Table 1.

Definition of post polio syndrome (PPS) according to march of dimes, time from acute polio infection and start of PPS, fatigue, pain; paresis, the grade of paresis, walking aids and concomitant diseases.

PPS was defined according to the criteria of March of Dimes [13]. Criteria of March of Dimes 1. A history of paralytic poliomyelitis, as confirmed by history, neurologic examination, and electromyography. 2. A period of partial or complete functional recovery, followed by a stable period of at least 15 years. 3. Gradual or sudden onset of progressive and persistent new muscle weakness or decreased endurance, with or without generalized fatigue, muscle atrophy, or muscle and joint pain. (Sudden onset may follow a period of inactivity, or trauma or surgery.) 4. The symptoms should persist for at least a year. 5. Exclusion of other causes. Time from the acute polio infection and the start of PPS was calculated and given in years. Fatigue: was measured with the fatigue severity scale with 9 questions related to how fatigue interferes with certain activities and relates and rates its severity. The questions are scored on a 7 point scale with 1= strongly disagree and 7 = strongly agree. The answers were graded 1-7 [14]. Pain: was graded according to the Visual analogue scale (VAS) 0-100 [15] Pain was chronic when exceeded three months. Pain was graded severe when a VAS was over 50. Paresis:  was divided into para-paresis, mono-paresis when paresis of one leg or one arm was present, Tetra-paresis and hemi- pares. The grade of paresis was divided in severe, moderate or mild. Muscle function was graded from 0-5. 0 is no muscle function and 5 is normal muscle function. A paresis was considered severe when key muscles were graded 0-1, moderate when graded 2- 3 and mild when graded 4-5. Walking aids were divided into use of wheelchair, two crutches or one crutch/ cane and walking un-aided. Concomitant diseases were divided in hypertension, cardiovascular disease, diabetes mellitus, hyper/hypothyroidism and malignancies.