[The Dutch poliomyelitis epidemic 1992/'93; invalidity and rehabilitation].

OBJECTIVE

To describe epidemiologic characteristics and neurological and functional recovery of the victims of the 1992/'93 Dutch poliomyelitis epidemic compared to the 1971 and 1978 epidemics.

DESIGN

Descriptive research.

SETTING

Rehabilitation Centre 'De Hoogstraat', Utrecht, The Netherlands.

METHODS

Two written questionnaires were sent out: one to the doctors attending the 71 registered patients five months after the end of the epidemic, the second 30 months after the end of the epidemic to the doctors of the patients with initial neurological impairments. Once every three months, muscular strength (MRC criteria), activities of daily life (ADL; using the Functional Independence Measure) and mobility (according to Hoffer) were assessed for 13 adult patients with moderately severe and severe disabilities.

RESULTS

The questionnaire response was 100%. The median age increased from 5-9 years in 1971 to 10-14 years in 1978 to 20 years old in 1992/'93. Due to the 1992/'93 epidemic adults ( > or = 20 years) had more moderately severe and severe sequelae than people below 20 years of age (p < 0.00I). In the 1978 epidemic these differences were not significant. Muscular strength improved until 30 months after the onset of the disease although no improvement was seen in 10/13 patients after 18 months. The ability to cope independently with the ADL improved until 18 months; ten patients became almost independent. Mobility improved until 12 months. Three patients remained wheelchair bound, 1 became an exercise walker, 5 household walkers and 4 community walkers.

CONCLUSION

Poliomyelitis is no longer a paediatric disease in the Netherlands. In future epidemics it should be borne in mind that most disablement probably will occur among adults. After an attack of acute poliomyelitis, muscular strength can continue to improve for up to two and a half years, while ADL usually remain stable after one and a half years and mobility after one year.