Depression, anxiety, stress, and suicidal behavior among Bangladeshi undergraduate rehabilitation students: An observational study amidst the COVID-19 pandemic.

Background and Aims: Common mental health symptoms (CMHS) like depressive moods, anxiety, and stress are the underlying causes of suicidal behavior. The incidence of suicide is higher among Bangladeshi students. Due to the pandemic, students of health/rehabilitation sciences are at the most significant risk. This study aimed to measure the prevalence rate and predicting factors for depression, anxiety and stress, suicidal ideation, and suicide attempts in Bangladeshi undergraduate rehabilitation students. Methods: This cross-sectional study included data from 731 participants. Descriptive analyses estimated prevalence, and multivariate logistic regression models identified the factors associated with CMHS and suicidal behavior after adjusting the confounders. Results: The result shows a high prevalence of moderate to very severe CMHS and a higher risk of suicidal ideation among rehabilitation students. Sociodemographic factors, illness, behavior, institution, and subject-related issues were identified as the predicting factors of CMHS and suicidal behavior. The students suffering from mental health symptoms reported suicidal ideation and attempted at a significantly higher rate. Conclusion: To deal with CHMS and suicide risk, a holistic, supportive approach from government and academic institutions are essential for minimizing the predicting factors identified by this study. The study is helpful for the government regulatory body and policymakers to take immediate steps for preventing CMHS and suicidal behavior among rehabilitation students in Bangladesh.

A Delphi-Based Consensus Statement: Recommendation for Physiotherapy Management and Rehabilitation of People Living with Long COVID in Bangladesh (preprint)

Background: A Delphi-Based Consensus Statement: Recommendation for Physiotherapy Management and Rehabilitation of people living with Long COVID in Bangladesh Background: Covid-19 is a new and deadly virus with global consequences with special vulnerabilities in Bangladesh. The World Health Organization confirmed 22,451,122,614 cases and 4,627,540 deaths, worldwide (13th September 2021). In the United Kingdom, 1.5% of the estimated population of 970,000, suffers from Long COVID. Physiotherapy plays a vital role both in decreasing the number of deaths during the acute stage and improving function for patients across the spectrum of severity in the acute, sub-acute, and long-term context. Objectives: This Delphi-Based Consensus, provides recommendations for physiotherapy management and rehabilitation of people living with Long COVID. It includes recommendations for physiotherapy management for acute and subacute respiratory complications, a specific prescriptive exercise guideline for fatigue and musculoskeletal dysfunction and for improving psychological outcomes through combination of both counseling and rehabilitation. Methods: A team of 8 national and 6 international experts working in different disciplines were provided with studies on physiotherapy interventions in Long COVID-19 and were asked to provide treatment opinions based on the current literature for musculoskeletal, neurorehabilitation, respiratory, cardiac and psychological health domains. Statements were ranked and presented with individual opinions measured on a 10-point Likert Scale. The mean scores for each intervention were calculated and a manuscript with recommended physiotherapy interventions was prepared based on currently available evidence as presented and agreed upon by expert consensus. Findings: Experts recommended the following interventions based on mean agreement scores: diaphragmatic breathing (Mean = 7.5), thoracic expansion (with shoulder elevation) (Mean =8.5) and expiratory muscle training (Mean=6.3) for respiratory rehabilitation. Mild to moderate graded exercise (Mean= 7.7) was suggested for recovery from fatigue and McKenzie directional preference exercises for low back pain (Mean= 8.6), neck pain (Mean =7.9) and knee pain (Mean =8.3). Additionally, communicative and educative strategies were recommended for the rehabilitation of COVID-19. Conclusion: This consensus is structured according to the expert opinions of medical and rehabilitation professionals and based on current literature to recommend a series of rehabilitation interventions for physiotherapy professionals to manage Long COVID cases.Funding: This research has not been funded by any other external organization nor received any grants from commercial or not-for-profit organizations.Declaration of Interests: None declared.Ethics Approval Statement: Ethical permission was obtained from the Centre for the Rehabilitation of the Paralysed (CRP) ethics committee. The reference number CRP-R&E-0401-337.Trial Registration: Trial registration from the WHO Clinical trial registry platform, the reference number CTRI/2020/10/028179.

Prevalence of Long COVID Symptoms in Bangladesh: A Prospective Inception Cohort Study of COVID-19 Survivors (preprint)

Background: The aim of this study was to identify the prevalence of ‘Long COVID’ symptoms (LCS) in a large cohort of survivors and identify any potential associated risk factors.Methods: A prospective survey was undertaken of an inception cohort of confirmed COV|ID-19 survivors (Aged 18 to 87 years). 14392 participants were recruited from 24 testing facilities across Bangladesh between June, and November 2020. All participants had a previously confirmed positive COVID-19 diagnosis, and reported persistent symptoms and difficulties in performing daily activities. Participants who consented, were contacted by telephone, and were interviewed regarding LCS, and restriction of activities of daily living. Cardio-respiratory parameters were also measured. Statistical analysis included binary logistic and multiple linear regressions were performed with LCS as the dependent variable. Associated risk factors were identified using Structural Equation Modelling (SEM).Findings: Among 2198 participants, the prevalence of LCS at 12 weeks was 16·1%. Overall, eight LCS were identified and in descending order of prominence are: fatigue, pain, dyspnea, cough, anosmia, appetite loss, headache, and chest pain. COVID survivors experienced between 1 to 5 LCS with an overall duration period of 21·8 ± 5·2 weeks. SEM predicted the length of LCS to be related to younger age, female gender, rural residence, prior functional limitation and smoking.Interpretation: In this cohort of survivors, at 31 weeks post diagnosis, the prevalence of LCS was 16·1%. The risk factors identified for presence and longer length of LCS warrant further research and consideration to support public health initiatives.Clinical Trial Registration Details: The study was registered at World Health Organization (WHO) Primary Clinical trial registry platform (CTRI/2020/09/028165) on 30/09/2020 with the title “Symptoms presentation among the COVID-19 survivors in Bangladesh”.Funding Information: No funding.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Ethical permission was obtained from the Institutional Review Board at the Institute of Physiotherapy, Rehabilitation, and Research (Ethical review committee at Bangladesh Physiotherapy Association) on September 17, 2020 (BPA-IPRR/IRB/17/09/2020/028). Verbal consent was obtained during the initial telephone call and written consent was obtained at interview. The principles of the Helsinki Declaration19 were followed throughout the research to ensure confidentiality, ethics and privacy.

Prevalence of Long COVID symptoms in Bangladesh: A Prospective Inception Cohort Study of COVID-19 survivors. (preprint)

Background: The aim of this study was to identify the prevalence of 'Long COVID' symptoms (LCS) in a large cohort of survivors and identify any potential associated risk factors. Methods: A prospective survey was undertaken of an inception cohort of confirmed COVID-19 survivors (Aged 18 to 87 years). 14392 participants were recruited from 24 testing facilities across Bangladesh between June, and November 2020. All participants had a previously confirmed positive COVID-19 diagnosis, and reported persistent symptoms and difficulties in performing daily activities. Participants who consented, were contacted by telephone, and were interviewed regarding LCS, and restriction of activities of daily living. Cardio-respiratory parameters were also measured. Statistical analysis included binary logistic and multiple linear regressions were performed with LCS as the dependent variable. Associated risk factors were identified using Structural Equation Modelling (SEM). Findings: Among 2198 participants, the prevalence of LCS at 12 weeks was 16.1%. Overall, eight LCS were identified and in descending order of prominence are: fatigue, pain, dyspnea, cough, anosmia, appetite loss, headache, and chest pain. COVID survivors experienced between 1 to 5 LCS with an overall duration period of 21.8 SD 5.2 weeks. SEM predicted the length of LCS to be related to younger age, female gender, rural residence, prior functional limitation and smoking. Interpretation: In this cohort of survivors, at 31 weeks post diagnosis, the prevalence of LCS was 16.1%. The risk factors identified for presence and longer length of LCS warrant further research and consideration to support public health initiatives. Funding: No funding

Coping with COVID-19 Pandemic: A Population-Based Study in Bangladesh (preprint)

ABSTRACT This study aims to investigate coping strategies used by Bangladeshi citizens during the COVID-19 pandemic. Design Prospective, cross-sectional survey of adults (N=2001) living in Bangladesh. Methods Participants were interviewed for socio-demographic data and completed the Bengali translated Brief-COPE Inventory. Statistical data analysis was conducted using SPSS (Version 20). Results Participants (N=2001), aged 18 to 86 years, were recruited from eight administrative divisions within Bangladesh (mean age 31.85±14.2 years). Male to female participant ratio was 53.4% (n=1074) to 46.6% (n=927). Higher scores were reported for approach coping styles (29.83±8.9), with lower scores reported for avoidant coping styles (20.83 ± 6.05). Humor coping scores were reported at 2.68±1.3 and religion coping scores at 5.64±1.8. Both men and women showed similar coping styles. Multivariate analysis found a significant relationship between male gender and both humor and avoidant coping (p Conclusion Participants in this study coped with the COVID-19 pandemic by utilizing a combination of coping strategies. Factor 1 revealed both avoidant and approach coping strategies and Factor 2 revealed a combination of humor and avoidant coping strategies. Overall, a higher utilization of approach coping strategies was reported, which has previously been associated with better physical and mental health outcomes. Religion was found to be a coping strategy for all participants. Future research may focus on understanding resilience in vulnerable populations, including people with disability or with migrant or refugee status in Bangladesh.

Knowledge, Attitudes, and Practices of People living with SCI towards COVID-19 and their Psychological State during In-patient Rehabilitation in Bangladesh (preprint)

Study Design: A prospective cross-sectional survey. Objective: The study aimed to examine the Knowledge, Attitudes, and Practices (KAP) of people living with Spinal cord injury (SCI) towards COVID-19 and their psychological status during in-patient rehabilitation in Bangladesh. Setting: The Centre for the Rehabilitation of the Paralyzed (CRP) and the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), two tertiary level hospitals in Dhaka, Bangladesh. Methods: From July to September 2020, a prospective, cross-sectional survey of SCI subjects, 13-78 years of age, carried out in two SCI rehab centers in Bangladesh. Data has been collected by face to face interview through a pretested, and language validated questionnaire on KAP and Depression, Anxiety, Stress (DASS). Ethical approval and trial registration obtained prospectively. As all the patients were previously living with Spinal cord injury (SCI), therefore, all the patients admitted/ attend SCI rehab centers were considered as SCI positive samples. Results: A total of 207 people with SCI responded, 87%were male, and 13% were female with mean age34.18 (SD 12.9) years. 33.8% was tetraplegic and 66.2% was paraplegic and 63.8% of them were diagnosed ASIA-A, with a motor score mean 45.38, the sensory score of 97.2, SpO2 95.07, and Vo2max 35.7 mL/kg/min. 178 people had at least one health issue. Overall knowledge score was 8.59 (SD 2.3) out of 12, depression 11.18 (SD 8), anxiety 7.72 (SD 5.1), and stress were 9.32 (SD 6.7) from a total of 21 scores each. There was a correlation between Knowledge and DASS with age (P

Coping with COVID Pandemic

Knowledge, Attitudes, and Fear of COVID-19 during the Rapid Rise Period in Bangladesh (preprint)

ObjectivesTo determine the level of Knowledge, Attitude, and Practice (KAP) related to COVID-19 preventive health habits and perception of Fear towards COVID-19 in subjects living in Bangladesh. DesignProspective, cross-sectional survey of (n= 2157) male and female subjects, 13-90 years of age, living in Bangladesh. MethodsEthical Approval and Trial registration were obtained prior to the commencement of the study. Subjects who volunteered to participate and signed the informed consent were enrolled in the study and completed the "Fear of COVID-19 Scale" (FCS). ResultsTwenty-eight percent (28.69%) of subjects reported one or more COVID-19 symptoms and 21.4% of subjects reported one or more comorbidities. Knowledge scores were slightly higher in males (8.75{+/-} 1.58) than females (8.66{+/-} 1.70). Knowledge was significantly correlated with age (p

Follow-up of COVID-19 Positive Patients

Knowledge, Practice and mental health status of Spinal injured people

Knowledge, attitude and fear of COVID-19 in Bangladesh