What Are Culturally Relevant Activities of Daily Living in the Asian-Indian Population? A Survey of 402 Patients With Knee Pain

Abstract

BackgroundPatient-reported outcome measures are essential tools in assessing clinical outcomes. Although several patient-reported outcome measures such as the Oxford Knee Score and Knee Injury and Osteoarthritis Outcome Score have been developed and validated, their applicability in the Asian-Indian population may be limited; key cultural differences including varying functional demands, ethnicity-specific necessities, and social expectations represent a unique collection of needs. Such differences include preferences toward ground-level activities and those favoring the manual completion of tasks.Questions/purposes(1) Which activities of daily living (ADLs) do patients in an Asian-Indian population consider the most important? (2) How do the categories of ADLs (personal care, household, work, travel, and recreation) vary among patients of different gender (men and women) and age (< 60 and > 60 years) groups?MethodsA cross-sectional study was conducted in October 2019 at a hospital in Mumbai, India. We developed a questionnaire with five domains for physical activity (personal care, household, work, travel, and recreation) formulated from a review and modification of existing categories identified by the WHO and the American Heart Association. Forty key ADLs were identified according to input obtained from detailed interviews of healthcare providers involved in the care of patients with orthopaedic illness, based on established domains. Respondents were instructed to identify the ADLs that were the most relevant to their lifestyle and culture. Responses from 402 patients (mean age 60 ± 12 years; 51% [206 of 402] were women) were analyzed to identify the most commonly selected ADLs. Responses were further evaluated to understand the impact of gender and age on these preferences by comparing men and women, as well as younger (age < 60 years) and older (age > 60 years) patients.ResultsThe three most frequently reported ADLs in each domain, representing the ADLs that were the most important to the Asian-Indian population, were standing without assistance (82% [331 of 402]), getting up with support (81% [324 of 402]), and toilet use (74% [298 of 402]) in the personal activity category; climbing stairs (80% [322 of 402]), sitting cross-legged (80% [320 of 402]), and praying (79% [319 of 402]) in the household activity category; going to the market (72% [291 of 402]), long-distance walking (62% [250 of 402]), and carrying a shopping bag (60% [242 of 402]) in the work activity category; walking on an uneven surface (66% [266 of 402]), using a taxi (61% [247 of 402]), and traveling by train (59% [239 of 402]) in the travel activity category; and yoga (67% [269 of 402]), playing with children (66% [264 of 402]), and indoor games (63% [252 of 402]) in the recreational activity category. The order of importance of ADL domains was identical in the men versus women groups as well as in the younger age versus older age groups; ADL domains with the highest number of selected ADLs in order of decreasing importance were hou...

CORR Insights®: What Are Culturally Relevant Activities of Daily Living in the Asian-Indian Population? A Survey of 402 Patients With Knee Pain

“…Patients who reside in urban and rural areas may vary in their expected activities of daily living. For instance, compared with the study by Kulkarni et al [4], which was conducted in an urban setting in India, a similar study of patients in rural areas might find that squatting is a key desired activity for toilet use, because western-style toilets are rare in rural India. The disparity in daily and recreational activities among people from different ethnic groups also makes it crucial to modify the current commonly used generic patient-reported outcome measures to include questions that are relevant to a specific ethnic group.…”

“…One of the key factors related to satisfaction after treatment is setting patient expectations [2]. This is where Kulkarni et al’s study [4] brings a fresh perspective to the treatment of knee pain; it reminds us of the importance of discussing individual patient expectations as an indispensable part of pretreatment counseling. With the rise in population migration and globalization, it is common for healthcare professionals to treat patients from different regions and ethnicities.…”

“…With this as background, in this month’s Clinical Orthopaedics and Related Research ® , an exciting study by Kulkarni et al [4] highlights the most relevant activities of daily living reported by 402 patients with knee pain from western India. This survey-based study identified that simple daily activities like standing without assistance, getting up with support, toilet use, sitting cross-legged, praying (sitting on a chair or the floor), and yoga were among the most important daily and recreational activities for Asian-Indian people, irrespective of age and gender.…”

“…Based on these discoveries [4], surgeons treating patients of Indian subcontinent origin could include the activities that are most relevant to patients with knee pain in pretreatment counseling to set realistic treatment expectations. The study by Kulkarni et al [4] could lead to the development of culture-specific or region-specific modifications to patient-reported outcome tools that are commonly used to evaluate orthopaedic diseases by considering activities of daily living relevant to each population.…”

Effects of age and sex on patient-reported outcomes following total knee arthroplasty with a rotating bearing tibial platform design: A single-surgeon practice registry study

“…However, the scale in the OKS does not accommodate for the complex and interrelated nature of many patients' problems, nor is there any allowance for reporting of comorbidities (Whitehouse et al, 2005). Applicability of the OKS in culturally diverse populations may also be limited due to differences in functional demands, ethnicity-specific necessities, and social expectations (Kulkarni et al, 2023).…”