Journal of Rehabilitation Medicine 51-11 | Page 49

Polio and post-polio syndrome in non-Western immigrants to Norway
Resilience. The Resilience Scale for Adults (RSA) is a self-re-
port scale designed to measure factors associated with resilience
in 3 resource domains; dispositional, social and external (21).
RSA consists of 33 items grouped into 5 factors: 1) Personal
strength contains 2 primary factors: 1A. Perception of self,
and 1B. Perception of future; 2) Social competence; 3) Family
cohesion; 4) Social resources; and 5) Structured style. Each
item was scored on a 5-point semantic scale, the total score
ranging from 33 to 165. RSA has been tested in both Western
and non-Western populations and shows stability in different
cultural contexts (22).
Pain. The respondents estimated mean pain over the previous
week on a visual analogue scale, ranging from 0=no pain to
10 = unbearable pain.
Fatigue. The Fatigue Severity Scale (FSS) includes 9 statements
assessing perceived fatigue. Each statement was rated on a scale
from 1=”strong disagreement” to 7 = ”strong agreement”. The
individual score is the mean of all numerical responses, i.e. a
maximum score of 7. Severe fatigue was defined as scores > 5,
and moderate fatigue scores 4.0–4.9 (23).
Body mass index. BMI is calculated as weight (in kg)/(height
(in m)) 2 . Normal body weight was defined in the range 19–25
kg/m 2 in persons age < 70 years, while in persons > 70 years
the normal range was 22–24 kg/m 2 (lower limit) and 27–29 kg/
m 2 (upper limit) (24).
RESULTS
The results are generally presented as descriptive statistics,
analysed using IBM SPSS Statistics version 25 (IBM, Armonk,
New York, USA). Differences between the 3 polio groups were
tested with Pearson’s χ 2 tests for nominal data and with 1-way
analysis of variance to compare the means for interval data. The
chosen level of significance was p < 0.05. No adjustments were
made for multiple comparisons.
Statistical analysis
The findings from the immigrant polio groups and the
native Norwegian polio group are shown in Tables
II–V. We have mainly compared the findings with
863
those from our survey on health and social conditions
in Norwegian polio survivors from 2016 (15), but
some variables were also compared with the general
immigrant population from non-Western countries to
Norway (19, 20).
The non-Western polio group was significantly
younger than the 2 other polio groups, with a mean
age of 46 years (range 18–61 years). The mean age of
the Western immigrant group was similar to that of
the native Norwegian group, i.e. 71 years. The male/
female ratio was the same in all groups, with twice as
many women as men. The non-Western immigrant
group was significantly more highly educated; 43%
reported more than 12 years of education, compared
with 33% in the Western immigrant group and 26%
in the native Norwegian group. Thirty-one percent of
the non-Western immigrants were working full-time
or part-time. The majority (60–70%) of people in the
other 2 groups were retired. A high percentage (41%)
of subjects in the non-Western immigrant group recei-
ved disability pension, and 33% had an annual gross
income of < 50% of the mean household income in
Norway (Table II).
In the non-Western immigrant group, the mean age
for contracting polio was 2.8 years (range 0–11 years),
with no significant sex difference, compared with 5.1
years in the Western immigrant group and 6.2 years in
the native Norwegian group. Only 30% of subjects in
the non-Western immigrant group were hospitalized
in the acute phase, compared with 60% and 62% in
the Western immigrant and native Norwegian groups
(p = 0.002) (Table III). Furthermore, 71% of subjects in
the non-Western group reported no hospitalization in
the rehabilitation phase, and 80% reported no surgical
or corrective operations due to their polio.
The main localization of chronic polio paresis in
all groups was the lower limbs, resulting in moderate
Table II. Demographic characteristics, length of education and employment status of subjects with late effects of polio
Non-Western immigrant Western immigrant Native Norwegian
polio group (n  = 34)
polio group (n  = 32) polio group (n  = 1,342) p-value
Sex, % 36/65 28/72 31/66 n.s
male/female (n  = 31/32/1,307)
Age, years (n  = 32/32/1,309), mean (SD)
Education (n  = 30/30/1,240), %
1–9 years
10–12 years
> 12 years
Employment (n  = 29/31/1,173), %
Work, full-time
Work, part-time
Disability pension
Retirement
Other
Married/cohabitant (n  = 32/31/1,299), % 11/20
45.7 (10.7) 11/21
71.5 (8.4) 416/891
70.8 (7.8) 0.000
10.0
46.7
43.3 6.7
60.0
33.3 21.9
52.6
25.5 0.040
0.582
0.058
17.2
13.8
41.4
0
27.4
78.1 0
3.2
12.9
71.0
13.0
74.2 5.2
3.5
27.3
60.8
3.2
65.1 0.007
0.015
0.046
0.000
0.000
0.309
10.3 0.001
Annual income less than 50% of mean a,b (n  = 30/29/1,312), %
33.3
10.3
a
b
SD: standard deviation. Numbers of respondents (n) are given for each variable. Unknown=missing data. Total gross household income in relation to income
and wealth statistics for households; Statistics Norway 2014 (37).
J Rehabil Med 51, 2019