A Longitudinal Observational Study of Multimorbidity and Partner Support for Physical Activity Among People with Osteoarthritis.

BACKGROUND: Physical activity can improve osteoarthritis-related symptoms; however, many people with osteoarthritis (PWOA) are insufficiently active. Social support for physical activity from an intimate partner can help PWOA increase activity, but managing multiple, chronic physical or mental health conditions (i.e., multimorbidity) may influence provision and receipt of that support. METHOD: Data from a 1-year longitudinal observational study was used to examine associations between multimorbidity and three dimensions of partner support for physical activity-companionship partner support (doing activity together), enacted partner support, and social support effectiveness-in 169 insufficiently active PWOA and their partners. RESULTS: Multivariable-adjusted multi-level models indicated baseline differences in support by multimorbidity status: when partners had multimorbidity, PWOA reported receiving less companionship support and less effective support from partners; when PWOA had multimorbidity, partners reported providing less enacted support and both partners and PWOA reported less effective partner support. Broad trends (p < .05) indicate initial increases and subsequent decreases in companionship and enacted partner support when PWOA had multimorbidity, and among partners with and without multimorbidity. When PWOA had multimorbidity, an initial increase in support effectiveness was followed by no significant change; a similar trend was seen among partners with and without multimorbidity. CONCLUSION: Multimorbidity may generally contribute to less partner support for physical activity or less effective support, although influences on support over time are less clear. Physical activity interventions for couples experiencing multimorbidity would likely benefit from attention to the impact of multiple chronic health conditions on physical activity and physical activity-related partner support.

Overcoming Barriers to Physical Activity in People with Osteoarthritis: the Role of Empathic Accuracy in Couples' Planning Discussions.

BACKGROUND: Osteoarthritis (OA) is a common chronic joint disease with significant individual and public health consequences. Physical activity can reduce OA symptoms, but patients often fall below recommended levels. Social support from an intimate partner can help them become more active; however, some couples are better than others at enacting effective support. We examined the role of empathic accuracy (EA)-the ability to understand another person's thoughts and feelings-in couples' ability to identify strategies for overcoming barriers to increasing activity. We also examined whether EA was associated with changes in affect and with emotion regulation and communication skills. METHOD: Forty-two insufficiently physically active participants with OA identified a barrier to becoming more active in a recorded discussion with their partner. Next, both rated self and partner thoughts and feelings during the discussion. Raters coded EA and whether discussions reached a solution. Affect and skills were assessed with validated questionnaires. RESULTS: An actor-partner interdependence model found higher EA for participants in couples who reached a solution compared to those who did not reach a solution in the allotted time. Both partners' EA was associated with reduced negative affect in the other member of the couple. Unexpectedly, EA in people with OA was associated with reduced positive affect for their partners. EA was positively associated with one skill: emotional clarity. CONCLUSION: Findings from this early-stage study suggest that EA can help couples manage health-related issues together. Emotional clarity emerged as a skill related to EA, suggesting avenues for additional research.

The Role of Cohabitating Partner and Relationship Characteristics on Physical Activity among Individuals with Osteoarthritis.

BACKGROUND: Most individuals with knee or hip osteoarthritis do not meet recommendations for physical activity. The Social Cognitive Theory suggests that the social environment (e.g., spouses/partners) may influence the physical activity of individuals with osteoarthritis. The purpose of this study was to examine whether the physical activity of insufficiently active, coupled adults with osteoarthritis was associated with received partner support for physical activity, partner's engagement in physical activity, and relationship satisfaction. METHODS: Cross-sectional data from 169 couples were collected. Accelerometers estimated moderate-to-vigorous physical activity and daily steps for participants with osteoarthritis and their partners. Participants with osteoarthritis reported total received partner support for physical activity and relationship satisfaction. RESULTS: Participants with osteoarthritis were on average 65 years old, 65% female, 86% non-Hispanic white, and 47% retired. Receiving total partner support more frequently was associated with more minutes of moderate-to-vigorous physical activity but not with steps. Relationship satisfaction moderated the association of partner's physical activity on the daily steps of individuals with osteoarthritis such that having a partner who accomplished more daily steps was associated with participants with osteoarthritis accomplishing more daily steps themselves when they reported greater relationship satisfaction. CONCLUSIONS: Partners and relationship satisfaction may play an important role in the physical activity of individuals with osteoarthritis. Interventions seeking to increase physical activity in this population may be enhanced by promoting partner support. Additional research is needed to further explain these associations within the context of relationship satisfaction.

Developing a couple typology: A qualitative study of couple dynamics around physical activity.

Partner-based social support can motivate engagement in physical activity (PA); however, couples approach exchanging support in different ways. This study aimed to elucidate the role of relationship dynamics in couple-based support for PA, with the goal of informing intervention strategies that will effectively leverage couple characteristics to increase support for PA. We conducted a qualitative study of couples who completed a longitudinal study of social support for PA. Participants were people with osteoarthritis who were not meeting PA recommendations and their cohabitating partners (n = 19 couples). We conducted in-depth, semistructured interviews and analyzed transcripts using narrative analysis. Participants were 76% non-Hispanic White and, on average, 62 years old. Themes in the data included (a) attitudes about working together to be more active (ranging from positive to negative) and (b) couples' narrative concordance (high to low shared reality). We developed a couple typology with four categories: "Working together works" (positive attitudes/high shared reality; n = 4 couples), "Doing our own thing" (range of attitudes with practical/preferential barriers to working together/high shared reality; n = 5 couples), "Conscious conflict" (discrepant attitudes/high shared reality; n = 5 couples), and "Different realities" (discrepant attitudes/low shared reality; n = 5 couples). We describe examples of each type. In a sample of 19 couples, there were observable differences in participants' attitudes about working together to be more active and in couples' shared reality around those attitudes. Future research should investigate implications for the efficacy of interventions and, if warranted, develop methods to identify couple types and offer appropriate intervention strategies.

Four Methods of Recruiting Couples Into a Longitudinal Study of Physical Activity in People With Osteoarthritis: Recruitment, Retention, and Lessons Learned.

Increases in physical activity can reduce joint pain among people with osteoarthritis (PWOA) who are insufficiently physically active. Because evidence suggests that social support from intimate partners may help PWOA become more active, researchers have been interested in recruiting couples to studies of physical activity interventions; however, little guidance exists describing efficient and effective strategies for engaging couples in research. We describe methods used to recruit couples and contrast methods in terms of the proportion of individuals enrolled, sample demographic composition, retention, and resources. We used four recruitment methods to enroll couples in a longitudinal study of PWOA: (1) visiting community sites, (2) sending university-wide emails, (3) contacting patients identified through electronic medical records (EMR), and (4) partnering with a county-based osteoarthritis (OA) research cohort. We found that these methods differed in their challenges and contribution to enrollment goals but demonstrated similar levels of retention. We contacted 747 PWOA; 56% were screened for eligibility and 23% enrolled in the study. The largest proportion of participants recruited were from the email method (35.1%), followed by the community (26%), EMR (22.0%), and OA cohort (19.6%). Couples enrolled through the different methods differed by age, employment, education, and household income. Across the methods for both PWOA and partners, over 80% of participants were non-Hispanic white, about 11% were non-Hispanic black, and 6-8% identified as another race. Over 12 months of follow-up, 31 (17.9%) PWOA and 36 (20.8%) partners were lost to follow-up. Using four distinct recruitment methods allowed us to meet recruitment goals and provided a broader, more diverse population compared to using one method. We recommend that researchers consider several recruitment methods to meet enrollment goals, to ensure a diverse sample, and to match available resources. The lessons learned from this research fill a critical gap in the understanding of how to overcome barriers to recruiting and retaining couples in behavioral research.