Osteoarthritis (OA) of the knee is one of the most common and debilitating forms of arthritis, particularly affecting older adults worldwide. It is a progressive joint disorder characterized by the gradual breakdown of cartilage, leading to pain, stiffness, swelling, and reduced mobility. As the disease progresses, the structural integrity of the knee joint deteriorates, causing significant discomfort and impairing the ability to perform daily activities. In severe cases, osteoarthritis can lead to disability, greatly diminishing the quality of life for those affected.^1-4

Globally, the prevalence of osteoarthritis is on the rise, driven by factors such as an aging population, increased life expectancy, and the growing prevalence of obesity. The knee is particularly vulnerable to osteoarthritis due to its weight-bearing function, making it a critical area of concern for public health. Despite its widespread impact, public awareness and understanding of osteoarthritis, especially in rural and semi-urban areas, remain inadequate. This lack of awareness often leads to delayed diagnosis, improper management, and increased healthcare costs, exacerbating the burden on both individuals and healthcare systems.^5-7

In India, osteoarthritis of the knee is becoming an increasingly significant public health issue. The problem is particularly acute in rural and semi-urban regions like District Kangra in Himachal Pradesh, where occupational activities, lifestyle factors, and limited access to healthcare services contribute to the growing incidence of the disease. The district, known for its diverse population engaged in activities ranging from agriculture to office work, presents a unique case for studying the public's awareness and knowledge of osteoarthritis of the knee. Understanding how different demographic and occupational groups perceive and manage this condition is crucial for developing targeted public health interventions.^8-10

The importance of public awareness cannot be overstated when it comes to managing and preventing osteoarthritis. Early diagnosis and timely intervention are key to slowing the progression of the disease and improving outcomes for those affected. However, misconceptions and a general lack of knowledge about the causes, symptoms, prevention, and treatment of osteoarthritis continue to hinder effective management. Addressing these issues through education and awareness campaigns is vital for reducing the incidence and impact of osteoarthritis on individuals and communities.

This study aims to assess the awareness and knowledge of osteoarthritis of the knee among adults in District Kangra, Himachal Pradesh. By conducting a comprehensive cross-sectional survey, the research seeks to identify gaps in understanding and to provide insights into the public's perception of this common condition. The findings from this study will contribute to the development of more effective public health strategies and educational interventions, ultimately aiming to improve the quality of life for those at risk of or living with osteoarthritis. Through this research, we hope to promote better health outcomes and reduce the overall burden of osteoarthritis in District Kangra and similar regions.

Objectives of the Study:

The primary objective is to gauge awareness and knowledge about Osteoarthritis (OA) Knees among general public of District Kangra, Himachal Pradesh. 

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: District Kangra, Himachal Pradesh

• Study duration- between January 2024 to May 2024

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Kangra Himachal Pradesh for a minimum of 12 months

• Sample size- A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Osteoarthritis (OA) Knees, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Osteoarthritis (OA) Knees was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structuredknowledge related questions regarding Osteoarthritis (OA) Knees. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Kangra Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

Ethical Considerations- Participants confidentiality and anonymity was maintained.

The study involved 400 participants from District Kangra, Himachal Pradesh, and provided a detailed analysis of their socio-demographic characteristics and knowledge regarding osteoarthritis (OA) of the knees. The socio-demographic distribution (Table 1) revealed that the participants were well-represented across different age groups, with 30.0% aged 18-30 years, 25.3% aged 31-40 years, 22.5% aged 41-50 years, and 22.2% above 50 years of age. The gender distribution was nearly balanced, with 48.8% males and 51.3% females. In terms of marital status, the majority were married (57.5%), followed by single individuals (39.0%), and a small percentage (3.5%) classified as others. The religious composition showed that most participants were Hindu (83.0%), with Muslims (7.0%) and Sikhs (7.8%) also represented. Employment status indicated that 50.0% were employed, 26.3% were unemployed, and 23.8% were students. Regarding education levels, 34.5% were graduates, 26.8% had completed high school, 25.3% had postgraduate or higher education, and 13.5% had education below high school.

Table 1: Socio-Demographic Characteristics of Study Participants (N=400)

In terms of knowledge about the symptoms of osteoarthritis of the knees (Table 2), 79.0% of participants had heard of OA knees, and 72.0% were aware that OA knees could cause joint pain. Additionally, 68.8% recognized that OA knees could lead to stiffness, 66.3% were aware of the potential for swelling around the knee joint, and 64.3% understood that OA knees could result in difficulty in movement. These findings suggest that while most participants are aware of the condition and its primary symptoms, there is room for improving knowledge, particularly regarding the range of symptoms associated with OA knees.

Table 2: Knowledge Regarding Symptoms of Osteoarthritis (OA) Knees (N=400)

Knowledge regarding the causes and risk factors of OA knees (Table 3) was moderate. About 61.3% of participants knew that aging increases the risk of OA knees, and 59.3% were aware that obesity is a significant risk factor. Additionally, 57.5% recognized that previous knee injuries could lead to OA knees, and 55.0% understood that excessive physical activity could contribute to the condition. However, only 52.3% were aware that OA knees could be hereditary. These findings highlight the need for public health efforts to emphasize the role of modifiable risk factors, such as weight management and injury prevention, in reducing the risk of OA knees.

Table 3: Knowledge Regarding Causes and Risk Factors of Osteoarthritis (OA) Knees (N=400)

Regarding prevention (Table 4), knowledge levels were relatively low, with only 53.8% of participants aware that maintaining a healthy weight could help prevent OA knees. Similarly, 52.0% knew that regular low-impact exercises could aid in prevention, and 50.0% recognized the importance of avoiding joint overuse. However, awareness of other preventive measures was lower, with 48.0% knowing that good posture could help prevent OA knees, and only 45.0% understanding the role of balanced nutrition in prevention. These results suggest a need for targeted educational interventions focusing on practical preventive strategies.

Table 4: Knowledge Regarding Prevention of Osteoarthritis (OA) Knees (N=400)

In terms of treatment and management of OA knees (Table 5), awareness was relatively limited. Only 47.5% of participants knew that medications could help manage symptoms, and 45.3% were aware of the benefits of physical therapy. Furthermore, 42.8% recognized that exercises targeting the knee muscles could help manage OA knees, and 40.3% knew that knee supports could alleviate symptoms. The lowest awareness was regarding surgical intervention, with only 37.3% understanding that it might be necessary in severe cases. These findings indicate the need for better dissemination of information regarding both conservative and surgical treatment options for OA knees.

Table 5: Knowledge Regarding Treatment and Management of Osteoarthritis (OA) Knees (N=400)

Finally, the overall knowledge scores (Table 6) revealed a varied distribution among participants. About 25.8% demonstrated very good knowledge (scoring 16-20 points), while 28.8% had good knowledge (12-15 points). A notable 27.3% had fair knowledge (8-11 points), and 18.3% fell into the poor knowledge category (scoring below 8 points). This distribution indicates that while a portion of the population has a solid understanding of OA knees, a significant percentage still requires better education and awareness regarding this common condition.

Table 6: Overall, Knowledge Score Categories for Osteoarthritis (OA) Knees (N=400)

This study provides a comprehensive assessment of the awareness and knowledge regarding osteoarthritis (OA) of the knees among the general public in District Kangra, Himachal Pradesh. The findings reveal both strengths and significant areas for improvement in the public’s understanding of this prevalent and debilitating condition. Despite osteoarthritis being a major public health concern, especially in aging populations, the study highlights gaps in knowledge that may contribute to delayed diagnosis, improper management, and increased burden on individuals and the healthcare system.

The study sample was well-distributed across various demographic categories, offering a representative snapshot of the population in District Kangra. The balanced gender distribution (48.8% males and 51.3% females) and the wide age range, with the majority of participants aged between 18-50 years, reflect the general population's characteristics. Interestingly, a significant portion of the sample had higher education levels, with 34.5% being graduates and 25.3% having postgraduate or higher education. This demographic distribution suggests that educational attainment could influence awareness and knowledge levels regarding OA knees, highlighting the need for targeted educational interventions that address all segments of the population, including those with lower education levels.^4,5

The study found that while a substantial majority of participants (79.0%) had heard of osteoarthritis of the knees, detailed knowledge of its symptoms was somewhat lower. For instance, while 72.0% knew that OA knees could cause joint pain, fewer participants recognized that it could lead to stiffness (68.8%), swelling (66.3%), or difficulty in movement (64.3%). These findings indicate that although the general concept of osteoarthritis is well-known, the full spectrum of its symptoms is not as widely understood. This gap in knowledge may contribute to delayed diagnosis and inadequate management, as individuals may not recognize the early signs of OA knees or seek timely medical intervention. Public health campaigns should focus on increasing awareness about the broader range of symptoms associated with OA knees to ensure that individuals seek appropriate care early in the disease course.^5-8

Knowledge about the causes and risk factors of OA knees was moderate among the participants. While a majority understood that aging (61.3%) and obesity (59.3%) are significant risk factors, fewer participants were aware of other important contributors such as previous knee injuries (57.5%), excessive physical activity (55.0%), and hereditary factors (52.3%). These findings highlight the need for public health interventions to emphasize the role of modifiable risk factors like weight management and injury prevention in reducing the risk of OA knees. Additionally, educating the public about non-modifiable risk factors, such as genetics, can help in early identification of those at higher risk and promote preventive measures.^9-12

The study identified significant gaps in participants' knowledge about the prevention of OA knees. While 53.8% of participants knew that maintaining a healthy weight could help prevent OA knees, awareness of other preventive measures was lower. Only 52.0% recognized the benefits of regular low-impact exercises, and 50.0% understood the importance of avoiding joint overuse. Even fewer participants were aware of the role of good posture (48.0%) and balanced nutrition (45.0%) in preventing OA knees. These results suggest that while some preventive strategies are known, there is a need for broader education on the full range of measures that can help prevent osteoarthritis of the knees. Public health campaigns should particularly focus on practical, actionable advice that individuals can incorporate into their daily routines to reduce their risk of developing OA knees.^9-11

Participants' knowledge regarding the treatment and management of OA knees was relatively limited. Less than half of the participants were aware that medications (47.5%) and physical therapy (45.3%) could help manage the condition. Even fewer understood the benefits of exercises targeting the knee muscles (42.8%) and the use of knee supports (40.3%). The lowest awareness was regarding surgical intervention, with only 37.3% of participants understanding that it might be necessary in severe cases. These findings indicate a need for better dissemination of information about both conservative and surgical treatment options for OA knees. Ensuring that individuals are well-informed about the full range of management strategies is essential for improving outcomes and reducing the burden of the condition on both individuals and the healthcare system.^8,9

The overall knowledge scores revealed a wide distribution among participants, with 25.8% demonstrating very good knowledge and 28.8% showing good knowledge. However, a significant portion of the population still fell into the fair (27.3%) and poor (18.3%) knowledge categories. This variability underscores the fact that while some individuals possess a strong understanding of osteoarthritis of the knees, a considerable percentage of the population still lacks adequate knowledge. These results point to the need for targeted educational interventions that address specific gaps in knowledge, particularly among those with lower overall awareness. Public health initiatives should focus on enhancing understanding of the condition’s symptoms, causes, prevention, and treatment options to ensure that all segments of the population are well-informed.^9-12

The findings of this study have important implications for public health strategies in District Kangra and similar regions. There is a clear need for comprehensive educational campaigns that address both the general awareness of osteoarthritis and the specific knowledge gaps identified in this study. Public health initiatives should prioritize the dissemination of information on modifiable risk factors, prevention strategies, and treatment options, with a focus on practical, actionable advice that can be easily implemented by the general public. Additionally, healthcare providers in the region should be equipped with the tools and resources to educate their patients about osteoarthritis, emphasizing early diagnosis and effective management. Community-based interventions, such as workshops, health camps, and workplace ergonomic assessments, could be effective in raising awareness and promoting healthy practices that prevent and manage osteoarthritis of the knees.

In conclusion, this study underscores the significant gaps in awareness and knowledge of osteoarthritis of the knees among the general population in District Kangra, Himachal Pradesh. While there is a basic level of awareness, there remains a strong need for focused educational initiatives that cover the full range of symptoms, causes, prevention, and treatment options for osteoarthritis. Strengthening public health campaigns, encouraging early detection, and promoting evidence-based management through community programs and healthcare professionals are essential steps toward reducing the impact of osteoarthritis. Additionally, utilizing digital platforms to spread information can enhance outreach efforts and promote a more informed and proactive approach to managing this widespread condition, ultimately improving the quality of life for those affected and reducing its broader societal impact.

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