CORRELATION OF FUNCTIONAL CAPACITY WITH PAIN, PHYSICAL AND PSYCHOLOGICAL FUNCTION IN SUBJECTS WITH POST-POLIO SYNDROME, GUJARAT, INDIA

S. Sharma¹, M. Sheth²

Background: In the past few years, many polio survivors have experienced late-onset neuromuscular symptoms and decreased functional abilities. Post-polio syndrome (PPS) refers to a clinical disorder affecting polio survivors with sequel years after the initial polio attack. They report new musculoskeletal symptoms like fatigue, pain, new and unusual muscular deficits, on healthy as well as deficient muscles initially affected by the poliovirus. Although these have been identified as common problems in individuals with PPS, less research has examined the role that these symptoms might exert in their physical or psychological function. In India, research on PPS is scarce. Prevalence of PPS among polio survivors in Gujarat was found to be 86%, commonest problems being difficulty in walking, joint and muscle pain, muscle weakness and fatigue.

Purpose: To determine the correlation of functional capacity with pain, and physical and psychological function in subjects with PPS.

Methods: A cross sectional survey was conducted in Gujarat, India using convenience sampling. Eighty individuals having PPS according to Halstead criteria-Self-reported history of prior poliomyelitis, period of neurological stability usually 15 years or more preceding the onset of new weakness, gradual or abrupt onset of new weakness or abnormal muscle fatigability with or without generalized fatigue, muscle atrophy and pain, aged between 18-65 years, having locomotor ability were included. People using psychotrophic drugs, having respiratory/cardiac problems or cognitive impairments were excluded.Outcome measures used were 2 minute walk distance for functional capacity(FC), Numeric pain rating scale(NPRS) for pain, PROMIS for physical function(PF) and PHQ-9 for psychological function.

Results: Mean scores of functional capacity was 87.51 meters(SD:14.03, 95%CI:58-115) of pain was 4.54(SD:1.29, 95%CI:2-7) of physical function was 44.33(SD:3.1, 95% CI:36.00-51.00) and of psychological function was 8.04 (SD: 2.04, 95% CI:4-12). Correlation using Spearman correlation between FC and pain r=-0.60, p=0.01, FC and PROMIS r=0.33, p=0.003, FC and PHQ-9 r = -0.20,p= 0.09.

Conclusion(s): Functional capacity in PPS strongly correlates with pain, weakly correlates with physical function, and does not correlate with psychological function.

Implications: These findings raise concern about health aspects of people with PPS. Significant correlation between these variables points to an obvious need for targeted rehabilitation.Functional capacity, which holds significant correlation with pain, implies that managing pain, could lead to enhanced functional capacity.Therefore, future studies are warranted to determine the effect of employing interventions in these variables. This study concluded that the condition PPS has a dramatic impact on the physical function and hence, these findings can be applicable into public domain across India. PPS, compounded with aging and other health conditions persists to be a daily struggle in terms of definitive therapies, and also the quality of life of such individuals keeps declining each day. Given the magnitude of their afflictions,those living with this catastrophic illness, thought to be a dormant one previously,can be better addressed. Particularly with myriad of obstacles already standing in the way of polio survivors, much can be delivered with strengthening evidence on people living with the effects of polio, day in and day out in spite of its major eradication.

Funding, acknowledgements: None

Keywords: Post-polio syndrome, functional capacity, function

Topic: Neurology

Did this work require ethics approval? Yes

Institution: C M Patel college of Physiotherapy

Committee: Institutional Ethics Committee - C M Patel college of Physiotherapy

Ethics number: (IEC-CMPP/01/2017-18)