Daily Individual and Marital Processes in Osteoarthritis

描述(申请人提供)：骨性关节炎(OA)是晚年最常见的慢性疾病，当它影响到臀部或膝盖时，尤其令人丧失能力。确定患者日常生活中的经历，随着时间的推移，增加或减少OA的一般严重程度，可能会使许多老年人受益。虽然配偶的日常支持可能会影响患者的功能(疼痛、僵硬、体力活动)，但与身体功能相关的配偶支持在很大程度上被忽视了。在这项拟议的研究中，我们将调查患者-配偶在患者症状严重性、关节炎自我效能和症状灾难方面的日常一致性(一致性)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)之间的关联程度。我们还将调查患者的疾病认知(自我效能感，灾难)，以此作为配偶支持与患者的日常功能和随着时间的推移一般的OA严重程度相关联的手段。此外，我们将研究配偶支持如何不同地影响女性和男性患者的疾病认知和功能。这项二元研究将集中在150名患有髋关节或膝骨性关节炎的老年人(75名男性和75名女性)及其配偶。我们将在基线、6个月和12个月进行为期21天的电子日记评估和活动记录(一种对患者体力活动的客观测量)与面对面访谈相结合。我们的具体目标是：1)检查患者与配偶之间的日常和谐及其对配偶支持质量的影响；2)检查患者日常疾病认知，以此作为将配偶支持与患者功能联系起来的机制；以及3)检查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内和人与人之间的可变性，以及这两种类型的可变性对骨关节炎严重程度的短期和长期变化的影响。研究结果将对加强对骨性关节炎的心理社会干预的有效性产生直接的影响。

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.