Introduction
Knee osteoarthritis (OA) has a major effect on function and quality of life (QOL)1. Limited knowledge of the disease and its management options are common problems for people diagnosed with knee OA2-5. This lack of knowledge is known to decrease adherence to treatment and consequently affect symptoms and functioning and increase healthcare costs6,7. The level of understanding of the pathology of knee OA, its symptoms, how others perceive knee OA, and functional impairment were also identified to affect the experiences of people diagnosed with knee OA8. However, those aspects were identified in a review exploring the experiences of people living mainly in the developed world. Thus, the results cannot express the experiences of people from different cultural backgrounds such as the Middle East.
Knee OA is a common musculoskeletal problem in Jordan, one of the countries in the WHO Eastern Mediterranean Region, however studies exploring its prevalence and risk factors are lacking. Hawamdeh and Al-Ajlouni9 showed that Jordanians have a higher severity of knee OA compared to the developed world and they referred this to the higher body mass index and the cultural habits such as praying and crossed legs sitting.
The population in Jordan are mainly Muslims and those who practice Islam prays five times a day, this involves transitioning between heel sitting, prostration with flexed knees, and standing. Moreover, cross sitting is common which could increase the stresses on the knees. The atmosphere and geography in Jordan does not support outdoor physical activity and exercise; the weather is hot in summer, proper infrastructure is lacking in winter, and it mainly consists of mountains and valleys with limited straight roads. Moreover, public transportation is not well-organized10. The culture in Jordan mostly favors men over women as demonstrated by the Global Gender Index with a Global Gender Gap Score of 0.605, where a score of less than 1 favors men over women e.g. women were mainly unemployed and wages were higher for men compared to women for similar work11. These socio-cultural differences when compared to countries of the developed world might affect the impact of knee OA on health.
To understand the impact of OA on health worldwide, the results could be mapped to international frameworks to offer optimal assessment and management options for different populations and to allow for international comparison. The International Classification of Functioning, Disability and Health (ICF) framework was approved by the World Health Organization in 200112. The framework considers the symptoms, limited activities and restricted participation caused by any medical condition in addition to the environmental and personal factors that could affect the patient.
Xie et al14 was the only study to explore the impact of knee OA on different cultures in Singapore and linked the result with the comprehensive and brief ICF core sets for OA15. A discrepancy was reported between the items identified by their participants and the comprehensive and brief core sets. They have reported new items such as religion and spirituality which was an important limitation for Malay participants who are Muslims. However, this item was not covered by the core sets demonstrating that the effect of knee OA varies among different cultures. A cultural adaptation of international frameworks might be suggested.
Therefore, this study aimed to explore the knowledge of people diagnosed with knee OA living in Jordan of their condition and its management options. In addition to exploring the impact of knee OA on their health and mapping the results to the ICF framework.