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.