Review article
The Course of Functional Status and Muscle Strength in Patients With Late-Onset Sequelae of Poliomyelitis: A Systematic Review

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Abstract

Stolwijk-Swüste JM, Beelen A, Lankhorst GJ, Nollet F, for the CARPA Study Group. The course of functional status and muscle strength in patients with late-onset sequelae of poliomyelitis: a systematic review.

Objectives

To review systematically studies of late-onset polio sequelae on the course of functional status and muscle strength over time and to identify prognostic factors of change.

Data Sources

We conducted a computerized literature search up to July 2004 in MEDLINE, EMBASE, CINAHL, Web of Science, PsychInfo, and the Cochrane controlled trial register using the key words: postpolio, postpoliomyelitis, postpoliomyelitis syndrome, post poliomyelitis muscular atrophy, and poliomyelitis.

Study Selection

Reports were selected by 1 reviewer if the study involved subjects with a history of poliomyelitis, the outcome measures described functional status or muscle strength, and follow-up was for at least 6 months.

Data Extraction

Studies were summarized with regard to population, design, sample size, outcome measures, results, and methodologic scores. Overlap in populations between studies was checked.

Data Synthesis

Of 71 potentially relevant studies, 19 were included (2 on functional status, 15 on muscle strength, 2 on both muscle strength and functional status). Two studies on the course of functional status had sufficient quality and reported inconsistent results. Four studies on the course of muscle strength had sufficient quality. Two studies reported a decline in strength and 2 reported no change. Decline in strength was only reported in studies with a follow-up period longer than 2 years. One study reported extent of paresis as a prognostic factor for change in perceived physical mobility.

Conclusions

Conclusions cannot be drawn from the literature with regard to the functional course or prognostic factors in late-onset polio sequelae. The rate of decline in muscle strength is slow, and prognostic factors have not yet been identified. Long-term follow-up studies with unselected study populations and age-matched controls are needed, with specific focus on prognostic factors.

Section snippets

Searching

A literature search up to July 2004 was conducted in the computerized bibliographic databases MEDLINE (1966– 2004), EMBASE (1974–2004), CINAHL (1982–2004), Web of Science (1988–2004), PsychInfo (1887–2004), and the Cochrane controlled trial register (2004, issue 1). The following key words were used: postpolio, postpoliomyelitis, postpoliomyelitis syndrome, post poliomyelitis muscular atrophy, and poliomyelitis. References from retrieved articles were also screened (citation tracking).

Selection

A study

Results

Of the 71 potentially relevant studies identified through the search, 19 met the inclusion criteria: 2 articles reported on the course of functional status,18, 19 15 on the course of muscle strength,2, 3, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 and 2 on both functional status and muscle strength.33, 34 One article on the course of muscle strength used 2 different study populations that were scored separately with regard to methodologic quality.20

Functional Status

Because of the limited number of studies on the course of functional status that were of sufficient or high quality (2 studies18, 34), and the heterogeneity of these studies with respect to the outcome measures used, it was not possible to analyze quantitatively changes in functional status over time. Even within these 2 studies, further limitations must be considered. Nollet34 selected a study population by including patients with PPS and excluding comorbidity, whereas Windebank18 studied an

Conclusions

Due to the limited number of studies included in this review and their heterogeneity, it was not possible to draw a conclusion about the functional course of people with late-onset sequelae of poliomyelitis or the prognostic factors. Muscle strength deteriorates slowly over the years, and this was only reported in studies with a follow-up of at least 4 years. Because prognostic factors for change were not identified, and aging and comorbidity may be assumed to aggravate the course of functional

Acknowledgments

Participants in the CARPA study group include: Janneke M. Stolwijk-Swüste, Anita Beelen, Frans Nollet, Gustaaf J. Lankhorst, Joost Dekker, Gaby M. van Dijk, Els H. van den Ende, Bart Post, Maruschka Merkus, and Hans Speelman.

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