for RPE was between 4 and 6 scale points. The variability in walking performance was significantly correlated with the variability in heart rate at self-preferred speed (r =.36, P <.01) but not with the variability in RPE (r =.20, P =.11).

Conclusions: Both walking tests showed good reproducibility and may be appropriate to monitor (individual) changes in walking capacity in patients with PPS. Because of its moderate reproducibility, RPE does not seem to be suitable to monitor physical exertion. The usefulness of an objective measure such as heart rate for this purpose needs further investigation.

Outcome of Research: More research required

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Activity Levels

Title: Walking in postpoliomyelitis syndrome: the relationships between time‐scored tests, walking in daily life and perceived mobility problems
Author: Horemans HL, Bussmann JB, Beelen A, Stam HJ, Nollet F
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):142-6.
Publication Year and Month: 2005 05

Abstract: OBJECTIVE: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome.

SUBJECTS: Twenty-four ambulant patients with post-poliomyelitis syndrome.

METHODS: Walking tests were performed at self-preferred and maximal speed. Walking activity was measured with an ambulatory activity monitor. Heart rate, step cadence and walking speed in the test and in daily life were compared. Walking speed in daily life was represented by the intensity of walking. Perceived mobility problems were assessed with the Nottingham Health Profile.

RESULTS: Heart rate during walking was lower in the test at self-preferred speed than in daily life (mean difference: 11.3+/-10.4; p=0.001). Self-preferred walking speed in the test and in daily life correlated significantly (r=0.55; p=0.04). In a sub-group with a test performance below the median value, test performance correlated significantly with walking activity. No significant correlation was found between perceived mobility problems and walking activity.

Conclusions: Walking in daily life may be more demanding than walking under standardized conditions. Patients with post-poliomyelitis syndrome with the lowest test performance walked less in daily life. Patients do not necessarily match their activity pattern to their perceived mobility problems.

Outcome of Research: Not applicable.

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Category: Activity Levels

Title: A Brief Questionnaire to Assess Post-Exertional Malaise
Author: Joseph Cotler, Carly Holtzman, Catherine Dudun and Leonard A. Jason
Affiliation:
Journal: Diagnostics
Citation: 11 September 2018
Publication Year and Month: 2018 09

Abstract: Post-exertional malaise (PEM) is a key symptom of myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Currently, five PEM-items from the DePaul Symptom Questionnaire (DSQ) were recommended as a first step in measuring this symptom for patients with ME and CFS by the National Institutes of Health/Centers for Disease Control and Prevention (NIH/CDC) Common Data Elements’ (CDE) working group. The second step in this process, as recommended by the NIH/CDC CDE working group, involves assembling information from various sources to confirm the presence of PEM. There have not been any efforts, to date, to standardize this second-step process in the assessment of PEM. The current study examined whether five supplementary items on the DSQ could be used to operationalize the second step of the recommendations made by the NIH/CDC CDE working group. The five supplementary DSQ PEM duration items correctly categorized patients with ME or CFS 81.7% of the time, while incorrectly categorizing multiple sclerosis (MS) and post-polio syndrome (PPS) as ME or CFS only 16.6% of the time. The findings suggested that a PEM second-step process could be operationalized using supplementary DSQ items.

Conclusions:

Outcome of Research: More research required

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Category: Activity Levels

Title: Actual and perceived activity levels in polio survivors and older controls: a longitudinal study
Author: Klein MG, Braitman LE, Costello R, Keenan MA, Esquenazi A
Affiliation: Moss Rehabilitation Research Institute, Philadelphia, PA; Thomas Jefferson University, Philadelphia 19141, USA – [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2008 Feb; 89(2):297-303
Publication Year and Month: 2008 02

Abstract: OBJECTIVE: To examine factors associated with daily step activity, perceived activity, maximum walking speed, and walking speed reserve over time in polio survivors and older adults with no history of polio.

DESIGN: Longitudinal study.

SETTING: A research clinic and the community.

PARTICIPANTS: Polio survivors (n=96; 65 in postpolio syndrome [PPS] group, 31 in non-PPS group) and older adults (n=112) with no history of polio.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Daily step activity, perceived activity, maximum walking speed, and walking speed reserve.

RESULTS: Results showed decreases in perceived activity over time in the PPS group. However, there was no change in average daily walking activity. Overall, polio survivors walk less and have a smaller walking speed reserve than controls. Knee strength was positively associated with maximum walking speed and walking speed reserve in all groups. Weight and age were associated with daily step activity in controls but not polio survivors.

Conclusions: Daily walking activity did not change statistically over the 3-year study period, although perceived activity and the walking speed reserve decreased among polio survivors with PPS. On average, polio survivors appear to function with minimal functional reserve, as their preferred walking speed was close to their maximum speed.

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Category: Activity Levels, Psychology

Title: Exercise therapy and cognitive behavioural therapy to improve fatigue, daily activity performance and quality of life in postpoliomyelitis syndrome: the protocol of the FACTS-2-PPS trial
Author: Koopman FS (1), Beelen A (1), Gerrits KH (2), Bleijenberg G (3), Abma TA (4), de Visser M (5), Nollet F (1)
Affiliation: (1) Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; (2) Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Expert Centre Chronic Fatigue Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;(4) Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands; (5) Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands - [email protected]
Journal: BioMed Central Neurology
Citation: BMC Neurol. 2010 Jan 18;10:8. doi: 10.1186/1471-2377-10-8
Publication Year and Month: 2010 01

Abstract: BACKGROUND: Postpoliomyelitis Syndrome (PPS) is a complex of late onset neuromuscular symptoms with new or increased muscle weakness and muscle fatigability as key symptoms. Main clinical complaints are severe fatigue, deterioration in functional abilities and health related quality of life. Rehabilitation management is the mainstay of treatment. Two different therapeutic interventions may be prescribed (1) exercise therapy or (2) cognitive behavioural therapy (CBT). However, the evidence on the effectiveness of both interventions is limited. The primary aim of the FACTS-2-PPS trial is to study the efficacy of exercise therapy and CBT for reducing fatigue and improving activities and quality of life in patients with PPS. Additionally, the working mechanisms, patients' and therapists' expectations of and experiences with both interventions and cost-effectiveness will be evaluated.

METHODS/DESIGN: A multi-centre, single-blinded, randomized controlled trial will be conducted. A sample of 81 severely fatigued patients with PPS will be recruited from 3 different university hospitals and their affiliate rehabilitation centres. Patients will be randomized to one of three groups i.e. (1) exercise therapy + usual care, (2) CBT + usual care, (3) usual care. At baseline, immediately post-intervention and at 3- and 6-months follow-up, fatigue, activities, quality of life and secondary outcomes will be assessed. Costs will be based on a cost questionnaire, and statistical analyses on GEE (generalized estimated equations). Analysis will also consider mechanisms of change during therapy. A responsive evaluation will be conducted to monitor the implementation process and to investigate the perspectives of patients and therapists on both interventions.

DISCUSSION: A major strength of the FACTS-2-PPS study is the use of a mixed methods design in which a responsive and economic evaluation runs parallel to the trial. The results of this study will generate new evidence for the rehabilitation treatment of persons with PPS.

TRIAL REGISTRATION: Dutch Trial Register NTR1371.

Conclusions:

Outcome of Research: Not applicable.

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any):

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Category: Activity Levels, Psychology,

Title: No reduction of severe fatigue in patients with postpolio syndrome by exercise therapy or cognitive behavioral therapy: results of an RCT
Author: Koopman FS (1), Voorn EL (1), Beelen A (1), Bleijenberg G (2), de Visser M (1), Brehm MA (1), Nollet F (1)
Affiliation: (1) University of Amsterdam, Amsterdam, The Netherlands; (2) Radboud University Medical Centre, Nijmegen, The Netherlands
Journal: Neurorehabilitation & Neural Repair
Citation: Neurorehabil Neural Repair. 2015 Aug 7. pii: 1545968315600271
Publication Year and Month: 2015 08

Abstract: BACKGROUND: People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL).

OBJECTIVES: To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS.

METHODS: We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months.

RESULTS: A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = -2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = -2.24 to 5.98, for CBT versus UC), activities, or HRQoL.

Conclusions: Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.

Outcome of Research: More research required

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Category: Exercise, Activity Levels

Title: The Postpolio Syndrome: An Overuse Phenomenon
Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08

Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.

Conclusions:

Outcome of Research: Not applicable

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any): Paul Cavendish
(Clinical Health Educator):
This article discusses manual muscle testing and gait dynamics with EMG, demonstrating excessive muscle use during gait, demonstrating increased fatigue for this sample of people with a history of polio.

Link to Paper (if available): Click here to view full text or to download


Category: Activity Levels, Late Effects of Polio, Muscle Strength, Psychology, Quality of Life

Title: Health-related quality of life, self-reported impairments and activities of daily living in relation to muscle function in post-polio syndrome
Author: Vanya Gocheva,corresponding author1 Patricia Hafner,1 Anna-Lena Orsini,1,2 Simone Schmidt,1,3 Sabine Schaedelin,4 Nicole Rueedi,1 Daniela Rubino-Nacht,1 Peter Weber,1 and Dirk Fischer1
Affiliation: 1Division of Neuropediatrics and Developmental Medicine, University Children’s Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056 Basel, Switzerland
2Division of Neurology, University Hospital Basel, Basel, Switzerland
3Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
4Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
Vanya Gocheva, Email: [email protected].
corresponding author.
Journal: Journal of Patient-Reported Outcomes
Citation: 4(1), 59. https://doi.org/10.1186/s41687-020-00226-5
Publication Year and Month: 2020 12

Abstract: Background
The symptoms of post-polio syndrome (PPS) and its resulting disabilities can affect quality of life and the ability to perform daily activities. No study has comprehensively analysed how various patient-reported outcome measures (PROMs) are associated with objectively assessed physical function in patients with PPS.

Aim
To investigate health-related quality of life (HRQOL), self-reported impairments and activities of daily living during 6 months and evaluate their association with clinical muscle function outcomes in individuals with PPS.

Methods
Twenty-seven patients with PPS were included in the study. At baseline and 6 months, patients were administered PROMs measuring HRQOL (WHOQOL-BREF), self-reported impairments related to PPS (SIPP-RS) and activities of daily living (IBM-FRS). Clinical muscle function outcomes included 6 min walking distance (6MWD) and motor function measure (MFM).

Results
There were no changes in self-reported impairments (25.52 to 24.93, p = 0.40), activities of daily living (33.89 to 33.30, p = 0.20), 6MWD (391.52 to 401.85, p = 0.30) and MFM (83.87 to 85.46, p = 0.14) during 6 months, while the HRQOL psychological health decreased during this period (76.85 to 72.38, p = 0.05). A strong association was found between activities of daily living and clinical muscle function outcomes (6MWD: ß = 0.02, 95% CI: 0.02;0.03, t = 6.88, p < 0.01; MFM: ß = 0.25, 95% CI: 0.17;0.33, t = 6.69, p < 0.01). Self-reported impairments and HRQOL domains were not associated with the clinical muscle outcomes.

Conclusions
Study findings indicate that objectively measured walking and motor abilities do not reflect patient’s perspectives of their HRQOL and impairment due to PPS. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.

Conclusions: Self-reported impairments, HRQOL domains, activities of daily living and muscle function outcomes remained stable during 6 months in patients with PPS, except for the HRQOL psychological health domain which declined during this period. Clinical muscle outcomes had no statistically significant relationship with HRQOL and self-reported impairments of PPS patients while a significant relationship was observed with the activities of daily living. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.

Outcome of Research: More research required

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Activity Levels

Title: Physical activity in persons with late effects of polio: a descriptive study.
Author: Winberg C, Flansbjer UB, Carlsson G, Rimmer J, Lexell J.
Affiliation: 1 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden. Electronic address: [email protected].
2 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden; Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
3 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden.
4 University of Alabama, Birmingham, USA.
Journal: Disability and Health Journal
Citation: 2014 Jul;7(3):302-8. doi: 10.
Publication Year and Month: 2014 07

Abstract: BACKGROUND:
To promote a healthy and active lifestyle there is a need to increase our knowledge of the level of physical activity (PA) among people with late effects of polio.

OBJECTIVES:
To examine PA in people with late effects of polio and to assess the relationship between PA, life satisfaction and various sociodemographic factors.

METHODS:
PA was assessed in 81 persons with late effects of polio using the Physical Activity and Disability Survey (PADS) and by a pedometer. Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11).

RESULTS:
The amount of PA varied considerably but on average the participants were physically active almost 3 h per day, mostly in household activities. The mean value of the pedometer counts was 6212 steps per day (SD = 3208). Sixty-nine percent of the participants rated themselves as satisfied with life as a whole. The sum of PADS was positively and significantly related to the number of steps (r = 0.39, p < 0.001), increasing age (r = 0.26, p < 0.05) and to the level of global satisfaction with life (rho = 0.23, p < 0.05). The number of steps was also positively and significantly associated with level of global satisfaction with life (rho = 0.37, p < 0.001).

Conclusions: Despite a progressive physical disability, people with late effects of polio are physically active, but much of the activities are performed as part of their household activities and not as traditional exercise. The relationship between PA, life satisfaction and age further supports the general contention that an active lifestyle is an important factor for perceived well-being among older people.

Outcome of Research: More research required

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Category: Activity Levels

Title: Energy conservation, occupational therapy, and the treatment of post-polio sequelae
Author: Young GR
Affiliation: Department of Occupational Therapy, Kaiser-Permanente Medical Center, Downey, California 90242
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1233-9
Publication Year and Month: 1991 11

Abstract: Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.

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There are currently 12 papers in this category.

Category: Activity Levels

Title: Actual and perceived activity levels in polio survivors and older controls: a longitudinal study
Author: Klein MG, Braitman LE, Costello R, Keenan MA, Esquenazi A
Affiliation: Moss Rehabilitation Research Institute, Philadelphia, PA; Thomas Jefferson University, Philadelphia 19141, USA – [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2008 Feb; 89(2):297-303
Publication Year and Month: 2008 02

Abstract: OBJECTIVE: To examine factors associated with daily step activity, perceived activity, maximum walking speed, and walking speed reserve over time in polio survivors and older adults with no history of polio.

DESIGN: Longitudinal study.

SETTING: A research clinic and the community.

PARTICIPANTS: Polio survivors (n=96; 65 in postpolio syndrome [PPS] group, 31 in non-PPS group) and older adults (n=112) with no history of polio.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Daily step activity, perceived activity, maximum walking speed, and walking speed reserve.

RESULTS: Results showed decreases in perceived activity over time in the PPS group. However, there was no change in average daily walking activity. Overall, polio survivors walk less and have a smaller walking speed reserve than controls. Knee strength was positively associated with maximum walking speed and walking speed reserve in all groups. Weight and age were associated with daily step activity in controls but not polio survivors.

Conclusions: Daily walking activity did not change statistically over the 3-year study period, although perceived activity and the walking speed reserve decreased among polio survivors with PPS. On average, polio survivors appear to function with minimal functional reserve, as their preferred walking speed was close to their maximum speed.

Outcome of Research:

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Category: Activity Levels

Title: Reproducibility of walking at self-preferred and maximal speed in patients with postpoliomyelitis syndrome
Author: Horemans HL (1), Beelen A (2), Nollet F (2), Lankhorst GJ (1)
Affiliation: (1) Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; (2) Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2004 Dec;85(12):1929-32
Publication Year and Month: 2004 12

Abstract: OBJECTIVE:
To assess the reproducibility of walking performance, heart rate, and perceived exertion at self-preferred speed and maximal walking speed in patients with the postpoliomyelitis syndrome (PPS).

DESIGN: Repeated measurement at a 3-week interval.

SETTING: University hospital.

PARTICIPANTS: Convenience sample of 65 patients with PPS.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Walking performance: the distance walked in 2 minutes at a self-preferred speed and the time needed to walk 75 m at maximal speed, heart rate, and rating of perceived exertion (RPE) on an 11-point scale.

RESULTS: Test-retest reliability of walking performance was excellent for both tests (intraclass correlation coefficient [ICC] range, .94-.97). No systematic differences existed between test and retest. The smallest detectable change for an individual was 15% for both tests. Test-retest reliability for heart rate was good (ICC=.86) but moderate for RPE (Spearman rho range, .67-.70). The smallest detectable change for RPE was between 4 and 6 scale points. The variability in walking performance was significantly correlated with the variability in heart rate at self-preferred speed (r =.36, P <.01) but not with the variability in RPE (r =.20, P =.11).

Conclusions: Both walking tests showed good reproducibility and may be appropriate to monitor (individual) changes in walking capacity in patients with PPS. Because of its moderate reproducibility, RPE does not seem to be suitable to monitor physical exertion. The usefulness of an objective measure such as heart rate for this purpose needs further investigation.

Outcome of Research: More research required

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any):

Link to Paper (if available): Click here to view full text or to download


Category: Activity Levels, Psychology

Title: Exercise therapy and cognitive behavioural therapy to improve fatigue, daily activity performance and quality of life in postpoliomyelitis syndrome: the protocol of the FACTS-2-PPS trial
Author: Koopman FS (1), Beelen A (1), Gerrits KH (2), Bleijenberg G (3), Abma TA (4), de Visser M (5), Nollet F (1)
Affiliation: (1) Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; (2) Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Expert Centre Chronic Fatigue Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;(4) Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands; (5) Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands - [email protected]
Journal: BioMed Central Neurology
Citation: BMC Neurol. 2010 Jan 18;10:8. doi: 10.1186/1471-2377-10-8
Publication Year and Month: 2010 01

Abstract: BACKGROUND: Postpoliomyelitis Syndrome (PPS) is a complex of late onset neuromuscular symptoms with new or increased muscle weakness and muscle fatigability as key symptoms. Main clinical complaints are severe fatigue, deterioration in functional abilities and health related quality of life. Rehabilitation management is the mainstay of treatment. Two different therapeutic interventions may be prescribed (1) exercise therapy or (2) cognitive behavioural therapy (CBT). However, the evidence on the effectiveness of both interventions is limited. The primary aim of the FACTS-2-PPS trial is to study the efficacy of exercise therapy and CBT for reducing fatigue and improving activities and quality of life in patients with PPS. Additionally, the working mechanisms, patients' and therapists' expectations of and experiences with both interventions and cost-effectiveness will be evaluated.

METHODS/DESIGN: A multi-centre, single-blinded, randomized controlled trial will be conducted. A sample of 81 severely fatigued patients with PPS will be recruited from 3 different university hospitals and their affiliate rehabilitation centres. Patients will be randomized to one of three groups i.e. (1) exercise therapy + usual care, (2) CBT + usual care, (3) usual care. At baseline, immediately post-intervention and at 3- and 6-months follow-up, fatigue, activities, quality of life and secondary outcomes will be assessed. Costs will be based on a cost questionnaire, and statistical analyses on GEE (generalized estimated equations). Analysis will also consider mechanisms of change during therapy. A responsive evaluation will be conducted to monitor the implementation process and to investigate the perspectives of patients and therapists on both interventions.

DISCUSSION: A major strength of the FACTS-2-PPS study is the use of a mixed methods design in which a responsive and economic evaluation runs parallel to the trial. The results of this study will generate new evidence for the rehabilitation treatment of persons with PPS.

TRIAL REGISTRATION: Dutch Trial Register NTR1371.

Conclusions:

Outcome of Research: Not applicable.

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any):

Link to Paper (if available): Click here to view full text or to download


Category: Exercise, Activity Levels

Title: The Postpolio Syndrome: An Overuse Phenomenon
Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08

Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.

Conclusions:

Outcome of Research: Not applicable

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any): Paul Cavendish
(Clinical Health Educator):
This article discusses manual muscle testing and gait dynamics with EMG, demonstrating excessive muscle use during gait, demonstrating increased fatigue for this sample of people with a history of polio.

Link to Paper (if available): Click here to view full text or to download


Category: Activity Levels

Title: A Brief Questionnaire to Assess Post-Exertional Malaise
Author: Joseph Cotler, Carly Holtzman, Catherine Dudun and Leonard A. Jason
Affiliation:
Journal: Diagnostics
Citation: 11 September 2018
Publication Year and Month: 2018 09

Abstract: Post-exertional malaise (PEM) is a key symptom of myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Currently, five PEM-items from the DePaul Symptom Questionnaire (DSQ) were recommended as a first step in measuring this symptom for patients with ME and CFS by the National Institutes of Health/Centers for Disease Control and Prevention (NIH/CDC) Common Data Elements’ (CDE) working group. The second step in this process, as recommended by the NIH/CDC CDE working group, involves assembling information from various sources to confirm the presence of PEM. There have not been any efforts, to date, to standardize this second-step process in the assessment of PEM. The current study examined whether five supplementary items on the DSQ could be used to operationalize the second step of the recommendations made by the NIH/CDC CDE working group. The five supplementary DSQ PEM duration items correctly categorized patients with ME or CFS 81.7% of the time, while incorrectly categorizing multiple sclerosis (MS) and post-polio syndrome (PPS) as ME or CFS only 16.6% of the time. The findings suggested that a PEM second-step process could be operationalized using supplementary DSQ items.

Conclusions:

Outcome of Research: More research required

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Category: Activity Levels

Title: Physical activity in persons with late effects of polio: a descriptive study.
Author: Winberg C, Flansbjer UB, Carlsson G, Rimmer J, Lexell J.
Affiliation: 1 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden. Electronic address: [email protected].
2 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden; Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
3 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden.
4 University of Alabama, Birmingham, USA.
Journal: Disability and Health Journal
Citation: 2014 Jul;7(3):302-8. doi: 10.
Publication Year and Month: 2014 07

Abstract: BACKGROUND:
To promote a healthy and active lifestyle there is a need to increase our knowledge of the level of physical activity (PA) among people with late effects of polio.

OBJECTIVES:
To examine PA in people with late effects of polio and to assess the relationship between PA, life satisfaction and various sociodemographic factors.

METHODS:
PA was assessed in 81 persons with late effects of polio using the Physical Activity and Disability Survey (PADS) and by a pedometer. Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11).

RESULTS:
The amount of PA varied considerably but on average the participants were physically active almost 3 h per day, mostly in household activities. The mean value of the pedometer counts was 6212 steps per day (SD = 3208). Sixty-nine percent of the participants rated themselves as satisfied with life as a whole. The sum of PADS was positively and significantly related to the number of steps (r = 0.39, p < 0.001), increasing age (r = 0.26, p < 0.05) and to the level of global satisfaction with life (rho = 0.23, p < 0.05). The number of steps was also positively and significantly associated with level of global satisfaction with life (rho = 0.37, p < 0.001).

Conclusions: Despite a progressive physical disability, people with late effects of polio are physically active, but much of the activities are performed as part of their household activities and not as traditional exercise. The relationship between PA, life satisfaction and age further supports the general contention that an active lifestyle is an important factor for perceived well-being among older people.

Outcome of Research: More research required

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Category: Activity Levels, Late Effects of Polio, Muscle Strength, Psychology, Quality of Life

Title: Health-related quality of life, self-reported impairments and activities of daily living in relation to muscle function in post-polio syndrome
Author: Vanya Gocheva,corresponding author1 Patricia Hafner,1 Anna-Lena Orsini,1,2 Simone Schmidt,1,3 Sabine Schaedelin,4 Nicole Rueedi,1 Daniela Rubino-Nacht,1 Peter Weber,1 and Dirk Fischer1
Affiliation: 1Division of Neuropediatrics and Developmental Medicine, University Children’s Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056 Basel, Switzerland
2Division of Neurology, University Hospital Basel, Basel, Switzerland
3Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
4Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
Vanya Gocheva, Email: [email protected].
corresponding author.
Journal: Journal of Patient-Reported Outcomes
Citation: 4(1), 59. https://doi.org/10.1186/s41687-020-00226-5
Publication Year and Month: 2020 12

Abstract: Background
The symptoms of post-polio syndrome (PPS) and its resulting disabilities can affect quality of life and the ability to perform daily activities. No study has comprehensively analysed how various patient-reported outcome measures (PROMs) are associated with objectively assessed physical function in patients with PPS.

Aim
To investigate health-related quality of life (HRQOL), self-reported impairments and activities of daily living during 6 months and evaluate their association with clinical muscle function outcomes in individuals with PPS.

Methods
Twenty-seven patients with PPS were included in the study. At baseline and 6 months, patients were administered PROMs measuring HRQOL (WHOQOL-BREF), self-reported impairments related to PPS (SIPP-RS) and activities of daily living (IBM-FRS). Clinical muscle function outcomes included 6 min walking distance (6MWD) and motor function measure (MFM).

Results
There were no changes in self-reported impairments (25.52 to 24.93, p = 0.40), activities of daily living (33.89 to 33.30, p = 0.20), 6MWD (391.52 to 401.85, p = 0.30) and MFM (83.87 to 85.46, p = 0.14) during 6 months, while the HRQOL psychological health decreased during this period (76.85 to 72.38, p = 0.05). A strong association was found between activities of daily living and clinical muscle function outcomes (6MWD: ß = 0.02, 95% CI: 0.02;0.03, t = 6.88, p < 0.01; MFM: ß = 0.25, 95% CI: 0.17;0.33, t = 6.69, p < 0.01). Self-reported impairments and HRQOL domains were not associated with the clinical muscle outcomes.

Conclusions
Study findings indicate that objectively measured walking and motor abilities do not reflect patient’s perspectives of their HRQOL and impairment due to PPS. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.

Conclusions: Self-reported impairments, HRQOL domains, activities of daily living and muscle function outcomes remained stable during 6 months in patients with PPS, except for the HRQOL psychological health domain which declined during this period. Clinical muscle outcomes had no statistically significant relationship with HRQOL and self-reported impairments of PPS patients while a significant relationship was observed with the activities of daily living. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.

Outcome of Research: More research required

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Activity Levels

Title: Walking in postpoliomyelitis syndrome: the relationships between time‐scored tests, walking in daily life and perceived mobility problems
Author: Horemans HL, Bussmann JB, Beelen A, Stam HJ, Nollet F
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):142-6.
Publication Year and Month: 2005 05

Abstract: OBJECTIVE: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome.

SUBJECTS: Twenty-four ambulant patients with post-poliomyelitis syndrome.

METHODS: Walking tests were performed at self-preferred and maximal speed. Walking activity was measured with an ambulatory activity monitor. Heart rate, step cadence and walking speed in the test and in daily life were compared. Walking speed in daily life was represented by the intensity of walking. Perceived mobility problems were assessed with the Nottingham Health Profile.

RESULTS: Heart rate during walking was lower in the test at self-preferred speed than in daily life (mean difference: 11.3+/-10.4; p=0.001). Self-preferred walking speed in the test and in daily life correlated significantly (r=0.55; p=0.04). In a sub-group with a test performance below the median value, test performance correlated significantly with walking activity. No significant correlation was found between perceived mobility problems and walking activity.

Conclusions: Walking in daily life may be more demanding than walking under standardized conditions. Patients with post-poliomyelitis syndrome with the lowest test performance walked less in daily life. Patients do not necessarily match their activity pattern to their perceived mobility problems.

Outcome of Research: Not applicable.

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Category: Activity Levels

Title: Change in physical mobility over 10 years in post-polio syndrome
Author: Bickerstaffe A (1), Beelen A (2), Nollet F (2)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands; (2) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
Journal: Neuromuscular Disorders
Citation: Neuromuscul Disord. 2015 Mar;25(3):225-30. doi: 10.1016/j.nmd.2014.11.015
Publication Year and Month: 2015 03

Abstract: Post-polio syndrome is characterised by progressive muscle weakness and other symptoms which can limit physical mobility. We assessed the rate of decline in mobility over 10 years in relation to strength decline; and investigated potential predictors for the rate of decline of walking capacity, a measure of mobility, in 48 patients with post-polio syndrome and proven quadriceps dysfunction at baseline. Average walking capacity and self-reported physical mobility declined over 10 years, by 6 and 14%, respectively. Concomitantly people lost an average of 15% of isometric quadriceps strength. Significantly more people used walking aids offering greater support at follow-up. Notably, there was much individual variation, with 18% of participants losing a substantial amount of walking capacity (27% decline) and concomitant self-reported physical mobility (38% decline). Loss of quadriceps strength only explained a small proportion of the variance of the decline in walking capacity (R = 11%) and the rate of decline could not be predicted from baseline values for strength, walking capacity, self-reported physical mobility or basic demographics. The individual variability, yet lack of predictive factors, underscores the need for personally tailored care based on actual functional decline in patients with post-polio syndrome.

Conclusions: • The majority of post-polio patients experienced modest declines in physical mobility in 10 years.
• One-fifth of patients experienced substantial declines in walking capacity.
• The rate of decline in walking capacity could not be predicted from baseline quadriceps strength.
• These findings underscore the need for personally tailored care based on actual functional
decline.

Outcome of Research: Not applicable

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Category: Activity Levels, Psychology,

Title: No reduction of severe fatigue in patients with postpolio syndrome by exercise therapy or cognitive behavioral therapy: results of an RCT
Author: Koopman FS (1), Voorn EL (1), Beelen A (1), Bleijenberg G (2), de Visser M (1), Brehm MA (1), Nollet F (1)
Affiliation: (1) University of Amsterdam, Amsterdam, The Netherlands; (2) Radboud University Medical Centre, Nijmegen, The Netherlands
Journal: Neurorehabilitation & Neural Repair
Citation: Neurorehabil Neural Repair. 2015 Aug 7. pii: 1545968315600271
Publication Year and Month: 2015 08

Abstract: BACKGROUND: People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL).

OBJECTIVES: To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS.

METHODS: We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months.

RESULTS: A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = -2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = -2.24 to 5.98, for CBT versus UC), activities, or HRQoL.

Conclusions: Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.

Outcome of Research: More research required

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Category: Activity Levels

Title: Energy conservation, occupational therapy, and the treatment of post-polio sequelae
Author: Young GR
Affiliation: Department of Occupational Therapy, Kaiser-Permanente Medical Center, Downey, California 90242
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1233-9
Publication Year and Month: 1991 11

Abstract: Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.

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Category: Activity Levels

Title: Neuromuscular function in polio survivors
Author: Agre JC, Rodriquez AA
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin - Madison Medical School 53792
Journal: Orthopedics
Citation: Orthopedics. 1991 Dec; 14(12):1343-7
Publication Year and Month: 1991 12

Abstract: Although there is no documented, objective evidence that symptomatic post-polio subjects are rapidly losing strength, they have a number of neuromuscular deficits related to a more severe poliomyelitis illness that may explain why they complain of problems with strength, endurance, and local muscle fatigue. Symptomatic post-polio subjects were hospitalized longer during the acute poliomyelitis, recovered more slowly, and had electromyographic evidence of greater loss of anterior horn cells. Additionally, recent assessment demonstrated that they were weaker, had a reduced work capacity, and recovered strength less readily after activity in the quadriceps muscles as compared to asymptomatic subjects. Of great clinical importance, rating of perceived exertion in the muscle during exercise was the same in symptomatic and asymptomatic post-polio and control subjects, indicating that symptomatic subjects have a mechanism to monitor local muscle fatigue that could be used to avoid exhaustion. A study of pacing (interspersing activity with rest breaks) showed that symptomatic subjects had less local muscle fatigue and greater strength recovery when they paced their activity than when they worked at a constant rate to exhaustion. We recommend that post-polio individuals pace their daily activity to avoid excessive fatigue.

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There are currently 12 papers in this category.

Category: Activity Levels, Late Effects of Polio, Muscle Strength, Psychology, Quality of Life

Title: Health-related quality of life, self-reported impairments and activities of daily living in relation to muscle function in post-polio syndrome
Author: Vanya Gocheva,corresponding author1 Patricia Hafner,1 Anna-Lena Orsini,1,2 Simone Schmidt,1,3 Sabine Schaedelin,4 Nicole Rueedi,1 Daniela Rubino-Nacht,1 Peter Weber,1 and Dirk Fischer1
Affiliation: 1Division of Neuropediatrics and Developmental Medicine, University Children’s Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056 Basel, Switzerland
2Division of Neurology, University Hospital Basel, Basel, Switzerland
3Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
4Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
Vanya Gocheva, Email: [email protected].
corresponding author.
Journal: Journal of Patient-Reported Outcomes
Citation: 4(1), 59. https://doi.org/10.1186/s41687-020-00226-5
Publication Year and Month: 2020 12

Abstract: Background
The symptoms of post-polio syndrome (PPS) and its resulting disabilities can affect quality of life and the ability to perform daily activities. No study has comprehensively analysed how various patient-reported outcome measures (PROMs) are associated with objectively assessed physical function in patients with PPS.

Aim
To investigate health-related quality of life (HRQOL), self-reported impairments and activities of daily living during 6 months and evaluate their association with clinical muscle function outcomes in individuals with PPS.

Methods
Twenty-seven patients with PPS were included in the study. At baseline and 6 months, patients were administered PROMs measuring HRQOL (WHOQOL-BREF), self-reported impairments related to PPS (SIPP-RS) and activities of daily living (IBM-FRS). Clinical muscle function outcomes included 6 min walking distance (6MWD) and motor function measure (MFM).

Results
There were no changes in self-reported impairments (25.52 to 24.93, p = 0.40), activities of daily living (33.89 to 33.30, p = 0.20), 6MWD (391.52 to 401.85, p = 0.30) and MFM (83.87 to 85.46, p = 0.14) during 6 months, while the HRQOL psychological health decreased during this period (76.85 to 72.38, p = 0.05). A strong association was found between activities of daily living and clinical muscle function outcomes (6MWD: ß = 0.02, 95% CI: 0.02;0.03, t = 6.88, p < 0.01; MFM: ß = 0.25, 95% CI: 0.17;0.33, t = 6.69, p < 0.01). Self-reported impairments and HRQOL domains were not associated with the clinical muscle outcomes.

Conclusions
Study findings indicate that objectively measured walking and motor abilities do not reflect patient’s perspectives of their HRQOL and impairment due to PPS. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.

Conclusions: Self-reported impairments, HRQOL domains, activities of daily living and muscle function outcomes remained stable during 6 months in patients with PPS, except for the HRQOL psychological health domain which declined during this period. Clinical muscle outcomes had no statistically significant relationship with HRQOL and self-reported impairments of PPS patients while a significant relationship was observed with the activities of daily living. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.

Outcome of Research: More research required

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Activity Levels

Title: A Brief Questionnaire to Assess Post-Exertional Malaise
Author: Joseph Cotler, Carly Holtzman, Catherine Dudun and Leonard A. Jason
Affiliation:
Journal: Diagnostics
Citation: 11 September 2018
Publication Year and Month: 2018 09

Abstract: Post-exertional malaise (PEM) is a key symptom of myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Currently, five PEM-items from the DePaul Symptom Questionnaire (DSQ) were recommended as a first step in measuring this symptom for patients with ME and CFS by the National Institutes of Health/Centers for Disease Control and Prevention (NIH/CDC) Common Data Elements’ (CDE) working group. The second step in this process, as recommended by the NIH/CDC CDE working group, involves assembling information from various sources to confirm the presence of PEM. There have not been any efforts, to date, to standardize this second-step process in the assessment of PEM. The current study examined whether five supplementary items on the DSQ could be used to operationalize the second step of the recommendations made by the NIH/CDC CDE working group. The five supplementary DSQ PEM duration items correctly categorized patients with ME or CFS 81.7% of the time, while incorrectly categorizing multiple sclerosis (MS) and post-polio syndrome (PPS) as ME or CFS only 16.6% of the time. The findings suggested that a PEM second-step process could be operationalized using supplementary DSQ items.

Conclusions:

Outcome of Research: More research required

Availability of Paper:

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Category: Activity Levels, Psychology,

Title: No reduction of severe fatigue in patients with postpolio syndrome by exercise therapy or cognitive behavioral therapy: results of an RCT
Author: Koopman FS (1), Voorn EL (1), Beelen A (1), Bleijenberg G (2), de Visser M (1), Brehm MA (1), Nollet F (1)
Affiliation: (1) University of Amsterdam, Amsterdam, The Netherlands; (2) Radboud University Medical Centre, Nijmegen, The Netherlands
Journal: Neurorehabilitation & Neural Repair
Citation: Neurorehabil Neural Repair. 2015 Aug 7. pii: 1545968315600271
Publication Year and Month: 2015 08

Abstract: BACKGROUND: People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL).

OBJECTIVES: To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS.

METHODS: We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months.

RESULTS: A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = -2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = -2.24 to 5.98, for CBT versus UC), activities, or HRQoL.

Conclusions: Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.

Outcome of Research: More research required

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Category: Activity Levels

Title: Change in physical mobility over 10 years in post-polio syndrome
Author: Bickerstaffe A (1), Beelen A (2), Nollet F (2)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands; (2) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
Journal: Neuromuscular Disorders
Citation: Neuromuscul Disord. 2015 Mar;25(3):225-30. doi: 10.1016/j.nmd.2014.11.015
Publication Year and Month: 2015 03

Abstract: Post-polio syndrome is characterised by progressive muscle weakness and other symptoms which can limit physical mobility. We assessed the rate of decline in mobility over 10 years in relation to strength decline; and investigated potential predictors for the rate of decline of walking capacity, a measure of mobility, in 48 patients with post-polio syndrome and proven quadriceps dysfunction at baseline. Average walking capacity and self-reported physical mobility declined over 10 years, by 6 and 14%, respectively. Concomitantly people lost an average of 15% of isometric quadriceps strength. Significantly more people used walking aids offering greater support at follow-up. Notably, there was much individual variation, with 18% of participants losing a substantial amount of walking capacity (27% decline) and concomitant self-reported physical mobility (38% decline). Loss of quadriceps strength only explained a small proportion of the variance of the decline in walking capacity (R = 11%) and the rate of decline could not be predicted from baseline values for strength, walking capacity, self-reported physical mobility or basic demographics. The individual variability, yet lack of predictive factors, underscores the need for personally tailored care based on actual functional decline in patients with post-polio syndrome.

Conclusions: • The majority of post-polio patients experienced modest declines in physical mobility in 10 years.
• One-fifth of patients experienced substantial declines in walking capacity.
• The rate of decline in walking capacity could not be predicted from baseline quadriceps strength.
• These findings underscore the need for personally tailored care based on actual functional
decline.

Outcome of Research: Not applicable

Availability of Paper: Paid subscription required to view or download full text.

Comments (if any):

Link to Paper (if available): Click here to view Abstract


Category: Activity Levels

Title: Physical activity in persons with late effects of polio: a descriptive study.
Author: Winberg C, Flansbjer UB, Carlsson G, Rimmer J, Lexell J.
Affiliation: 1 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden. Electronic address: [email protected].
2 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden; Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
3 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden.
4 University of Alabama, Birmingham, USA.
Journal: Disability and Health Journal
Citation: 2014 Jul;7(3):302-8. doi: 10.
Publication Year and Month: 2014 07

Abstract: BACKGROUND:
To promote a healthy and active lifestyle there is a need to increase our knowledge of the level of physical activity (PA) among people with late effects of polio.

OBJECTIVES:
To examine PA in people with late effects of polio and to assess the relationship between PA, life satisfaction and various sociodemographic factors.

METHODS:
PA was assessed in 81 persons with late effects of polio using the Physical Activity and Disability Survey (PADS) and by a pedometer. Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11).

RESULTS:
The amount of PA varied considerably but on average the participants were physically active almost 3 h per day, mostly in household activities. The mean value of the pedometer counts was 6212 steps per day (SD = 3208). Sixty-nine percent of the participants rated themselves as satisfied with life as a whole. The sum of PADS was positively and significantly related to the number of steps (r = 0.39, p < 0.001), increasing age (r = 0.26, p < 0.05) and to the level of global satisfaction with life (rho = 0.23, p < 0.05). The number of steps was also positively and significantly associated with level of global satisfaction with life (rho = 0.37, p < 0.001).

Conclusions: Despite a progressive physical disability, people with late effects of polio are physically active, but much of the activities are performed as part of their household activities and not as traditional exercise. The relationship between PA, life satisfaction and age further supports the general contention that an active lifestyle is an important factor for perceived well-being among older people.

Outcome of Research: More research required

Availability of Paper:

Comments (if any):

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Category: Activity Levels, Psychology

Title: Exercise therapy and cognitive behavioural therapy to improve fatigue, daily activity performance and quality of life in postpoliomyelitis syndrome: the protocol of the FACTS-2-PPS trial
Author: Koopman FS (1), Beelen A (1), Gerrits KH (2), Bleijenberg G (3), Abma TA (4), de Visser M (5), Nollet F (1)
Affiliation: (1) Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; (2) Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Expert Centre Chronic Fatigue Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;(4) Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands; (5) Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands - [email protected]
Journal: BioMed Central Neurology
Citation: BMC Neurol. 2010 Jan 18;10:8. doi: 10.1186/1471-2377-10-8
Publication Year and Month: 2010 01

Abstract: BACKGROUND: Postpoliomyelitis Syndrome (PPS) is a complex of late onset neuromuscular symptoms with new or increased muscle weakness and muscle fatigability as key symptoms. Main clinical complaints are severe fatigue, deterioration in functional abilities and health related quality of life. Rehabilitation management is the mainstay of treatment. Two different therapeutic interventions may be prescribed (1) exercise therapy or (2) cognitive behavioural therapy (CBT). However, the evidence on the effectiveness of both interventions is limited. The primary aim of the FACTS-2-PPS trial is to study the efficacy of exercise therapy and CBT for reducing fatigue and improving activities and quality of life in patients with PPS. Additionally, the working mechanisms, patients' and therapists' expectations of and experiences with both interventions and cost-effectiveness will be evaluated.

METHODS/DESIGN: A multi-centre, single-blinded, randomized controlled trial will be conducted. A sample of 81 severely fatigued patients with PPS will be recruited from 3 different university hospitals and their affiliate rehabilitation centres. Patients will be randomized to one of three groups i.e. (1) exercise therapy + usual care, (2) CBT + usual care, (3) usual care. At baseline, immediately post-intervention and at 3- and 6-months follow-up, fatigue, activities, quality of life and secondary outcomes will be assessed. Costs will be based on a cost questionnaire, and statistical analyses on GEE (generalized estimated equations). Analysis will also consider mechanisms of change during therapy. A responsive evaluation will be conducted to monitor the implementation process and to investigate the perspectives of patients and therapists on both interventions.

DISCUSSION: A major strength of the FACTS-2-PPS study is the use of a mixed methods design in which a responsive and economic evaluation runs parallel to the trial. The results of this study will generate new evidence for the rehabilitation treatment of persons with PPS.

TRIAL REGISTRATION: Dutch Trial Register NTR1371.

Conclusions:

Outcome of Research: Not applicable.

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Activity Levels

Title: Actual and perceived activity levels in polio survivors and older controls: a longitudinal study
Author: Klein MG, Braitman LE, Costello R, Keenan MA, Esquenazi A
Affiliation: Moss Rehabilitation Research Institute, Philadelphia, PA; Thomas Jefferson University, Philadelphia 19141, USA – [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2008 Feb; 89(2):297-303
Publication Year and Month: 2008 02

Abstract: OBJECTIVE: To examine factors associated with daily step activity, perceived activity, maximum walking speed, and walking speed reserve over time in polio survivors and older adults with no history of polio.

DESIGN: Longitudinal study.

SETTING: A research clinic and the community.

PARTICIPANTS: Polio survivors (n=96; 65 in postpolio syndrome [PPS] group, 31 in non-PPS group) and older adults (n=112) with no history of polio.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Daily step activity, perceived activity, maximum walking speed, and walking speed reserve.

RESULTS: Results showed decreases in perceived activity over time in the PPS group. However, there was no change in average daily walking activity. Overall, polio survivors walk less and have a smaller walking speed reserve than controls. Knee strength was positively associated with maximum walking speed and walking speed reserve in all groups. Weight and age were associated with daily step activity in controls but not polio survivors.

Conclusions: Daily walking activity did not change statistically over the 3-year study period, although perceived activity and the walking speed reserve decreased among polio survivors with PPS. On average, polio survivors appear to function with minimal functional reserve, as their preferred walking speed was close to their maximum speed.

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Category: Activity Levels

Title: Walking in postpoliomyelitis syndrome: the relationships between time‐scored tests, walking in daily life and perceived mobility problems
Author: Horemans HL, Bussmann JB, Beelen A, Stam HJ, Nollet F
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):142-6.
Publication Year and Month: 2005 05

Abstract: OBJECTIVE: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome.

SUBJECTS: Twenty-four ambulant patients with post-poliomyelitis syndrome.

METHODS: Walking tests were performed at self-preferred and maximal speed. Walking activity was measured with an ambulatory activity monitor. Heart rate, step cadence and walking speed in the test and in daily life were compared. Walking speed in daily life was represented by the intensity of walking. Perceived mobility problems were assessed with the Nottingham Health Profile.

RESULTS: Heart rate during walking was lower in the test at self-preferred speed than in daily life (mean difference: 11.3+/-10.4; p=0.001). Self-preferred walking speed in the test and in daily life correlated significantly (r=0.55; p=0.04). In a sub-group with a test performance below the median value, test performance correlated significantly with walking activity. No significant correlation was found between perceived mobility problems and walking activity.

Conclusions: Walking in daily life may be more demanding than walking under standardized conditions. Patients with post-poliomyelitis syndrome with the lowest test performance walked less in daily life. Patients do not necessarily match their activity pattern to their perceived mobility problems.

Outcome of Research: Not applicable.

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Activity Levels

Title: Reproducibility of walking at self-preferred and maximal speed in patients with postpoliomyelitis syndrome
Author: Horemans HL (1), Beelen A (2), Nollet F (2), Lankhorst GJ (1)
Affiliation: (1) Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; (2) Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2004 Dec;85(12):1929-32
Publication Year and Month: 2004 12

Abstract: OBJECTIVE:
To assess the reproducibility of walking performance, heart rate, and perceived exertion at self-preferred speed and maximal walking speed in patients with the postpoliomyelitis syndrome (PPS).

DESIGN: Repeated measurement at a 3-week interval.

SETTING: University hospital.

PARTICIPANTS: Convenience sample of 65 patients with PPS.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Walking performance: the distance walked in 2 minutes at a self-preferred speed and the time needed to walk 75 m at maximal speed, heart rate, and rating of perceived exertion (RPE) on an 11-point scale.

RESULTS: Test-retest reliability of walking performance was excellent for both tests (intraclass correlation coefficient [ICC] range, .94-.97). No systematic differences existed between test and retest. The smallest detectable change for an individual was 15% for both tests. Test-retest reliability for heart rate was good (ICC=.86) but moderate for RPE (Spearman rho range, .67-.70). The smallest detectable change for RPE was between 4 and 6 scale points. The variability in walking performance was significantly correlated with the variability in heart rate at self-preferred speed (r =.36, P <.01) but not with the variability in RPE (r =.20, P =.11).

Conclusions: Both walking tests showed good reproducibility and may be appropriate to monitor (individual) changes in walking capacity in patients with PPS. Because of its moderate reproducibility, RPE does not seem to be suitable to monitor physical exertion. The usefulness of an objective measure such as heart rate for this purpose needs further investigation.

Outcome of Research: More research required

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Category: Activity Levels

Title: Neuromuscular function in polio survivors
Author: Agre JC, Rodriquez AA
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin - Madison Medical School 53792
Journal: Orthopedics
Citation: Orthopedics. 1991 Dec; 14(12):1343-7
Publication Year and Month: 1991 12

Abstract: Although there is no documented, objective evidence that symptomatic post-polio subjects are rapidly losing strength, they have a number of neuromuscular deficits related to a more severe poliomyelitis illness that may explain why they complain of problems with strength, endurance, and local muscle fatigue. Symptomatic post-polio subjects were hospitalized longer during the acute poliomyelitis, recovered more slowly, and had electromyographic evidence of greater loss of anterior horn cells. Additionally, recent assessment demonstrated that they were weaker, had a reduced work capacity, and recovered strength less readily after activity in the quadriceps muscles as compared to asymptomatic subjects. Of great clinical importance, rating of perceived exertion in the muscle during exercise was the same in symptomatic and asymptomatic post-polio and control subjects, indicating that symptomatic subjects have a mechanism to monitor local muscle fatigue that could be used to avoid exhaustion. A study of pacing (interspersing activity with rest breaks) showed that symptomatic subjects had less local muscle fatigue and greater strength recovery when they paced their activity than when they worked at a constant rate to exhaustion. We recommend that post-polio individuals pace their daily activity to avoid excessive fatigue.

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Category: Activity Levels

Title: Energy conservation, occupational therapy, and the treatment of post-polio sequelae
Author: Young GR
Affiliation: Department of Occupational Therapy, Kaiser-Permanente Medical Center, Downey, California 90242
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1233-9
Publication Year and Month: 1991 11

Abstract: Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.

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Category: Exercise, Activity Levels

Title: The Postpolio Syndrome: An Overuse Phenomenon
Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08

Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.

Conclusions:

Outcome of Research: Not applicable

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any): Paul Cavendish
(Clinical Health Educator):
This article discusses manual muscle testing and gait dynamics with EMG, demonstrating excessive muscle use during gait, demonstrating increased fatigue for this sample of people with a history of polio.

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Outcomes of Research or Clinical Trials Activity Levels Acute Flaccid Paralysis Ageing Anaerobic Threshold Anaesthesia Assistive Technology Brain Cardiorespiratory Cardiovascular Clinical Evaluation Cold Intolerance Complementary Therapies Continence Coping Styles and Strategies Cultural Context Diagnosis and Management Differential Diagnosis Drugs Dysphagia Dysphonia Epidemiology Exercise Falls Fatigue Fractures Gender Differences Immune Response Inflammation Late Effects of Polio Muscle Strength Muscular Atrophy Orthoses Pain Polio Immunisation Post-Polio Motor Unit Psychology Quality of Life Renal Complications Respiratory Complications and Management Restless Legs Syndrome Sleep Analaysis Surgery Vitality Vocational Implications