@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2020;12(4):213-221

Background
The World Health Organization (WHO) after an increase in the incidence and global spread of the SARS-CoV-2), in a statement in early 2020, declared the new coronavirus as the sixth leading cause of public health emergency worldwide and considered it a threat to all countries and named it COVID-19 [1]. Thus, to prevent the spread of this emerging disease, cooperation at the national and global levels between governments and the general public is essential [2].
Previous Studies
... [3-6]. In order to prevent the spread of the virus and reduce the infection, it was recommended to follow the instructions and care recommended by the WHO [7]. ... [8, 9]. In the late 1980s, the WHO considered it necessary to add spiritual aspects to the definition of health and disease. ... [10]. ... [11, 12]. There is an inconsistency on the role of spirituality in promoting health from the perspective of researchers [13, 14] ... [15-17]. However, there is no consensus on effective methods based on complementary medicine on the recovery process of COVID-19 and various approaches, such as Ayurveda, traditional Chinese medicine, homeopathy, and spiritual and religious care based on religious teachings have been assessed in some studies [21-21]. ... [21, 22].
Aim(s)
The aim of this study was to determine the effectiveness of spiritual practice on the recovery process of patients with COVID-19.
Research type
The present study is a single-blind, randomized-controlled clinical trial.
Research society, place and time
In this study, the effect of spiritual practice on the treatment and recovery process of patients with COVID-19 admitted to Imam Hossein Hospital in July 2020 was evaluated.
Sampling method and number
Inclusion criteria were hospitalization due to COVID-19 with positive PCR test, oxygen saturation percentage less than 93, and the age of over 18 years. ICU patients, pregnant cases, those with known psychiatric disorders, and cases who were not able to perform self-care exercises (for reasons, such as drowsiness) were excluded from the study. Due to the lack of a similar study on the effect of spiritual practice and COVID-19, a minimum sample size for clinical trial studies was used. Accordingly, 70 patients were enrolled in the study, and 35 cases were assigned to the intervention or control groups. Using the blocked randomization method, two blocks were considered (random block of the age of 60 years and older and random block of the age of 18-60 years). The variables studied in this study to compare the two groups included CT scan findings on admission, the score obtained from the Hospital Anxiety and Depression Scale (HADS), length of hospital stay, transfer to ICU, intubation (mechanical ventilation), and death. Vital signs in the two groups were recorded by the nurse on the first, third, fifth, and seventh days.
Used devices&materials
First, the objectives of the study were explained to patients and the written informed consent was obtained from all participants. In this study, the patient's usual medical treatments were continued according to the doctor's instructions and there was no interruption. In this regard, it was ensured that there will be no restrictions on receiving the required medical services. The intervention used was a spiritual practice for healing and recovery. Patients prayed for themselves and were aware of the intervention; thus, blinding the patients was not possible, and blinding of the data analyst was considered and the research was a single-blind study. Using religious teachings and quoting the verse "and we send down from the Qur'an what is a source of healing and mercy for the believers" (Surat al-Isra ', verse 82), the spiritual practice was taught to the patients in the intervention group. Based on previous clinical trials, the Surah Al-Hamad and the mention of "Ya Allah" (from the divine names) used in previous studies were used for the recovery of patients [23-27]. Patients were asked to read Surah Al-Hamd three times in each spiritual practice, followed by the mention of "Ya Allah" 66 times for healing. The patient was asked to perform spiritual practice for 7 days (from the first day of admission to the hospital and hospitalization in the ward with a diagnosis of COVID-19). The intervention lasts one week (from the admission to Imam Hossein Hospital in July 2020) three times a day for 10 minutes each time, which included a total of 21 sessions of treatment. The time of spiritual practice was considered at the same time as taking the patient's medicines (every 8 hours). Participants in the intervention group (35 cases) were given a spiritual practice registration form and they were asked to note their practice in the form after doing (this also reminded them of the considered practice). The Hospital Anxiety and Depression Scale (HADS) was used to determine the symptoms of depression and anxiety. … [28]. This research was approved with the ethics ID of IR.ISAAR.REC.1399.001. Data were analyzed using Chi-square, independent t-test, Mann-Whitney, and Fisher's exact tests. Regression analysis was used to determine the factors that are independently related to the recovery process of patients with COVID-19. Data were analyzed by SPSS 20 at a significant level of P <0.005.
Findings by Text
Out of 74 patients who met the inclusion criteria, 4 patients were unwilling to participate in the study (participation rate = 94.6%) and 35 cases were assigned to the control group. In the intervention group, out of 35 cases, 29 patients were included in the study; 6 patients underwent spiritual practice less than 15 times and were excluded from the study (17.1%). The mean (standard deviation) age of hospitalized patients in the two intervention and control groups was 53.5 (17.6) and 56.9 (16.4) years, respectively. There was no significant difference in age between the two groups (P=0.3). The median level of education in the two groups of intervention and control was 8 and 12 years, respectively (between zero and 14 years) and there was no significant difference between the two groups (P=0.3). The median onset of symptoms in both groups was 4 days (P = 0.4). Demographic and contextual-clinical characteristics in both groups are provided in Table 1. Most patients in the intervention (23 patients; 79.3%) and control groups (30 patients; 85.7%) were married. The marital status was not significantly different between the two groups (P=0.1). The median of the frequency of spiritual practice was 19 times, with an average of 18.9 (standard deviation of 2.1). Twelve patients (41.4%) from the intervention group performed spiritual practice completely (21 times) and 17 patients (58.6%) forgot to perform spiritual practice at least once. To check the normality of the quantitative data distribution, Kolmogorov-Smirnov test was performed and it was found that the data related to body mass index (P<0.001), number of underlying diseases/risk factors (P<0.001), body temperature (P=0.001), heart rate (P<0.001), oxygen saturation (P<0.001) had no normal distribution. The variables of age, length of hospital stay, anxiety, and depression had a normal distribution (P>0.05). CT scan findings and clinical signs in patients admitted with COVID-19 by two groups at baseline are compared in Table 2. At baseline, the mean heart rate in the intervention group was significantly higher than the control group and the mean body temperature and depression score in the control group were significantly higher than the intervention group (Table 2). The median length of hospital stay in the intervention and control groups was 5 days (between 3 and 10 days) and 6.7 days (between 3 and 15 days). Comparison of the length of hospital stay, transfer to ICU, death, and the scores of anxiety and depression of the two groups are shown in Tables 3 and 4. A total of 16 cases were transferred to the ICU with a decreased level of consciousness and 14 cases died (Table 4). At the end of the study, 46 patients had an appropriate level of consciousness and completed the HADS questionnaire. Depression score at baseline was significantly different between the two groups and to analyze the data, the difference between anxiety and depression scores before and after the intervention in the two groups was used (Table 4). According to Table 4, the mean changes in the score of the two subscales of anxiety and depression in the intervention group were significantly higher than the control group (P <0.05). In the intervention group, patients who had completed their spiritual practice (21 times) had a significantly lower mean depression score than those who could not complete their spiritual practice (P<0.001) but there was no significant difference between these two groups during hospitalization. To determine the factors effective for anxiety and depression in patients with COVID-19, the variables that at the baseline were significantly different between the control and intervention groups, including fever, heart rate, blood oxygen level, and depression score (before intervention) were included in the linear regression model and their effect on anxiety and depression scores was measured at the end of the study (Table 5). As shown in the table, the spiritual practice had a significant effect on the final score of both the subscale of anxiety and depression. Patients who received spiritual practice had lower anxiety and depression scores at the end of the study. In addition, a higher depression score at the beginning of the study was associated with a higher anxiety score at the end of the study.
Main comparison to the similar studies
... [29]. ... [31]. The results of review studies have shown that spiritual practice using Recitation of the Quran has positive effects on strengthening memory, mental health, reducing anger/aggression, anxiety, and depression, treating sleep disorders, improving vital signs, reducing pain, increasing optimism and life expectancy. [30,32]. ... [33]. In our study, the need for ICU and intubation was significantly lower in the intervention group than in the control group. Although the length of hospital stay in the intervention group was one day less than the control group, this difference was not significant. None of the cases in the intervention group died. ... [34-37]. Roman et al. reported spiritual practice as a strong level of immunity against COVID-19 [19]. In the study, the need for antibiotics, diuretics, ventilation equipment, and artificial ventilation was less than the control group with a shorter duration [38]. Similar studies have shown different findings, including positive or no effects on the rate of improvement [38-42]. During prayer, the secretion of the hormones of cortisol, epinephrine, and hormones in the adrenal gland is stopped in response to norepinephrine (a stress hormone), and the body's immune system is strengthened [43]. ... [44-51].
Suggestions
It is recommended that in future studies, the independent effect of factors be measured.
Limitations
Due to the small sample size, we could not investigate the simultaneous effect of the variables.
Conclusions
The findings showed that spiritual practice reduced the rate of death, transfer to the ICU, the need for intubation, anxiety, and depression in hospitalized COVID-19 patients.
Acknowledgments
The authors are grateful for the sincere cooperation of the staff and nurses of the COVID-19 ward of Imam Hossein Hospital, as well as Ms. Shirin Abdolkarimi, Maryam Bakhshaish, and Ms. Zohreh Ganjparvar in collecting data.
Conflict of interest
None declared.
Ethical Permissions
None declared.
Funding Sources
None declared.

TABLES and CHARTS

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