Journal of Religion and Health

https://doi.org/10.1007/s10943-019-00878-8

ORIGINAL PAPER

Physical Function and Quality of Life and Modification

of Authentic Islamic Prayer Procedure by Osteoarthritis
Knee Patients in Saudi Arabia: A Cross‑sectional Study

Mahamed Ateef1   · Mazen Mushabab Alqahtani1 · Msaad Alzhrani1 ·

Shady Alshewaier1

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract
Physical activity and quality of life of older people decline as age increases and
with associated chronic diseases. The quality of life of patients was assessed using
generic measures in Saudi Arabian patients. The objective of this cross-sectional
study was to evaluate the quality of life among Osteoarthritis knee patients who have
modified their lifestyle and adapted to chair usage to offer prayers using disease-
specific knee measures. A total of 107 subjects have been evaluated among Muslims
with a chair usage history to offer the prayers. There is a statistically significant dif-
ference (p < 0.001) among the history of chair users to offer prayers. Function as
well as quality of life has been declined over the years, that is, from 0 to 9 years of
modified (chair use) prayer in Saudi Arabian Muslims.

Keywords  Osteoarthritis knee · Physical function · Quality of life · Muslims · Saudi

Arabia

Introduction

Knee osteoarthritis (OA) is said to be a debilitating musculoskeletal disorder bother-

ing the older adults with their daily activities. It is a progressive knee disorder lead-
ing to disability observed during the day-to-day activities (Klippel et al. 2001). This
global disability is caused by knee OA which in turn impairs the person’s routine life
and declines quality of life (Cross et al. 2010); delayed surgical intervention is also a
reason for decline in quality of life (Losina et al. 2015).
Knee being the most weight-bearing joint involves in most of the activities
of daily living, and the joint has to be subjected to several stresses during the

* Mahamed Ateef
m.jeelani@mu.edu.sa
1
Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences,
Majmaah University, Al‑Majmaah 11952, Saudi Arabia

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 Journal of Religion and Health

day, and the knee is the most commonly affected with OA with an estimate of
nearly 27 million people in the USA (Lawrence et al. 2008). The Saudi Arabian
health data reported that musculoskeletal disorders caused the most disability
with 64.7% during 2007–2017 (www.healt​hdata​.org/saudi​-Arabi​a). The quality
of life of any individual reflects the general well-being and healthy individual
joints; the overall quality of life of an individual is associated with his age and
lower limb mobility. The quality of life is basically depending on once’s mobility
and a disease-free, pain-free body. As the age increases, the knee OA progresses
and the quality of life of individual decreases as the life expectancy increases
(Abbott et al. 2017). Since OA knee is associated with aging, the disease is affect-
ing the older population with the limitation of physical activities leading to OA
morbidity burden (Marlene et  al. 2011), and the disease has doubled in preva-
lence (Wallacea et  al. 2017) and the impact is severe on older adults with OA
knee (Jennifer et al. 2012). The incidence of OA knee data estimated by the USA
was an average incidence of approximately 0.25% from age 25 to 85 years. The
previous Saudi Arabian study has estimated the prevalence of OA knee as 60.6%
over 65–75 years of age in Saudi Arabian populace (Al-Arfaj et al. 2003). There
are several health-related measures available to quantify the quality of life using
generic forms.
Knee injury and Osteoarthritis Outcome Score (KOOS) is a disease-specific ques-
tionnaire to measure knee and associated problems in OA knee patients; it has a total
of five domains (www.koos.nu). One study has explained the difference between
quality adjusted life years (QALYs) and disability adjusted life years (DALYs) for
the researchers to understand the health outcomes (Sassi 2006). It has been well
noticed among the Muslim population worldwide the usage of chair to offer the
prayers either in mosques or at home instead of authentic Islamic payer procedure
that is to offer prayers on ground; one reason could be knee OA as (Abbott et  al.
2017) this is associated with aging. The objective of this study is to evaluate the
knee difficulty (loss of function) and quality of life among the population of Saudi
Arabia who have been adapted to chair usage to offer the prayers five times a day.

Methods

The main purpose of our study is to evaluate the knee OA-related knee difficulty and
quality of life among the Muslim older population who have been adapted to chair
usage to offer the prayers instead of using the kneeling (both thigh and calf contact)
and squatting positions which are authentic in Muslim religious prayer practice.

Study Design

This is a cross-sectional study design where the convenience sampling method

was used to collect the subjects.

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Study Sample and Setting

The target population was older Muslim people who have modified prayer proce-
dure by adapting the chair to offer the prayers instead of praying on the ground
(squatting and kneeling which are involved during prayers on the ground), and the
sample data were collected from twenty-seven Mosques in and around the Maj-
maah City, Riyad Province, Saudi Arabia.

Sample Size

An average of 5 subjects offering prayers using chair were recruited from each
Mosque from a total of twenty-seven Mosque, and a total of 135 older subjects
identified. The study was conducted during 2018 in and around Majmaah City,
Riyad Province, Saudi Arabia.

Study Protocol

The researcher done the recruitment of subjects in a convenience method from

different mosques in and around the Majmaah City, Riyad Province. All the avail-
able subjects were assessed for their demographic data and for various knee prob-
lems. Upon initial counseling, most of the subjects found to have osteoarthritis
knee which was previously diagnosed by orthopedic specialists. Authors again
evaluated the subjects during the study period using the ‘American College of
Rheumatology criteria’ for the diagnosis of the knee osteoarthritis (Altman et al.
1986) to prevent the recall bias to self-report the diagnosis by the subjects. The
subjects were mostly 102 (95.3%) with bilateral chronic OA knee with unequal
left and right pain threshold. The total chair users to offer the prayers were 135;
among 107 (79.2%) subjects met the inclusion criteria for OA knee, 7 (5.1%)
subjects were withdrawn from the study during initial counseling as they were
not interested to fill the questionnaire, and the rest 21 (15.5%) were excluded as
per the exclusion criteria. Informed consent was obtained from the whole study
sample.
Inclusion Criteria Muslim subjects offering prayers using chair at different
mosques with primary knee osteoarthritis.
Exclusion Criteria TKR and other knee surgeries, rheumatoid arthritis and
other types of arthritis, residual weakness following the stroke, hip arthritis and
total hip replacement surgeries, morbid obesity, imbalance related to brain disor-
ders, the old neck of femur fractures, subjects more than 9 years history of chair
usage and also expatriates as we intent to study the Saudi population.

Subject Allocation

The sample age was pooled, and we split the obtained sample into three catego-
ries based on the history of the number of years of chair usage to offer the prayers

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five times a day at the time of cross-sectional survey from the time of adaptation
to chair usage. The first category of chair users to offer the prayer was 0–3 years
duration (n = 31) from the onset of not offering the prayers on ground, the second
category was 3–6 years (n = 34), and the third category was 6–9 years (n = 42) of
chair habituation to offer the prayers. Subjects more than 9 years history of chair
adaptability were excluded from the study to prevent biased outcomes compared
to the first and second categories.

Research Measurement Tools

Knee injury and Osteoarthritis Outcome Score (KOOS Arabic version)

All the study participants were evaluated for their knee difficulties and quality of life
related to Knee OA using the disease-specific Arabic version of the Knee injury and
Osteoarthritis Outcome Score (KOOS) questionnaire, which was administered to
the Arab Muslim religious practice (prayers) populace who were using the chair to
offer prayers. The KOOS is a questionnaire to measure knee difficulty level and qual-
ity of life in elderly with OA knee population (WWW.KOOS.nu). This questionnaire
has five domains such as symptoms, pain, function in daily living (ADL), function
in sport and recreation (sport & recreation) and knee-related quality of life (QOL).
The measurement properties of KOOS were better linked with ‘International classi-
fication of functioning and Health,’ ICF (Alviar et al. 2011). The patients with knee
OA have shown high values for the Minimal Detectable Change (MDC) for sports/
rec 19.6, QOL 21.1 in OA knee subjects for the original scale (Collins et al. 2011).
The measurement properties of KOOS Arabic version were also well acceptable for
all the dimensions, and they are specific to our hypothesis testing (knee higher level
difficulty sports/rec, during kneeling and squatting, and quality of life).

Data Collection

An informed consent was obtained from the whole study sample along with their
demographic data. All the participants were individually asked to accurately rate or
reproduce the level of difficulty and quality of life including all the domains. To
accurately rate, the subjects told to attempt to squat and kneel down if possible and
then to fill the Arabic version KOOS questionnaire.

Statistical Analysis

The data were collated using descriptive (case processing summary), nonparametric
test such as Kruskal–Wallis rank and post hoc test (Tukey HSD); for category com-
parison analysis was done using IBM SPPSS (version 25.0) software. The level of
significance was set at 0.05.

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Table 1  Demographic data of the subjects in all the three categories (n = 107)

Parameter Category 1 Min–max Category 2 Min–max Category 3 Min–max
(n = 31) range (n = 34) range (n = 42) range
Mean ± SD Mean ± SD Mean ± SD

Age (years) 60.7 ± 3.361 54–67 65.6 ± 2.5 59–71 71.9 ± 3.71 64–77

Height (cm) 165.3 ± 7.02 156–174 165.8 ± 7.03 156–174 165.3 ± 4.9 156–173
Weight (kg) 80.63 ± 2.6 74–86 81.07 ± 2.8 74–87 80 ± 3.22 74–87

Table 2  Descriptive analysis KOOS subscales Category 1 Category 2 Category 3

of KOOS subscales in the three (n = 31) (n = 34) (n = 42)
chair using categories of OA Mean ± SD Mean ± SD Mean ± SD
knee subjects
1. Symptom 39.02 ± 13.2 37.4 ± 12.4 36.08 ± 12.6
2. Pain 43.6 ± 12.6 41.3 ± 11.7 38.6 ± 11.4
3. Function, daily living 39.04 ± 13.4 36.04 ± 13.4 34.08 ± 12.4
4. Sports/rec 36.08 ± 9.34 32.08 ± 9.02 30.05 ± 8.83
5. Quality of life 29.44 ± 11.8 27.42 ± 11.4 24.22 ± 10.6

Results

Patient’s Characteristics

Among the total sample size of 107 participants, the classified category 1 (n = 31)
was with a mean age, standard deviation of 60.7 ± 3.361, category 2 (n = 34) was
with a mean age, standard deviation of 65.6 ± 2.5, category 3 (n = 42) was with a
mean age, standard deviation of 71.9 ± 3.71, and the whole sample age ranged from
54 to 77 years. The height, weight mean and standard deviation were 165.3 ± 7.02,
165.8 ± 7.03 and 165.3 ± 4.9, the whole sample height ranged from 156 to 174 cm
and weight 80.63 ± 2.6, 81.07 ± 2.8 and 80 ± 3.22, and the whole sample weight
ranged from 74 to 87 kilograms, respectively, as depicted in Table 1.
Table 2 shows the mean and standard deviation of symptom domain in the cat-
egories 1, 2 and 3 as 39.02 ± 13.2, 37.4 ± 12.4 and 36.08 ± 12.6; pain as 43.6 ± 12.6,
41.3 ± 11.7 and 38.6 ± 11.4; function, daily living as 39.04 ± 13.4, 36.04 ± 13.4 and
34.08 ± 12.4; sports/rec as 36.08 ± 9.34, 32.08 ± 9.02 and 30.05 ± 8.83; and quality
of life as 29.44 ± 11.8, 27.42 ± 11.4 and 24.22 ± 10.6, respectively.
In Table 3, as per the post hoc analysis, the mean difference (MD) was 6.845*,
p < 0.001 for category 1 compared to category 2 in KOOS sports/rec subscale. When
category 1 was compared to category 3, the MD was 13.652*, p < 0.001. And when
category 2 was compared to category 3, the MD was 6.807*, p < 0.001. There was a
statistically significant difference in KOOS sports/rec subscale among the three pro-
posed chair usage categories, stating that there was difficulty in physical function or
prevailing disability among Muslim OA knee population.
In Table  4, the post hoc analysis shows the mean difference (MD) was 7.561*,
(0.002) for category 1 compared to category 2 in KOOS-QOL subscale. When

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Table 3  Multiple comparison (post hoc-Tukey HSD) analysis in sports/rec domain among the three cat-
egories in OA knee subjects with chair adaptation to offer the prayers
KOOS domain Category Difference multiple Mean difference Significance
comparisons (I J) p value

Sports/rec Category 1 Category 2 6.845* < 0.001

Category 3 13.652* < 0.001
Category 2 Category 3 6.807* < 0.001

*p < 0.05; **p < 0.01; ***p < 0.001

Table 4  Post hoc (Tukey HSD) multiple comparison analysis in QOL domain among the three categories
in OA knee subjects with chair adaptation to offer the prayers
KOOS domain Category Difference multiple Mean difference Significance
comparisons (I J) p value

QOL Category 1 Category 2 7.561* 0.002

Category 3 14.593* < 0.001
Category 2 Category 3 7.032* 0.002

*p < 0.05; **p < 0.01; ***p < 0.001

category 1 was compared to category 3, the MD was 14.593* (p < 0.001). And

when category 2 was compared to category 3 in KOOS-QOL subscale, the MD was
7.032*, (0.002). There was a statistically significant difference in KOOS-QOL sub-
scale among the three proposed chair usage categories, stating that there was decline
in the quality of life among Muslim OA knee population who have adapted to chair
to offer prayers.

Discussion

To our knowledge, this is the first-hand scientific observation to report to the world
of scientific research community about the declined quality of life due to hidden
knee disability among the Muslim older population who have modified their life-
style and adapted to chair usage to offer the prayers. This cross-sectional attempt
has been taken to explore the degree of knee disability and decline in quality of life
related to knee OA in the three different proposed categories where the sample was
split based on the history of number of years of chair usage to offer the prayers in
Saudi Arabian Muslim OA knee subjects. One recent study reported that the self-
reported tools are more efficient while measuring the disability along with clini-
cal examination (Mactaggart et al. 2016); one such self-rated measure is the ‘Knee
injury and Osteoarthritis Outcome Score’ (KOOS) where the highest score indicates
no difficulty and the lowest score depicts the highest level of difficulty (www.koos.
nu) and disability (Guevara-Pacheco et al. 2017) leading to decline in knee-related
quality of life.

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Journal of Religion and Health

There was a significant difference in disability in sports/rec domain of the

self-rated KOOS in (p < 0.001) all the categories. The joint stiffness, especially
decreased knee flexion range of motion (Steultjens et al. 2000), allowed this group
of subjects to acquire an alternative method of offering the prayers to overcome the
terminal knee joint stiffness while kneeling and squatting. Our all category results
in sports/rec domain were similar to a study which has observed extreme disability
in sports/rec domain (Foo et al. 2015); this could be a reason to adapt chair usage
due to a possible reason that could be due to their avoidance nature from joint stiff-
ness (Evers et al. 1998). As the disease advances, the knee flexion range of motion
decreases and there is a possibility of joint stiffness and flexor muscle contracture
develops in the knee OA patients. One study observed in the year 2000 that the self-
reported restricted knee flexion due to knee OA could be a determinant of knee dis-
ability (Steultjens et al. 2000). The avoidance of physical activity increases the knee
disability by activity limitation (Evers et al. 1998) which may further enhance the
chronicity of the disability encouraging the OA knee patients to modify their actual
style to use a chair to offer the prayers.
Generally, any patient with Knee OA does have a considerable amount of pain
and stiffness and tries to overcome the appreciation of the symptoms either by
avoiding (Evers et al. 1998) or modifying the activity during these two squatting and
kneeling positions. This nature of avoidance is usually built within the patient and
leads to a vicious cycle associated with OA knee such as joint pain, muscle atrophy,
weakness, joint instability, joint stiffness, limitation of motion leads to disability,
and disability is strongly associated with quadriceps strength (O’Reilly et al. 1998)
which we believe that the OA knee patients have modified their lifestyle to offer the
prayers by using the chairs at home as well in mosques (‘prayer home’ for Muslims).
If the knee OA management is not suitable on time with the severity of the problem,
the disability may rise, and one systematic study recently stated that different cul-
tural habits among Asian countries influence the consideration of OA knee manage-
ment (Satyamoorthy et  al. 2018) and not opting an appropriate treatment on time
triggers the vicious cycle beginning from pain to disability.
One study in 2014 has concluded that the OA knee was positively associated
with the knee disability and quality of life was poor and significant (Alkan et  al.
2014). Another study concluded that the OA knee was responsible for the loss of
QOL (Abbott et  al. 2017). Our mean KOOS sports/rec, QOL domain results are
nearly similar to the mean values (Creamer et al. 2017; Bernad-Pineda et al. 2014)
of pre-total knee replacement evaluation using KOOS in a study conducted in 2017
(Gandek et  al. 2017). The same study also has evaluated 352 patients with assis-
tive devices used before TKR, and their KOOS-QOL mean value was 20.5 (Gandek
et  al. 2017)  which is nearly similar to our proposed groups. In one large sample
study in the Spanish population, both the subjective evaluation by WOMAC ques-
tionnaires and objective examination by rheumatologists have shown that there was
a decline in quality of life of OA knee patients (Bernad-Pineda et al. 2014).
A study by Hodge et al. (2009) on knee MRI-based osteoarthritis study was con-
ducted between the local Arabian and Western subjects, where they have found
that anteromedial pathology is common in Saudi Arabian subjects due to cultural
habituation patterns such as floor toileting and full knee flexed sitting on floor which

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involves squatting and kneeling among Saudi Arabian populace. The appreciation of
knee physical difficulty during squatting and kneeling could be possible for the sub-
jects with osteoarthritis knee who attain the kneeling and squatting to offer prayers
on the ground. One study concluded that the disease process such as knee stiffness
would have caused a decline in physical function (Kapstad et  al. 2007) and hence
opted to acquire a modified lifestyle. The cultural and disease pattern vicious cycle
explains the reason for the disability observed in all the categories of this study
due to which this group of growing subjects have modified their lifestyle and been
adapted to chair to offer the prayers and thereby declined in the quality of life of
these subjects in Saudi Arabia.

Limitations

‘We have not found old age people with Knee OA who offer (authentic procedure)
prayer on floor which was the limitation of our study.’ Second limitation of the study
was that local females and expatriates were not included in the study.

Conclusion

Function as well as quality of life has been declined over the years, that is, from 0 to
9 years of modified (chair use) prayer in Muslim populace in Saudi Arabia.

Acknowledgements  The author would like to thank Deanship of Scientific Research at Majmaah Uni-
versity, Al Majmaah, 11952, Saudi Arabia for supporting this work under the Project Number 1440-137.

Compliance with Ethical Standards 

Conflict of interest  Authors have declared that they have no conflict of interest.

Informed Consent  Informed consent was obtained from all the subjects.

References
Abbott, J. H., Usiskin, I. M., Wilson, R., Hansen, P., & Losina, E. (2017). The quality-of-life bur-
den of knee osteoarthritis in New Zealand adults: A model-based evaluation. PLoS ONE, 12,
e0185676.
Al-Arfaj, A. S., Alballa, S. R., Al-Saleh, S. S., Al-Dalaan, A. M., Bahabry, S. A., Mousa, M. A., et al.
(2003). Knee osteoarthritis in Al-Qaseem, Saudi Arabia. Saudi Medical Journal, 3, 291–293.
Alkan, B. M., Fidan, F., Tosun, A., & Ardıçoğlu, Ö. (2014). Quality of life and self-reported disability
in patients with knee osteoarthritis. Modern Rheumatology, 24, 166–171.
Altman, R., Asch, E., Bloch, D., Bole, G., Borenstein, D., Brandt, K., et al. (1986). Development of
criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the
knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
Arthritis and Rheumatism, 8, 1039–1049.
Alviar, M. J., Olver, J., Brand, C., Hale, T., & Khan, F. (2011). Do patient-reported outcome meas-
ures used in assessing outcomes in rehabilitation after hip and knee arthroplasty capture issues

13
Journal of Religion and Health

relevant to patients? Results of a systematic review and ICF linking process. Journal of Rehabili-
tation Medicine, 43, 374–381.
Bernad-Pineda, M., de las Heras-Sotos, J., & Garcés-Puentes, M. V. (2014). Calidad de vida en
pacientes con artrosis de rodilla y/o cadera. Revista Española de Cirugía Ortopédica y Trauma-
tología, 58, 283–289.
Collins, N. J., Misra, D., Felson, D. T., Crossley, K. M., & Roos, E. M. (2011). Measures of knee
function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation
Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis
Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of
Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), West-
ern Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale
(ARS), and Tegner Activity Score (TAS). Arthritis Care & Research, 63, 208–228.
Creamer, P., Lethbridge-Cejku, M., & Hochberg, M. C. (2017). Determinants of pain severity in knee
osteoarthritis: Effect of demographic and psychosocial variables using 3 pain measures. Journal
of Rheumatology, 26, 1785–1792.
Cross, M., Smith, E., Hoy, D., Nolte, S., Ackerman, I., Fransen, M., et al. (2010). The global burden
of hip and knee osteoarthritis: Estimates from the global burden of disease study. Annals of the
Rheumatic Diseases, 73, 1323–1330.
Evers, A. W. M., Kraaimaat, F. W., Geenen, R., & Bijlsma, J. W. J. (1998). Psychological predictors
of functional change in recently diagnosed rheumatoid arthritis patients. Behaviour Research
and Therapy, 36, 179–193.
Foo, C. N., Manohar, A., Rampa, L., Lye, M. N., Mohd-Sidik, S., & Jamil Osman, Z. J. (2015). Knee
pain and functional disability of knee osteoarthritis patients seen at Malaysian government hos-
pitals. Malaysian Journal of Medicine and Health Sciences, 13, 7–15.
Gandek, B., John, E., & Ware, Jr. (2017). Validity and responsiveness of the knee injury and Osteo-
arthritis Outcome Score (KOOS): A comparative study among total knee replacement patients.
Arthritis Care & Research, 69, 817–825.
Guevara-Pacheco, S. V., Felica-Alvarado, A., Delgado-Pauta, J., Linguicidal-Segarra, A., & Pelaez-
Ballestas, I. (2017). Prevalence of disability in patients with musculoskeletal pain and rheumatic
diseases in a population from Cuenca, Ecuador. Journal of Clinical Rheumatology, 23, 324–329.
Hodge, W. A., Harman, M. K., & Banks, S. A. (2009). Patterns of knee osteoarthritis in Arabian and
American knees. The Journal of Arthroplasty, 24, 448–453.
Jennifer, M., Charles, G. H., Helmick, M. D., Teresa, J., & Brady, A. (2012). Public health approach
to addressing arthritis in older adults. The most common cause of disability. American Journal
of Public Health, 102, 426–433.
Kapstad, H., Rustøen, T., Hanestad, B. R., Moum, T., Langeland, N. K., & Stavem, K. (2007).
Changes in pain, stiffness and physical function in patients with osteoarthritis waiting for hip or
knee joint replacement surgery. Osteoarthritis and Cartilage, 15, 837–843.
Klippel, J. H., Crofford, L. J., Stone, J. H., & Weyand, C. M. (2001). Primer on the rheumatic dis-
eases. Atlanta: Arthritis Foundation.
KOOS. http://www.koos.nu/. Accessed 22 Feb 2019.
Lawrence, R. C., Felson, D. T., Helmick, C. G., Arnold, L. M., Choi, H., Deyo, R. A., et al. (2008).
Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part
II. Arthritis and Rheumatism, 58, 26–35.
Losina, E., Paltiel, A. D., Weinstein, A. M., Yelin, E., Hunter, D. J., Chen, S. P., et al. (2015). Lifetime
medical costs of knee osteoarthritis management in the United States: Impact of extending indi-
cations for total knee arthroplasty. Arthritis Care & Research, 67, 203–215.
Mactaggart, I., Kuper, H., Murthy, G. V. S., Oye, J., & Polack, S. (2016). Measuring disability in
population based surveys: The interrelationship between clinical impairments and reported func-
tional limitations in Cameroon and India. PLoS One, 11, e0164470.
Marlene, F., Lisa, B., Lyn, M., Damian, H., Ester, P., & Peter, B. (2011). The epidemiology of osteo-
arthritis in Asia. International Journal of Rheumatic Diseases, 14, 113–121.
O’Reilly, S. C., Jones, A., Muir, K. R., & Doherty, M. (1998). Quadriceps weakness in knee osteoar-
thritis: The effect on pain and disability. Annals of the Rheumatic Diseases, 57, 588–594.
Sassi, F. (2006). Calculating QALYs, comparing QALY and DALY calculations. Health Policy Plan,
21, 402–408.
Satyamoorthy, T., Ali, S. A., & Kloseck, M. (2018). Cultural factors influencing osteoarthritis care in
asian communities: A review of the evidence. Journal of Community Health, 43, 816–826.

13
 Journal of Religion and Health

Steultjens, M. P., Dekker, J., van Baar, M. E., Oostendorp, R. A., & Bijlsma, J. W. (2000). Range of
joint motion and disability in patients with osteoarthritis of the knee or hip. Rheumatology, 39,
955–961.
Wallacea, I. J., Worthingtonb, S., Felson, D. T., Jurmaind, R. D., Wrene, K. T., Maijanenf, H., et  al.
(2017). Knee osteoarthritis has doubled in prevalence since the mid-20th century. PNAS, 114,
9332–9336.

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