Daily Individual and Marital Processes in Osteoarthritis

描述（由申请人提供）：骨关节炎（OA）是老年人最常见的慢性疾病，当影响髋关节或膝关节时，尤其会致残。确定患者日常生活中的经验，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。虽然来自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），但与身体功能相关的配偶支持在很大程度上被忽视了。在拟议的研究中，我们将调查患者症状严重程度，关节炎自我效能和症状灾难化的日常患者-配偶一致性（协议）与积极的配偶支持（移情和同情支持反应）和有问题的配偶支持（不敏感和热心的反应）相关的程度。我们还将调查患者的疾病认知（自我效能，灾难化）作为一种手段，通过这种手段，配偶支持与患者的日常功能和一般OA严重程度随着时间的推移。此外，我们将研究如何配偶的支持可能会影响不同的女性和男性患者的疾病认知和功能。这项二人研究将重点关注150名患有髋关节或膝关节OA的老年人（75名男性和75名女性）及其配偶。我们将结合联合收割机进行两次为期21天的电子日记评估和体动记录（一种患者体力活动的客观测量），并在基线、日记评估和体动记录后6个月和12个月进行面对面访谈。我们的具体目标是：1）检查患者-配偶日常一致性及其对配偶支持质量的影响; 2）检查患者的日常疾病认知，作为将配偶支持与患者功能联系起来的机制; 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变异性，以及两种类型的变异性对OA严重程度的短期和长期变化的影响。研究结果将有直接的影响，加强对OA的二元心理干预的有效性。

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.