Polio survivors self-report on impact of impairments and fatigue
Thank you in advance for your participation in this survey.

The aim of this survey is to help inform us on the impacts the late effects of polio (LEoP) has on everyday life and fatigue. This survey is open to polio survivors from Australia and New Zealand.

This information will help Polio Australia and Polio NZ advocate for polio survivors' needs within the areas of health and disability. We also continue to educate health professionals with current and specific information. By giving health professionals more details on the impacts of LEoP, it will help them understand how to treat and manage fatigue (and your overall health). Providing results to health professionals of this survey also encourages further research by universities and professional peak health bodies regarding LEoP.

The survey should take approximately 8 minutes to complete.

We do not collect any personal information with this survey. Your responses are anonymous.

If you do have any questions regarding this survey, you are encouraged to contact Paul Cavendish, Clinical Health Educator, Polio Australia:

T – 0466 719 013
E – paul@polioaustralia.org.au

1. What is your age?
Your answer
2. What is your gender?
3. What is your marital status?
4. What is your current occupational status?
5. What is your residential status?
6. Please indicate "Yes" or "No" to the following statement: I have been diagnosed by a Rehabilitation Physician or General Practitioner (GP) as having Post-Polio Syndrome
7. Please indicate "Yes" or "No" to the following statement: I have the late effects of polio (LEoP):
8. Please write the age you had acute polio (e.g. "6 months" if you were under the age of "1")
The next three questions relate to when you first had polio.
Your answer
9. Did you have breathing / swallowing difficulties from acute polio infection?
10. Did you experience paralysis (inability to move a joint or muscle) from acute polio infection?
11. Do you use an orthosis (e.g. customised footwear, calliper, or ankle-foot/ knee-ankle foot orthosis)?
The following questions relate to your current experience with LEoP.
12. Do you use a cane or 4-wheel walker?
13. Do you use a scooter, wheelchair (or similar mobility aid)?
14. Do you have, or are you being treated for the following health condition/s:
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