Physical medicine and rehabilitation (PMR) is evolving in low- to middle-income countries. Although established as a separate specialty in Bangladesh 40 years ago, there has been no formal documentation of the history and current state of PMR, or associated disability issues in Bangladesh. The aim of this review is to provide a brief overview of the health-care system in Bangladesh, to discuss the available disability statistics, legislation for persons with disability (PWD), and current system(s) of disability management in the country. The evolution of PMR is presented along with an exploration of future perspectives. Data sources included an online literature search (English language only; 1970–2018) with predefined keywords. Official government websites were examined for disability-related statistics, and informal interviews with Bangladeshi government officials and rehabilitation professionals provided further insights. The reported disability prevalence in Bangladesh varies widely from 5.6% to 16.2%. Currently, there are 130 physiatrists, and over 1400 physiotherapists, 190 occupational therapists, and 200 speech and language therapists. A developing economy, illiteracy, maldistributions of wealth, and a rising prevalence of chronic diseases add to the burden of the existing disability. Legislations have been passed with an aim to protect the rights and dignity of PWD, but there are major barriers in implementing the acts. Social stigmatization of PWD remains largely unaddressed, with low rates of community reintegration. PWD also face mobility barriers and accessibility issues. PMR and other rehabilitation services are improving, but disability management is largely considered a social issue rather than a medical problem. There is a need to involve all stakeholders in disability management to strengthen medical rehabilitation and improve service delivery, while advocating for the rights of PWD.

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Objectives: Gait ataxia, incontinence, and cognitive impairment are three typical symptoms of normal pressure hydrocephalus (NPH), however, similarity to other diseases' presentation, the diagnosis of NPH can be frequently missed. NPH-related education program to healthcare professionals appears very well needed and could be a promising way to improve its early diagnosis and treatment, but the actual effect of training programs is unknown. Therefore, we launched the Yangpu Community Training Program and conducted a survey to investigate the knowledge and awareness of NPH among rehabilitation professionals and the effectiveness of our training program. Methods: We conducted a well designed survey among the participants before and after education of NPH and analyzed the responses of returned questionnaires. We compared the percent of respondents who never learned about NPH before and after training, and analyzed potential factors (year of graduation and professions) that might affect NPH education. We also examined the source of the acquired NPH knowledge and the percentage of respondents who demonstrated their increased knowledge of this disease. Results: Eighty-two and eighty-six questionnaires were returned before and after training, respectively. Based on data from the returned questionnaires, more than 80% of participants in the training program are rehabilitation therapists (physical, occupational and speech therapists), 15% are physicians, and 2% are nurses. Before participating in the training program, more than two fifths (41.46%) surveyed healthcare professionals had never learned about NPH, however this number dropped to 4.76% after training, Sixty percent participants indicated that they learned about NPH from the provided training programs. Conclusion: Our results demonstrate that NPH knowledge is lacking among healthcare professionals and that training programs are effective in NPH education. We expect that increased knowledge of this disease would result in improvement on early detection of this condition and appropriate intervention implemented to reduce the patients, family and health care burden in the future.

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Background: Osteoarthritis (OA) of the knee is a significant cause of disability. The current conservative treatment options include physiotherapy, analgesia, intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid, or corticosteroids. Regarding PRP, some meta-analyses studies have been reported. However, these studies focused on the effectiveness of intra-articular PRP when compared to other controls, and none thoroughly investigated the anchored-based effectiveness concerning the minimal clinically important difference (MCID). Objective: We, therefore, conducted this work to address this apparent knowledge gap and to provide objective data that could be used by decision-makers. Methods: Electronic databases were searched to identify relevant publications. We included controlled trials that evaluated the efficacy of PRP for the treatment of OA of the knee. All included studies must have had a minimum follow-up of 24 weeks as well as pre- and post-injection Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Results: A total of 12 studies, involving 405 patients, were included in this analysis. The primary endpoint of this study was to compare the treatment effect measured by WOMAC scores improvement to MCID. For WOMAC score analyses, the mean difference (MD) between baseline and 6-month scores was utilized. The pooled data established significant functional improvement as demonstrated by MD of 25.5 ± 3.3 (95% confidence interval: 19.1–31.9, P< 0.001). In addition, the overall comparison of MD (25.5) to MCID (7.9) showed that the MD was approximately three-fold higher. Due to the known impact of the baseline scores on the MD, we conducted further analyses comparing MD values to the corresponding MCID for various baseline severity grades (i.e. high, intermediate, and low). The analyses showed significantly higher MD values in all categories. Conclusions: In conclusion, evidence from studies of low-to-moderate methodological quality shows that intra-articular PRP has the potential to provide a clinically meaningful symptomatic benefit for OA of the knee, at least in the short term.

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