Journal of Rehabilitation Medicine 51-11 | Page 53

Study limitations
acute and early rehabilitation phase could lead to in-
creased need for assistance and healthcare later in life.
Increased independence was a main aim for the early
rehabilitation of the native Norwegian polio group.
This probably influenced the answers from this group.
Polio and post-polio syndrome in non-Western immigrants to Norway
The current study was based on a sample of only 66
polio-injured persons from a wide range of countries.
Questions were based on a postal questionnaire and
self-report only, and were not adapted to immigrants.
Questionnaire-based studies might be susceptible to
under-reporting due to social desirability effects. How­
ever, the survey was anonymous, reducing this risk.
Comprehension of written Norwegian was required
to answer the detailed questionnaire; therefore, the
study population was probably biased toward highly
educated immigrants, excluding immigrants with the
most challenging social and economic situation. It is
not known if some participats had help completing
the questionnaire. However, the non-Western immi-
grant group reported a much higher level of medical,
psychological and social challenges than the Western
immigrant and native Norwegian polio groups, illustra-
ting the need for special attention for the non-Western
immigrant group.
The mean age of the non-Western polio group was
25 years younger than the Western immigrant and na-
tive Norwegian groups, and some of the findings were
probably affected by the age difference. There are some
reservations regarding our conclusions, due to both the
age difference and the small sample size. However,
in a study of a general immigrant population, it was
shown that the health differences between immigrants
and the total population could not be explained by the
immigrants being younger (20). We therefore consider
it justified to compare our 2 groups without adjusting
for age. An advantage of the current study is that the
immigrant results were compared with those for a
large group of Norwegian polio survivors. We there-
fore believe that our cautious conclusions are justified.
Conclusion
The group of non-Western immigrants to Norway with
polio studied here reported more health and social
problems than did the native Norwegian polio group
and the Western immigrant polio group, even though
they were younger and more highly educated. Their
complex psychological and social situation is relevant
and requires active intervention from the public health
system. Health professionals need extra skills to handle
the complex situation of this group of patients.
867
REFERENCES
1. Nathanson N, Kew OM. From emergence to eradication:
the epidemiology of poliomyelitis deconstructed. Am J
Epidemiol 2010; 172: 1213–1229.
2. Bodian D, Morgan IM, Howe HA. Differentiation of types of
poliomyelitis viruses; the grouping of 14 strains into three
basic immunological types. Am J Hyg 1949; 49: 234–245.
3. John TJ. Polio vaccine strategies for the end game. Lancet
2000; 356: 1682–1683.
4. Trevelyan B, Smallman-Raynor M, Cliff AD. The spatial
dynamics of poliomyelitis in the United States: from epi-
demic emergence to vaccine-induced retreat, 1910–1971.
Ann Assoc Am Geogr 2005; 95: 269–293.
5. Ward NA, Milstien JB, Hull HF, Hull BP, Kim-Farley RJ. The
WHO-EPI initiative for the global eradication of poliomy-
elitis. Biologicals 1993; 21: 327–333.
6. WHO. Polio, global eradication initiative. Eur Polio Union
2018 [cited 2019].
7. Kennedy J. Why have the majority of recent polio cases
occurred in countries affected by Islamist militancy? A
historical comparative analysis of thepolitical determinants
of polio in Nigeria, Somalia, Pakistan, Afghanistan and
Syria. Med Confl Surviv 2016; 32: 295–316.
8. Adegoke BOA, Oni AA, Gbiri CA, Akosile CO. Paralytic
poliomyelitis: Quality of life of adolescent survivors. Hong
Kong Physiother J 2012; 30: 93–98.
9. Halder AK, Kabir M. Child mortality inequalities and linkage
with sanitation facilities in Bangladesh. J Health Popul Nutr
2008; 26: 64–73.
10. Groce NE, Banks LM, Stein MA. Surviving polio in a post-
polio world. Soc Sci Med 2014; 107: 171–178.
11. Werhagen L, Borg K. Survey of young patients with polio
and a foreign background at a Swedish post-polio outpa-
tient clinic. Neurol Sci 2016; 37: 1597–1601.
12. Solum GM. [Who am I now? Reports from meetings with
the Norwegian welfare system] 2009. Sykehuset Innlan-
det HF, Avdeling for Fysikalsk medisin og rehabilitering:
Ottestad, Norway.
13. Levin N. [Through marrow and bones. The Norwegian
everyday life of immigrant women with late injuries after
polio] 2011. Faculty of Medicine. Institute of Health and
Society. University of Oslo, Norway.
14. Santos Tavares Silva I, Thoren-Jonsson AL. Struggling to
be part of Swedish society: Strategies used by immigrants
with late effects of polio. Scand J Occup Ther 2015; 22:
450–461.
15. Festvaag L, Schanke AK, Gilhus NE, Aarrestad S, Lofthus
K, Stanghelle JK et al. Health and social conditions in
Norwegian polio survivors: a 20-year follow-up study. J
Rehabil Med 2016; 48: 688–695.
16. Wekre LL, Stanghelle JK, Lobben B, Oyhaugen S. The
Norwegian Polio Study 1994: a nation-wide survey of
problems in long-standing poliomyelitis. Spinal Cord 1998;
36: 280–284.
17. Schanke AK, Lobben B, Oyhaugen S. The Norwegian Polio
Study 1994 part II: early experiences of polio and later
psychosocial well-being. Spinal Cord 1999; 37: 515–521.
18. Melin R, Fugl-Meyer KS, Fugl-Meyer AR. Life satisfaction in
18- to 64-year-old Swedes: in relation to education, em-
ployment situation, health and physical activity. J Rehabil
Med 2003; 35: 84–90.
19. Hunt databank. H.R.C.F.o.M., Norwegian University of
Science and Technology NTNU. Nord-Trøndelag County
Council, Central Norway Health Authority and the Norwe-
gian Institute of Public Health/Table: 11190. [Comorbi-
dity]. 03.01.2017.
20. Blom S. [Health of immigrants 2005/2006.] Statistics
Norway: Oslo-Kongsvinger 2008. Available from: https://
www.ssb.no/innvandreres-helse-2005-2006.
21. Friborg O, Hjemdal O, Rosenvinge JH, Martinussen M. A
J Rehabil Med 51, 2019