Daily Individual and Marital Processes in Osteoarthritis

描述（由申请人提供）：骨关节炎（OA）是晚年最常见的慢性疾病，当它影响臀部或膝盖时尤其致残。随着时间的推移，确定患者日常生活中增加或减少OA一般严重程度的经历可能对许多老年人有益。尽管配偶的日常支持可能会影响患者的功能（疼痛、僵硬、身体活动），但配偶对身体功能的支持在很大程度上被忽视了。在拟议的研究中，我们将调查患者-配偶关于患者症状严重程度、关节炎自我效能和症状灾难化的日常一致性（协议）与积极的配偶支持（共情和自主支持反应）和有问题的配偶支持（不敏感和关怀反应）的关联程度。我们还将调查患者的疾病认知（自我效能感、灾难化），通过这种方式，配偶支持与患者的日常功能和一般OA严重程度之间的关系。此外，我们将研究配偶支持如何影响女性和男性患者的疾病认知和功能。这项二元研究将重点关注150名患有髋关节或膝关节OA的老年人（男性75人，女性75人）及其配偶。我们将结合两次21天的电子日记评估和活动记录仪（一种对患者身体活动的客观测量），并在日记评估和活动记录仪后的基线、6个月和12个月进行面对面访谈。我们的具体目标是：1)检查日常患者-配偶的一致性及其对配偶支持质量的影响；2)研究患者的日常疾病认知作为配偶支持与患者功能联系的机制；3)研究性别对个体和二元过程的影响。研究设计将使我们能够检查人体内和人与人之间的变异性，以及两种变异性对OA严重程度的短期和长期变化的影响。研究结果将对加强对OA的双重心理社会干预的有效性产生直接影响。

DESCRIPTION (provided by applicant): Osteoarthritis (OA) is the most common chronic illness of late life and is especially disabling when it affects the hips or knees. Identifying experiences in patients' daily lives that increase or diminish the general severity of OA over time is likely to benefit many older adults. Although daily support from the spouse is likely to impact patients' functioning (pain, stiffness, physical activity), spousal support in relation to physical functioning has been largely overlooked. In the proposed study we will investigate the extent to which daily patient-spouse concordance (agreement) regarding patient symptom severity, arthritis self-efficacy, and symptom catastrophizing is associated with positive spousal support (empathic and autonomy-supportive responses) and problematic spousal support (insensitive and solicitous responses). We will also investigate patients' illness cognitions (self-efficacy, catastrophizing) as means through which spousal support is associated with patients' daily functioning and general OA severity over time. Further, we will examine how spousal support may differentially affect female and male patients' illness cognitions and functioning. This dyadic study will focus on 150 older adults with hip or knee OA (75 male and 75 female), and their spouses. We will combine two 21-day electronic diary assessments and actigraphy (an objective measure of patients' physical activity) with in-person interviews at baseline, 6 months, and 12 months after diary assessment and actigraphy. Our specific aims are: 1) to examine daily patient-spouse concordance and its effects on the quality of spousal support; 2) to examine patients' daily illness cognitions as mechanisms that link spousal support with patients' functioning; and 3) to examine the influence of gender on individual and dyadic processes. The study design will enable us to examine variability within and between persons, and the effects of both types of variability on short- and long-term change in OA severity. Findings will have direct implications for strengthening the effectiveness of dyadic psychosocial interventions for OA.