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: Falls and Bone Density

Title: Circumstances and consequences of falls in polio survivors
Author: Bickerstaffe A, Beelen A, Nollet F
Affiliation: Department of Rehabilitation AMC, Amsterdam, The Netherlands
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Nov;42(10):908-15. doi: 10.2340/16501977-0620
Publication Year and Month: 2010 11

Abstract: OBJECTIVES: Many polio survivors have symptoms that are known risk factors for falls in elderly people. This study aims to determine the: (i) frequency; (ii) consequences; (iii) circumstances; and (iv) factors associated with falls in polio survivors.

METHODS: A survey was conducted among 376 polio survivors. Participants completed a falls history questionnaire and additional information was obtained from their medical files.

RESULTS: Of the 305 respondents, 74% reported at least one fall in the past year and 60% two or more. Sixteen percent of fallers described a major injury after a fall in the last year and 69% reported fear of falling. One-third of fallers had reduced the amount they walked because of their fear of falling. Most reported falls in a familiar environment (86%), during ambulation (72%) and in the afternoon (50%). Quadriceps weakness of the weakest leg (Medical Research Council (MRC) ≤ 3), fear of falling and complaints of problems maintaining balance were independently associated with both falls and recurrent falls, while increasing age and medication use were not.

Conclusions: The high rate of falls and consequences thereof, merit the implementation of fall intervention strategies. To maximize effect, they should be tailor-made and target the fall mechanisms specific to polio survivors.

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: Falls and Bone Density

Title: Falls among adults aging with disability
Author: Matsuda PN (1), Verrall AM (2), Finlayson ML (3), Molton IR (2), Jensen MP (2)
Affiliation: (1) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: [email protected]; (2) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; (3) School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2015 Mar;96(3):464-71. doi: 10.1016/j.apmr.2014.09.034
Publication Year and Month: 2015 03

Abstract: OBJECTIVE: To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI).

DESIGN: Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not.

SETTING: Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%.

PARTICIPANTS: A convenience sample of community-dwelling individuals (N=1862; age, 18-94y) with MS, MD, PPS, or SCI in the United States.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Self-reported fall within the last 6 months.

RESULTS: Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45-64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age(2)), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups.

Conclusions: People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.

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: Falls and Bone Density

Title: Fractures in an aging population of poliomyelitis survivors: a community-based study in Olmsted County, Minnesota
Author: Goerss JB, Atkinson EJ, Windebank AJ, O'Fallon WM, Melton LJ 3rd
Affiliation: Department of Medical Genetics, Mayo Clinic Rochester, Minnesota 55905
Journal: Mayo Clinic Proceedings
Citation: Mayo Clin Proc. 1994 Apr; 69(4):333-9
Publication Year and Month: 1994 04

Abstract: OBJECTIVE: To determine the incidence of fractures in a cohort of survivors of paralytic poliomyelitis (“polio”).

DESIGN: We conducted a population-based retrospective cohort study of residents of Olmsted County, Minnesota, who had an initial diagnosis of polio between 1935 and 1959 and survived the acute illness.

MATERIALS AND METHODS: A comprehensive medical records-linkage system was used to retrieve all diagnoses of poliomyelitis in residents of the county for the specified 25-year period. For the 277 study subjects, the medical records were searched for the occurrence of fracture from the time of initial diagnosis of polio until death or the most recent clinical contact. All fractures were classified on the basis of type of associated injury and skeletal site of involvement. The influence of polio on the incidence of fractures was evaluated by estimating the cumulative incidence of new fractures after the diagnosis of polio and the standardized morbidity ratio. The relative influence of various factors on the risk of fracture was determined.

RESULTS: Of the 277 Olmsted County residents with polio, 87 experienced 161 fractures, and the estimated cumulative incidence of any fracture after 40 years was 48%. The cumulative incidence of any limb fracture was 41% and was less than the expected value of 44% (P = 0.001). Only the risk of distal femoral and proximal humeral fractures was significantly higher than that among Olmsted County residents in general. The increased risk seemed to be associated with weakness and disuse of the involved limbs rather than with generalized osteoporosis. Theoretically, a greater capacity for bone remodeling in response to changes in muscle use might have protected patients with polio in childhood, but such persons were as likely to sustain a fracture as those with adult-onset poliomyelitis.

Conclusions: These data indicate that survivors of paralytic poliomyelitis do not have an unusual risk of fracture except in affected limbs.

Outcome of Research:

Availability of Paper:

Comments (if any):

Link to Paper (if available):


Category: Falls and Bone Density

Title: High incidence of osteoporosis and fractures in an aging post-polio population
Author: Mohammad AF (1), Khan KA (1), Galvin L (2), Hardiman O (2), O’Connell PG (1)
Affiliation: Departments of (1) Rheumatology, and (2) Neurology, Beaumont Hospital, Dublin, Ireland
Journal: European Neurology
Citation: Eur Neurol. 2009 Nov; 62(6):369–374. doi:10.1159/000242444
Publication Year and Month: 2009 11

Abstract: BACKGROUND/AIMS: Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.

METHODS: Over a 6-month period, 50 post-polio patients attending outpatient clinics completed a questionnaire, and subsequently their medical records were reviewed. Demographic data and details of treatment were extracted. The patients underwent a dual-energy X-ray absorptiometry scanning to quantify bone mineral density. Results: Thirty subjects (60%) were females (26 were postmenopausal). The average age of females was 60 ± 13.4 years and of men 59 ± 16.8 years. Overall, 41 (82%) of the patients had experienced falls in the last 5 years and 32 (64%) in the last 6 months. Nineteen (38%) of the patients had experienced a bone fracture in the last 5 years. Based on the bone mineral density data, 28 (56%) of the patients were diagnosed with OP and 20 (40%) had osteopenia, but only 8 (16%) received anti-resorptive therapy. Of the 19 patients who had a fracture, 14 (74%) had OP and 5 (26%) had osteopenia, of whom only 6 (32%) received anti-resorptive therapy. Eight out of 9 fractures of the neck of femur occurred in the weaker leg.

Conclusions: Post-polio patients are a high-risk group for fracture, and thus bone density assessment, review of falls risk and therapeutic intervention should be considered for all patients. Both osteopenia and OP are associated with increased fracture risk.

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: Falls and Bone Density

Title: Osteoporosis in a postpolio clinic population
Author: Haziza M (1), Kremer R, Benedetti A, Trojan DA
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2007 Aug;88(8):1030-5
Publication Year and Month: 2007 08

Abstract: OBJECTIVES: To determine (1) the frequency of osteoporosis at the hip and lumbar spine in a postpolio clinic population and (2) the association of lower-extremity muscle strength and other potential contributing factors to osteoporosis with bone density measured at the hip.

DESIGN: Cross-sectional study involving a chart review.

SETTING: A university-affiliated hospital postpolio clinic.

PARTICIPANTS: Patient charts (N=379) were reviewed; 164 (26%) were included, and 215 (74%) were not included primarily (74%) because of the unavailability of bone density results.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Bone density (in g/cm(2)) and T score were assessed at the femoral neck and lumbar spine. Muscle strength was evaluated by manual muscle testing in 7 bilateral lower-extremity muscles.

RESULTS: The occurrence of osteoporosis at the hip and lumbar spine was 20 (32%) of 62 and 6 (10%) of 61 in men, 3 (9%) of 33 and 2 (6%) of 32 in premenopausal women, and 18 (27%) of 67 and 7 (11%) of 65 in postmenopausal women, respectively. In a logistic regression model, the presence of osteoporosis at the hip was significantly associated with strength sum score in the same extremity in which the bone density was performed after adjusting for other important risk factors (age, body mass index, time since polio).

Conclusions: Osteoporosis occurred commonly at the hip in a postpolio clinic population. Hip bone density was associated with muscle strength in the same lower extremity.

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: Falls and Bone Density

Title: Polio survivors: falls and subsequent injuries
Author: Silver JK, Aiello DD
Affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2002 Aug;81(8):567-70
Publication Year and Month: 2002 08

Abstract: OBJECTIVE: This study examines the frequency of falls in polio survivors and their resulting morbidity.

DESIGN: Two groups, fallers vs. nonfallers, were investigated in this descriptive study. A total of 233 polio survivors volunteered to complete a structured questionnaire on fall history and sequelae.

RESULTS: Of the study participants, 64% had fallen within the previous year, and 61% had falls for which they received medical attention, including 35% who had at least one fracture. There was not a correlation between age and falling, but there was a strong correlation between tripping and falling.

Conclusions: Falls with resultant injuries are a significant issue for polio survivors that warrants further study. Because tripping was predictive of falling in this sample, bracing should be considered as a treatment or preventative measure.

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


There are currently 6 papers in this category.

Category: Falls and Bone Density

Title: Circumstances and consequences of falls in polio survivors
Author: Bickerstaffe A, Beelen A, Nollet F
Affiliation: Department of Rehabilitation AMC, Amsterdam, The Netherlands
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Nov;42(10):908-15. doi: 10.2340/16501977-0620
Publication Year and Month: 2010 11

Abstract: OBJECTIVES: Many polio survivors have symptoms that are known risk factors for falls in elderly people. This study aims to determine the: (i) frequency; (ii) consequences; (iii) circumstances; and (iv) factors associated with falls in polio survivors.

METHODS: A survey was conducted among 376 polio survivors. Participants completed a falls history questionnaire and additional information was obtained from their medical files.

RESULTS: Of the 305 respondents, 74% reported at least one fall in the past year and 60% two or more. Sixteen percent of fallers described a major injury after a fall in the last year and 69% reported fear of falling. One-third of fallers had reduced the amount they walked because of their fear of falling. Most reported falls in a familiar environment (86%), during ambulation (72%) and in the afternoon (50%). Quadriceps weakness of the weakest leg (Medical Research Council (MRC) ≤ 3), fear of falling and complaints of problems maintaining balance were independently associated with both falls and recurrent falls, while increasing age and medication use were not.

Conclusions: The high rate of falls and consequences thereof, merit the implementation of fall intervention strategies. To maximize effect, they should be tailor-made and target the fall mechanisms specific to polio survivors.

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: Falls and Bone Density

Title: Fractures in an aging population of poliomyelitis survivors: a community-based study in Olmsted County, Minnesota
Author: Goerss JB, Atkinson EJ, Windebank AJ, O'Fallon WM, Melton LJ 3rd
Affiliation: Department of Medical Genetics, Mayo Clinic Rochester, Minnesota 55905
Journal: Mayo Clinic Proceedings
Citation: Mayo Clin Proc. 1994 Apr; 69(4):333-9
Publication Year and Month: 1994 04

Abstract: OBJECTIVE: To determine the incidence of fractures in a cohort of survivors of paralytic poliomyelitis (“polio”).

DESIGN: We conducted a population-based retrospective cohort study of residents of Olmsted County, Minnesota, who had an initial diagnosis of polio between 1935 and 1959 and survived the acute illness.

MATERIALS AND METHODS: A comprehensive medical records-linkage system was used to retrieve all diagnoses of poliomyelitis in residents of the county for the specified 25-year period. For the 277 study subjects, the medical records were searched for the occurrence of fracture from the time of initial diagnosis of polio until death or the most recent clinical contact. All fractures were classified on the basis of type of associated injury and skeletal site of involvement. The influence of polio on the incidence of fractures was evaluated by estimating the cumulative incidence of new fractures after the diagnosis of polio and the standardized morbidity ratio. The relative influence of various factors on the risk of fracture was determined.

RESULTS: Of the 277 Olmsted County residents with polio, 87 experienced 161 fractures, and the estimated cumulative incidence of any fracture after 40 years was 48%. The cumulative incidence of any limb fracture was 41% and was less than the expected value of 44% (P = 0.001). Only the risk of distal femoral and proximal humeral fractures was significantly higher than that among Olmsted County residents in general. The increased risk seemed to be associated with weakness and disuse of the involved limbs rather than with generalized osteoporosis. Theoretically, a greater capacity for bone remodeling in response to changes in muscle use might have protected patients with polio in childhood, but such persons were as likely to sustain a fracture as those with adult-onset poliomyelitis.

Conclusions: These data indicate that survivors of paralytic poliomyelitis do not have an unusual risk of fracture except in affected limbs.

Outcome of Research:

Availability of Paper:

Comments (if any):

Link to Paper (if available):


Category: Falls and Bone Density

Title: Osteoporosis in a postpolio clinic population
Author: Haziza M (1), Kremer R, Benedetti A, Trojan DA
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2007 Aug;88(8):1030-5
Publication Year and Month: 2007 08

Abstract: OBJECTIVES: To determine (1) the frequency of osteoporosis at the hip and lumbar spine in a postpolio clinic population and (2) the association of lower-extremity muscle strength and other potential contributing factors to osteoporosis with bone density measured at the hip.

DESIGN: Cross-sectional study involving a chart review.

SETTING: A university-affiliated hospital postpolio clinic.

PARTICIPANTS: Patient charts (N=379) were reviewed; 164 (26%) were included, and 215 (74%) were not included primarily (74%) because of the unavailability of bone density results.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Bone density (in g/cm(2)) and T score were assessed at the femoral neck and lumbar spine. Muscle strength was evaluated by manual muscle testing in 7 bilateral lower-extremity muscles.

RESULTS: The occurrence of osteoporosis at the hip and lumbar spine was 20 (32%) of 62 and 6 (10%) of 61 in men, 3 (9%) of 33 and 2 (6%) of 32 in premenopausal women, and 18 (27%) of 67 and 7 (11%) of 65 in postmenopausal women, respectively. In a logistic regression model, the presence of osteoporosis at the hip was significantly associated with strength sum score in the same extremity in which the bone density was performed after adjusting for other important risk factors (age, body mass index, time since polio).

Conclusions: Osteoporosis occurred commonly at the hip in a postpolio clinic population. Hip bone density was associated with muscle strength in the same lower extremity.

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: Falls and Bone Density

Title: Falls among adults aging with disability
Author: Matsuda PN (1), Verrall AM (2), Finlayson ML (3), Molton IR (2), Jensen MP (2)
Affiliation: (1) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: [email protected]; (2) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; (3) School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2015 Mar;96(3):464-71. doi: 10.1016/j.apmr.2014.09.034
Publication Year and Month: 2015 03

Abstract: OBJECTIVE: To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI).

DESIGN: Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not.

SETTING: Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%.

PARTICIPANTS: A convenience sample of community-dwelling individuals (N=1862; age, 18-94y) with MS, MD, PPS, or SCI in the United States.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Self-reported fall within the last 6 months.

RESULTS: Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45-64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age(2)), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups.

Conclusions: People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.

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: Falls and Bone Density

Title: High incidence of osteoporosis and fractures in an aging post-polio population
Author: Mohammad AF (1), Khan KA (1), Galvin L (2), Hardiman O (2), O’Connell PG (1)
Affiliation: Departments of (1) Rheumatology, and (2) Neurology, Beaumont Hospital, Dublin, Ireland
Journal: European Neurology
Citation: Eur Neurol. 2009 Nov; 62(6):369–374. doi:10.1159/000242444
Publication Year and Month: 2009 11

Abstract: BACKGROUND/AIMS: Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.

METHODS: Over a 6-month period, 50 post-polio patients attending outpatient clinics completed a questionnaire, and subsequently their medical records were reviewed. Demographic data and details of treatment were extracted. The patients underwent a dual-energy X-ray absorptiometry scanning to quantify bone mineral density. Results: Thirty subjects (60%) were females (26 were postmenopausal). The average age of females was 60 ± 13.4 years and of men 59 ± 16.8 years. Overall, 41 (82%) of the patients had experienced falls in the last 5 years and 32 (64%) in the last 6 months. Nineteen (38%) of the patients had experienced a bone fracture in the last 5 years. Based on the bone mineral density data, 28 (56%) of the patients were diagnosed with OP and 20 (40%) had osteopenia, but only 8 (16%) received anti-resorptive therapy. Of the 19 patients who had a fracture, 14 (74%) had OP and 5 (26%) had osteopenia, of whom only 6 (32%) received anti-resorptive therapy. Eight out of 9 fractures of the neck of femur occurred in the weaker leg.

Conclusions: Post-polio patients are a high-risk group for fracture, and thus bone density assessment, review of falls risk and therapeutic intervention should be considered for all patients. Both osteopenia and OP are associated with increased fracture risk.

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: Falls and Bone Density

Title: Polio survivors: falls and subsequent injuries
Author: Silver JK, Aiello DD
Affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2002 Aug;81(8):567-70
Publication Year and Month: 2002 08

Abstract: OBJECTIVE: This study examines the frequency of falls in polio survivors and their resulting morbidity.

DESIGN: Two groups, fallers vs. nonfallers, were investigated in this descriptive study. A total of 233 polio survivors volunteered to complete a structured questionnaire on fall history and sequelae.

RESULTS: Of the study participants, 64% had fallen within the previous year, and 61% had falls for which they received medical attention, including 35% who had at least one fracture. There was not a correlation between age and falling, but there was a strong correlation between tripping and falling.

Conclusions: Falls with resultant injuries are a significant issue for polio survivors that warrants further study. Because tripping was predictive of falling in this sample, bracing should be considered as a treatment or preventative measure.

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


There are currently 6 papers in this category.

Category: Falls and Bone Density

Title: Polio survivors: falls and subsequent injuries
Author: Silver JK, Aiello DD
Affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2002 Aug;81(8):567-70
Publication Year and Month: 2002 08

Abstract: OBJECTIVE: This study examines the frequency of falls in polio survivors and their resulting morbidity.

DESIGN: Two groups, fallers vs. nonfallers, were investigated in this descriptive study. A total of 233 polio survivors volunteered to complete a structured questionnaire on fall history and sequelae.

RESULTS: Of the study participants, 64% had fallen within the previous year, and 61% had falls for which they received medical attention, including 35% who had at least one fracture. There was not a correlation between age and falling, but there was a strong correlation between tripping and falling.

Conclusions: Falls with resultant injuries are a significant issue for polio survivors that warrants further study. Because tripping was predictive of falling in this sample, bracing should be considered as a treatment or preventative measure.

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: Falls and Bone Density

Title: Falls among adults aging with disability
Author: Matsuda PN (1), Verrall AM (2), Finlayson ML (3), Molton IR (2), Jensen MP (2)
Affiliation: (1) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: [email protected]; (2) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; (3) School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2015 Mar;96(3):464-71. doi: 10.1016/j.apmr.2014.09.034
Publication Year and Month: 2015 03

Abstract: OBJECTIVE: To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI).

DESIGN: Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not.

SETTING: Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%.

PARTICIPANTS: A convenience sample of community-dwelling individuals (N=1862; age, 18-94y) with MS, MD, PPS, or SCI in the United States.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Self-reported fall within the last 6 months.

RESULTS: Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45-64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age(2)), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups.

Conclusions: People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.

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: Falls and Bone Density

Title: Osteoporosis in a postpolio clinic population
Author: Haziza M (1), Kremer R, Benedetti A, Trojan DA
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2007 Aug;88(8):1030-5
Publication Year and Month: 2007 08

Abstract: OBJECTIVES: To determine (1) the frequency of osteoporosis at the hip and lumbar spine in a postpolio clinic population and (2) the association of lower-extremity muscle strength and other potential contributing factors to osteoporosis with bone density measured at the hip.

DESIGN: Cross-sectional study involving a chart review.

SETTING: A university-affiliated hospital postpolio clinic.

PARTICIPANTS: Patient charts (N=379) were reviewed; 164 (26%) were included, and 215 (74%) were not included primarily (74%) because of the unavailability of bone density results.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Bone density (in g/cm(2)) and T score were assessed at the femoral neck and lumbar spine. Muscle strength was evaluated by manual muscle testing in 7 bilateral lower-extremity muscles.

RESULTS: The occurrence of osteoporosis at the hip and lumbar spine was 20 (32%) of 62 and 6 (10%) of 61 in men, 3 (9%) of 33 and 2 (6%) of 32 in premenopausal women, and 18 (27%) of 67 and 7 (11%) of 65 in postmenopausal women, respectively. In a logistic regression model, the presence of osteoporosis at the hip was significantly associated with strength sum score in the same extremity in which the bone density was performed after adjusting for other important risk factors (age, body mass index, time since polio).

Conclusions: Osteoporosis occurred commonly at the hip in a postpolio clinic population. Hip bone density was associated with muscle strength in the same lower extremity.

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: Falls and Bone Density

Title: High incidence of osteoporosis and fractures in an aging post-polio population
Author: Mohammad AF (1), Khan KA (1), Galvin L (2), Hardiman O (2), O’Connell PG (1)
Affiliation: Departments of (1) Rheumatology, and (2) Neurology, Beaumont Hospital, Dublin, Ireland
Journal: European Neurology
Citation: Eur Neurol. 2009 Nov; 62(6):369–374. doi:10.1159/000242444
Publication Year and Month: 2009 11

Abstract: BACKGROUND/AIMS: Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.

METHODS: Over a 6-month period, 50 post-polio patients attending outpatient clinics completed a questionnaire, and subsequently their medical records were reviewed. Demographic data and details of treatment were extracted. The patients underwent a dual-energy X-ray absorptiometry scanning to quantify bone mineral density. Results: Thirty subjects (60%) were females (26 were postmenopausal). The average age of females was 60 ± 13.4 years and of men 59 ± 16.8 years. Overall, 41 (82%) of the patients had experienced falls in the last 5 years and 32 (64%) in the last 6 months. Nineteen (38%) of the patients had experienced a bone fracture in the last 5 years. Based on the bone mineral density data, 28 (56%) of the patients were diagnosed with OP and 20 (40%) had osteopenia, but only 8 (16%) received anti-resorptive therapy. Of the 19 patients who had a fracture, 14 (74%) had OP and 5 (26%) had osteopenia, of whom only 6 (32%) received anti-resorptive therapy. Eight out of 9 fractures of the neck of femur occurred in the weaker leg.

Conclusions: Post-polio patients are a high-risk group for fracture, and thus bone density assessment, review of falls risk and therapeutic intervention should be considered for all patients. Both osteopenia and OP are associated with increased fracture risk.

Outcome of Research: Not applicable

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Category: Falls and Bone Density

Title: Circumstances and consequences of falls in polio survivors
Author: Bickerstaffe A, Beelen A, Nollet F
Affiliation: Department of Rehabilitation AMC, Amsterdam, The Netherlands
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Nov;42(10):908-15. doi: 10.2340/16501977-0620
Publication Year and Month: 2010 11

Abstract: OBJECTIVES: Many polio survivors have symptoms that are known risk factors for falls in elderly people. This study aims to determine the: (i) frequency; (ii) consequences; (iii) circumstances; and (iv) factors associated with falls in polio survivors.

METHODS: A survey was conducted among 376 polio survivors. Participants completed a falls history questionnaire and additional information was obtained from their medical files.

RESULTS: Of the 305 respondents, 74% reported at least one fall in the past year and 60% two or more. Sixteen percent of fallers described a major injury after a fall in the last year and 69% reported fear of falling. One-third of fallers had reduced the amount they walked because of their fear of falling. Most reported falls in a familiar environment (86%), during ambulation (72%) and in the afternoon (50%). Quadriceps weakness of the weakest leg (Medical Research Council (MRC) ≤ 3), fear of falling and complaints of problems maintaining balance were independently associated with both falls and recurrent falls, while increasing age and medication use were not.

Conclusions: The high rate of falls and consequences thereof, merit the implementation of fall intervention strategies. To maximize effect, they should be tailor-made and target the fall mechanisms specific to polio survivors.

Outcome of Research: Not applicable

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Category: Falls and Bone Density

Title: Fractures in an aging population of poliomyelitis survivors: a community-based study in Olmsted County, Minnesota
Author: Goerss JB, Atkinson EJ, Windebank AJ, O'Fallon WM, Melton LJ 3rd
Affiliation: Department of Medical Genetics, Mayo Clinic Rochester, Minnesota 55905
Journal: Mayo Clinic Proceedings
Citation: Mayo Clin Proc. 1994 Apr; 69(4):333-9
Publication Year and Month: 1994 04

Abstract: OBJECTIVE: To determine the incidence of fractures in a cohort of survivors of paralytic poliomyelitis (“polio”).

DESIGN: We conducted a population-based retrospective cohort study of residents of Olmsted County, Minnesota, who had an initial diagnosis of polio between 1935 and 1959 and survived the acute illness.

MATERIALS AND METHODS: A comprehensive medical records-linkage system was used to retrieve all diagnoses of poliomyelitis in residents of the county for the specified 25-year period. For the 277 study subjects, the medical records were searched for the occurrence of fracture from the time of initial diagnosis of polio until death or the most recent clinical contact. All fractures were classified on the basis of type of associated injury and skeletal site of involvement. The influence of polio on the incidence of fractures was evaluated by estimating the cumulative incidence of new fractures after the diagnosis of polio and the standardized morbidity ratio. The relative influence of various factors on the risk of fracture was determined.

RESULTS: Of the 277 Olmsted County residents with polio, 87 experienced 161 fractures, and the estimated cumulative incidence of any fracture after 40 years was 48%. The cumulative incidence of any limb fracture was 41% and was less than the expected value of 44% (P = 0.001). Only the risk of distal femoral and proximal humeral fractures was significantly higher than that among Olmsted County residents in general. The increased risk seemed to be associated with weakness and disuse of the involved limbs rather than with generalized osteoporosis. Theoretically, a greater capacity for bone remodeling in response to changes in muscle use might have protected patients with polio in childhood, but such persons were as likely to sustain a fracture as those with adult-onset poliomyelitis.

Conclusions: These data indicate that survivors of paralytic poliomyelitis do not have an unusual risk of fracture except in affected limbs.

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There are currently 6 papers in this category.

Category: Falls and Bone Density

Title: Falls among adults aging with disability
Author: Matsuda PN (1), Verrall AM (2), Finlayson ML (3), Molton IR (2), Jensen MP (2)
Affiliation: (1) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: [email protected]; (2) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; (3) School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2015 Mar;96(3):464-71. doi: 10.1016/j.apmr.2014.09.034
Publication Year and Month: 2015 03

Abstract: OBJECTIVE: To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI).

DESIGN: Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not.

SETTING: Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%.

PARTICIPANTS: A convenience sample of community-dwelling individuals (N=1862; age, 18-94y) with MS, MD, PPS, or SCI in the United States.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Self-reported fall within the last 6 months.

RESULTS: Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45-64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age(2)), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups.

Conclusions: People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.

Outcome of Research: Not applicable

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Category: Falls and Bone Density

Title: Circumstances and consequences of falls in polio survivors
Author: Bickerstaffe A, Beelen A, Nollet F
Affiliation: Department of Rehabilitation AMC, Amsterdam, The Netherlands
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Nov;42(10):908-15. doi: 10.2340/16501977-0620
Publication Year and Month: 2010 11

Abstract: OBJECTIVES: Many polio survivors have symptoms that are known risk factors for falls in elderly people. This study aims to determine the: (i) frequency; (ii) consequences; (iii) circumstances; and (iv) factors associated with falls in polio survivors.

METHODS: A survey was conducted among 376 polio survivors. Participants completed a falls history questionnaire and additional information was obtained from their medical files.

RESULTS: Of the 305 respondents, 74% reported at least one fall in the past year and 60% two or more. Sixteen percent of fallers described a major injury after a fall in the last year and 69% reported fear of falling. One-third of fallers had reduced the amount they walked because of their fear of falling. Most reported falls in a familiar environment (86%), during ambulation (72%) and in the afternoon (50%). Quadriceps weakness of the weakest leg (Medical Research Council (MRC) ≤ 3), fear of falling and complaints of problems maintaining balance were independently associated with both falls and recurrent falls, while increasing age and medication use were not.

Conclusions: The high rate of falls and consequences thereof, merit the implementation of fall intervention strategies. To maximize effect, they should be tailor-made and target the fall mechanisms specific to polio survivors.

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: Falls and Bone Density

Title: High incidence of osteoporosis and fractures in an aging post-polio population
Author: Mohammad AF (1), Khan KA (1), Galvin L (2), Hardiman O (2), O’Connell PG (1)
Affiliation: Departments of (1) Rheumatology, and (2) Neurology, Beaumont Hospital, Dublin, Ireland
Journal: European Neurology
Citation: Eur Neurol. 2009 Nov; 62(6):369–374. doi:10.1159/000242444
Publication Year and Month: 2009 11

Abstract: BACKGROUND/AIMS: Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.

METHODS: Over a 6-month period, 50 post-polio patients attending outpatient clinics completed a questionnaire, and subsequently their medical records were reviewed. Demographic data and details of treatment were extracted. The patients underwent a dual-energy X-ray absorptiometry scanning to quantify bone mineral density. Results: Thirty subjects (60%) were females (26 were postmenopausal). The average age of females was 60 ± 13.4 years and of men 59 ± 16.8 years. Overall, 41 (82%) of the patients had experienced falls in the last 5 years and 32 (64%) in the last 6 months. Nineteen (38%) of the patients had experienced a bone fracture in the last 5 years. Based on the bone mineral density data, 28 (56%) of the patients were diagnosed with OP and 20 (40%) had osteopenia, but only 8 (16%) received anti-resorptive therapy. Of the 19 patients who had a fracture, 14 (74%) had OP and 5 (26%) had osteopenia, of whom only 6 (32%) received anti-resorptive therapy. Eight out of 9 fractures of the neck of femur occurred in the weaker leg.

Conclusions: Post-polio patients are a high-risk group for fracture, and thus bone density assessment, review of falls risk and therapeutic intervention should be considered for all patients. Both osteopenia and OP are associated with increased fracture risk.

Outcome of Research: Not applicable

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Category: Falls and Bone Density

Title: Osteoporosis in a postpolio clinic population
Author: Haziza M (1), Kremer R, Benedetti A, Trojan DA
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2007 Aug;88(8):1030-5
Publication Year and Month: 2007 08

Abstract: OBJECTIVES: To determine (1) the frequency of osteoporosis at the hip and lumbar spine in a postpolio clinic population and (2) the association of lower-extremity muscle strength and other potential contributing factors to osteoporosis with bone density measured at the hip.

DESIGN: Cross-sectional study involving a chart review.

SETTING: A university-affiliated hospital postpolio clinic.

PARTICIPANTS: Patient charts (N=379) were reviewed; 164 (26%) were included, and 215 (74%) were not included primarily (74%) because of the unavailability of bone density results.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Bone density (in g/cm(2)) and T score were assessed at the femoral neck and lumbar spine. Muscle strength was evaluated by manual muscle testing in 7 bilateral lower-extremity muscles.

RESULTS: The occurrence of osteoporosis at the hip and lumbar spine was 20 (32%) of 62 and 6 (10%) of 61 in men, 3 (9%) of 33 and 2 (6%) of 32 in premenopausal women, and 18 (27%) of 67 and 7 (11%) of 65 in postmenopausal women, respectively. In a logistic regression model, the presence of osteoporosis at the hip was significantly associated with strength sum score in the same extremity in which the bone density was performed after adjusting for other important risk factors (age, body mass index, time since polio).

Conclusions: Osteoporosis occurred commonly at the hip in a postpolio clinic population. Hip bone density was associated with muscle strength in the same lower extremity.

Outcome of Research: Not applicable

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Category: Falls and Bone Density

Title: Polio survivors: falls and subsequent injuries
Author: Silver JK, Aiello DD
Affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2002 Aug;81(8):567-70
Publication Year and Month: 2002 08

Abstract: OBJECTIVE: This study examines the frequency of falls in polio survivors and their resulting morbidity.

DESIGN: Two groups, fallers vs. nonfallers, were investigated in this descriptive study. A total of 233 polio survivors volunteered to complete a structured questionnaire on fall history and sequelae.

RESULTS: Of the study participants, 64% had fallen within the previous year, and 61% had falls for which they received medical attention, including 35% who had at least one fracture. There was not a correlation between age and falling, but there was a strong correlation between tripping and falling.

Conclusions: Falls with resultant injuries are a significant issue for polio survivors that warrants further study. Because tripping was predictive of falling in this sample, bracing should be considered as a treatment or preventative measure.

Outcome of Research: Not applicable

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Category: Falls and Bone Density

Title: Fractures in an aging population of poliomyelitis survivors: a community-based study in Olmsted County, Minnesota
Author: Goerss JB, Atkinson EJ, Windebank AJ, O'Fallon WM, Melton LJ 3rd
Affiliation: Department of Medical Genetics, Mayo Clinic Rochester, Minnesota 55905
Journal: Mayo Clinic Proceedings
Citation: Mayo Clin Proc. 1994 Apr; 69(4):333-9
Publication Year and Month: 1994 04

Abstract: OBJECTIVE: To determine the incidence of fractures in a cohort of survivors of paralytic poliomyelitis (“polio”).

DESIGN: We conducted a population-based retrospective cohort study of residents of Olmsted County, Minnesota, who had an initial diagnosis of polio between 1935 and 1959 and survived the acute illness.

MATERIALS AND METHODS: A comprehensive medical records-linkage system was used to retrieve all diagnoses of poliomyelitis in residents of the county for the specified 25-year period. For the 277 study subjects, the medical records were searched for the occurrence of fracture from the time of initial diagnosis of polio until death or the most recent clinical contact. All fractures were classified on the basis of type of associated injury and skeletal site of involvement. The influence of polio on the incidence of fractures was evaluated by estimating the cumulative incidence of new fractures after the diagnosis of polio and the standardized morbidity ratio. The relative influence of various factors on the risk of fracture was determined.

RESULTS: Of the 277 Olmsted County residents with polio, 87 experienced 161 fractures, and the estimated cumulative incidence of any fracture after 40 years was 48%. The cumulative incidence of any limb fracture was 41% and was less than the expected value of 44% (P = 0.001). Only the risk of distal femoral and proximal humeral fractures was significantly higher than that among Olmsted County residents in general. The increased risk seemed to be associated with weakness and disuse of the involved limbs rather than with generalized osteoporosis. Theoretically, a greater capacity for bone remodeling in response to changes in muscle use might have protected patients with polio in childhood, but such persons were as likely to sustain a fracture as those with adult-onset poliomyelitis.

Conclusions: These data indicate that survivors of paralytic poliomyelitis do not have an unusual risk of fracture except in affected limbs.

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There are currently 6 papers in this category.

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