Dyadic Coping with Dyspnoea-Related Kinesiophobia in Couples Living with COPD: "Entrapped Together or Moving Through Together” – A Constructivist Grounded Theory

Xing Liu,1 Wenxiang Fan,1 Tingxu Zhou,1 Shuhua Li,2 Linping Shang31Nursing College, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 2NHC Key Laboratory of Pneumoconiosis, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 3Nursing Department, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of ChinaCorrespondence: Linping Shang, Nursing Department, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China, Tel +86-13934226118, Email shanglp2002@163.comAim: To generate a theory explaining how patients with chronic obstructive pulmonary disease (COPD) and their partners experience and navigate the process of coping with dyspnoea-related kinesiophobia within everyday pulmonary rehabilitation and home-based disease management.Methods: A qualitative study using constructivist grounded theory was conducted in the respiratory department of one large tertiary hospital and its affiliated community health service centre in Shanxi Province, China. Initial purposive sampling and subsequent theoretical sampling were used to recruit 21 couples, comprising clinically stable patients with COPD and kinesiophobia (operationally defined as Breathlessness Beliefs Questionnaire–Activity Avoidance subscale score > 6) and their cohabiting partners. Data were collected through face-to-face dyadic interviews. Concurrent data analysis employed a constant comparative approach, facilitated by NVivo 12 software, to iteratively refine emerging codes and categories.Results: The 21 patients represented GOLD airflow limitation grades 1– 3, including grade 1 (n=2), grade 2 (n=12), and grade 3 (n=7). Analysis generated the core category "Entrapped Together or Moving Through Together”, which conceptualises kinesiophobia as a dynamic dyadic process rather than solely an individual experience. Patients’ symptom-related fear entered couple interactions through two distinct patterns: patients’ expressions of distress elicited kinesiophobia and protective anxiety in partners, whereas partners’ protective monitoring and restriction could become incorporated into patients’ movement-related concerns. Couples subsequently responded through four patterns—joint avoidance, motivational conflict, support mismatch, and the paradox of love. Over time, these interactions were associated with two contrasting relational states: becoming "entrapped together” through persistent avoidance and overprotection, or "moving through together” through communication, role adjustment, and accumulated successful experiences. These relational states could, in turn, shape subsequent couple interactions around kinesiophobia.Conclusion: The findings reveal profound dyadic interdependence in coping with kinesiophobia, providing support for the development of rehabilitative frameworks prioritising both objective functional outcomes and the subjective experiences of both partners. A couple-centred model of support warrants development and evaluation for sustainably improving rehabilitation trajectories for both patients and their partners.Keywords: chronic obstructive pulmonary disease, constructivist grounded theory, couples, dyadic coping, kinesiophobia