Health-Related Quality of Life and Coping Strategies adopted by COVID-19 survivors: A nationwide cross-sectional study in Bangladesh (preprint)

This study aims to investigate the health-related quality of life and coping strategies among COVID-19 survivors in Bangladesh. Methods: This is a cross-sectional study of 2198 adult, male was 72.38% (n=1591) and female 27.6% (n=607), COVID-19 survivors living in Bangladesh. Data were collected from previously diagnosed COVID-19 participants (confirmed by an RT-PCR test) via door-to-door interviews in the eight different divisions in Bangladesh. For data collection, Bengali translated Brief COPE inventory and WHO Brief Quality of Life (WHO-QOLBREF) questionnaires were used. The data collection period was from June 2020 to March 2021. Results: Males 72.38% (1591) were more affected by COVID-19 than females 27.62% (607). Age showed significant correlations with physical, psychological and social relationships; whereas, gender showed only significant correlation with physical health (p<0.001). Marital status, occupation, living area, and co-morbidities showed significant co-relation with all four domains of QoL (p<0.001). Education and affected family members showed significant correlation with physical and social relationship (p<0.001). However, smoking habit showed significant correlations with both social relationship and environment (p<0.001). Age and marital status showed a significant correlation with avoidant coping strategy (p<0.001); whereas gender and co-morbidities showed significant correlation with problem focused coping strategies (p<0.001). Educational qualification, occupation and living area showed significant correlation with all three coping strategies (p<0.001). Conclusion: Survivors of COVID-19 showed mixed types of coping strategies; however, the predominant coping strategy was avoidant coping, followed by problem focused coping, with emotion focused coping reported as the least prevalent. Marital status, occupation, living area and co-morbidities showed a greater effect on QoL in all participants.

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.