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

BACKGROUND: There are numbers of persons living in the community with late effects of polio, of which many develop new symptoms, but the course of progression is unclear. OBJECTIVES: To assess changes after 4 years in ability and perceived difficulty in persons with late effects of polio. MATERIAL AND METHODS: Community dwelling persons from a polio clinic. Information was gathered by questionnaire and interview on demographics, age at polio onset, affected body parts, health problems, the use of assistive devices, housing condition and activities of daily living (ADL) function as well as perceived difficulties. RESULTS: There were no significant increase in frequency of ADL dependency but perceived difficulties increased significantly and more used mobility devices. CONCLUSIONS: Over 4 years, more persons perceived difficulties and the use of assistive devices increased. This is might reflect adaptation and acknowledgement of problems previously ignored. Time is a factor in integrating knowledge and adaptation.

Lyme borreliosis in Sweden--diagnostic performance of five commercial Borrelia serology kits using sera from well-defined patient groups.

Five commercial Borrelia serology kits available in Sweden were evaluated and compared for their diagnostic performance in sera from clinically well-characterized patient groups. With the clinically defined groups as the gold standard, i.e. without knowledge of antibody status in serum and cerebrospinal fluid, the diagnostic performance of the kits was compared and important differences in diagnostic usefulness were found. The kits from Abbot and DAKO, that often predict clinically relevant Borrelia infection and do not detect antibodies in sera from patients without strong suspicion of Borrelia infection, were considered the most useful in the population studied. This kind of validation study is an important part of good laboratory practice and should be performed by laboratories serving patient populations with varying endemicity of Borrelia.

Distress in everyday life in people with poliomyelitis sequelae.

The prevalence of distress in aspects of perceived health and its relation to involvement of poliomyelitis sequelae were studied with the Nottingham Health Profile (NHP) in 113 outpatients (mean age 57 years). The leisure and employment situation was also recorded. Most distress was found in the NHP dimensions physical mobility, pain and energy, and least distress in social isolation. Most health-related problems were reported in housework, employment and leisure. Three-quarters of the persons were satisfied with their leisure, although many of them had problems. Fifty-nine per cent of the subjects of working age were in gainful employment, and no difference in employment rate due to the distribution of polio involvement was found. In comparison with norm values for the respective age groups, the subjects with poliomyelitis sequelae aged below 45 and 45-65 years had more distress in a larger number of NHP dimensions than older subjects.

Ability and perceived difficulty in daily activities in people with poliomyelitis sequelae.

Polio involvement and its relation to ability in terms of independence and perceived difficulty in activities in daily living (ADL) were studied in outpatients (median age 57 years) with poliomyelitis sequelae (n = 133). The use and need of assistive devices and housing conditions were recorded. The subjects had a high degree of independence in personal ADL, whereas more than 50% were dependent on cleaning, shopping and transportation. A considerable number of subjects independent in ADL reported difficulties in daily activities. The majority of interventions in the form of housing adaptation and assistive devices were provided for persons severely weakened by polio. Ratings of perceived difficulty indicated need of interventions to prevent overload and increased dependence in ADL. However, about half of the recommended mobility assistive devices were rejected. The results indicate that polio subjects try to maintain their independence despite perceived difficulties and may be reluctant to use assistive devices.

Coming to terms with the shift in one's capabilities: a study of the adaptive process in persons with poliomyelitis sequelae.

PURPOSE: The main purpose of this paper was to investigate the process of adaptation in persons with poliomyelitis sequelae with reference to daily occupations. In addition, changes in ability in activities in daily living (ADL) and in the use of assistive devices over a 4-5 year period will be described. METHOD: Qualitative interviews with 22 persons with poliomyelitis sequelae were content analysed according to grounded theory. Ability in personal and instrumental ADL was assessed. RESULTS: The core category 'coming to a changed approach' towards the shift in one's capabilities describes two integrated processes: one deals with the process of realization and reorganization; the other consists of six patterns of behaviour in daily occupations. The persons had a high degree of independence in personal ADL, whereas the dependence in cleaning, shopping and transportation was extensive. CONCLUSIONS: Flexibility in choosing strategies facilitated participation in daily occupations. Requirements for this adaptive pattern were time, energy and ability to solve problems, accessible environments, access to information and support, and readiness to compensate with assistive devices.

Managing occupations in everyday life to achieve adaptation.

OBJECTIVE: The aim of this qualitative study was to gain a deeper understanding of how persons with poliomyelitis sequelae manage their daily occupations in order to adapt to environmental demands. This was a study of adaptive processes and capability in everyday life. METHOD: Interviews with 22 persons with poliomyelitis sequelae were content analyzed according to grounded theory. RESULTS: The analysis yielded 18 concepts describing adaptive strategies of participants. The strategies were arranged in six general groups: utilizing physical capability, influencing emotions, altering pattern of occupations, promoting concrete problem-solving, influencing relations, and facilitating future activities. CONCLUSION: The strategies were interwoven, revealing different ways of reaching an adaptive balance in daily occupations for the present and the future.

Disability in poliomyelitis sequelae.

Patients who have been affected by poliomyelitis may develop new symptoms such as muscle weakness, muscle atrophy, muscle or joint pain, and unexplained fatigue several decades after the onset of their poliomyelitis (post-polio syndrome [PPS]). We report on the results of our study of 59 patients with poliomyelitis using a number of instruments for disability assessment, including a 4- to 5-year follow-up. The main impact of disability for most patients is in mobility-related activities. Dependence in personal activities of daily living is fairly rare, whereas dependence and difficulties in instrumental activities of daily living (eg, cooking, transportation, cleaning, shopping) are more common and also more severe in persons with PPS. Mental health, emotional reactions and social activity, interaction, and isolation are usually less affected, although considerable coping problems may occur, especially in persons with PPS who have new health problems and increasing disabilities. Examples of disabilities, intervention measures, and coping processes are given with case reports. The importance of a broad and interdisciplinary approach is emphasized, in which impairment as well as disability aspects should be considered in treatment and intervention programs.