Culturally Embedded Participation Restrictions in Indian Adults With Knee Osteoarthritis: An ICF‐Based Qualitative Study

OBJECTIVE: To identify culturally relevant functioning issues experienced by Indian adults with knee osteoarthritis (KOA) using the International Classification of Functioning, Disability and Health (ICF) framework. METHODS: A qualitative descriptive study using semi-structured focus group interviews was conducted with 38 ambulatory adults (35-85 years) diagnosed with knee osteoarthritis (KOA). Participants were recruited from physiotherapy outpatient departments and community settings using maximum variation sampling. Interviews were conducted in Gujarati, audio-recorded, transcribed verbatim, translated into English and analysed using reflexive thematic analysis. Meaningful concepts were systematically linked to ICF categories using established linking rules. Dual independent coding and consensus discussions ensured the analytic rigour. RESULTS: This study included 38 participants with KOA. Fifty-five meaningful second-level categories were identified. The most represented components were activities and participation (41.2%) and body functions (29.4%). Frequently mapped first-level categories included mobility (n = 22), neuromusculoskeletal and movement-related functions (n = 9), d6 domestic life (n = 10), community, social and civic life (n = 7) and products and technology (n = 9). Sixteen additional categories not represented in the existing ICF Core Set for OA emerged, particularly relating to culturally embedded activities such as floor sitting, squatting for toileting and religious participation. Environmental barriers, including inaccessible infrastructure and limited rehabilitation services, influenced disability experience. CONCLUSION: Functioning among Indian adults with KOA is influenced by culturally embedded participation demands and contextual barriers that are insufficiently captured in the existing ICF Core Set for osteoarthritis (OA). These findings provide preliminary empirical support for contextual validation of the ICF Core Set for OA and inform potential culturally responsive adaptation for KOA.