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The Revised
Fibromyalgia Questionnaire (FIQR)
The Fibromyalgia Impact
Questionnaire (FIQ) was originally constructed and validated in
1991. Over the ensuing years it became the most widely used
questionnaire to gauge the overall activity of fibromyalgia
symptoms. This questionnaire was subdivided into 3 domains; the
"functional" domain, the "overall" domain and the "symptom"
domain. These 3 FIQ domains have been retained in the FIQR. Over
the intervening years several deficiencies in the original FIQ
became apparent:
1. The functional domain was
originally devised with middle class Caucasian women in mind (as
this was the predominant group seen in the OHSU clinic).
Therefore, with the help of a patient focus group, a completely
new and more generic set of questions was substituted in the
original functional domain.
2. Three additional symptoms
needed to be added, to take into account the most recent
research finding. These related to: memory, balance and
environmental sensitivity and were added to the symptom domain.
3. It seemed important to ask
patients about their degree of tenderness, so that objective
measures of tenderness (e.g. the myalgic score) could be tested
against the patients report of this symptom; thus a tenderness
VAS was added to the symptom domain.
4. As many fibromyalgia patients
do not work outside the home, the overall domain question
regarding whether they could work, including housework,
introduced a scoring dichotomy. As it assumed that doing
housework involved the same time constraints and effort as
holding down a full time job. Therefore, the 2 overall domain
questions were phrased in terms as to the extent that
fibromyalgia interfered with the patient's goals for the week
and the extent that the patient felt overwhelmed by their
fibromyalgia symptoms.
5. The scoring of the original
FIQ was cumbersome and time-consuming. The FIQR has all
questions rated on a 0 -10 scale, and scoring is simply a matter
of adding the score for each domain and applying a
"normalization" factor to each of the 3 domain scores. The
functional domain score is divided by 3, the overall domain
score is divided by 1 (i.e. it is left unchanged), and the
symptom domain score is divided by 2. The total FIQR score is
the sum of the 3 normalized domain scores.
The psychometric properties of the
FIQR have been rigorously evaluated and compared to healthy
individuals, patients with RA, patients with SLE, and patients
with a diagnosis of major depressive disorder (MDD). A slightly
modified version of the FIQR was used in healthy controls; this
version does not contain the word "fibromyalgia" and can be used
as a more generic questionnaire (the Symptom Impact
Questionnaire or SIQR).
The FIQR can be compared with
publications using the original FIQ, as the total scores for the
2 questionnaires show a good agreement - see graph:
Addendum June 2010
Sometimes one or two items of the first domain (i.e. function),
cannot be answered because a subject has not performed that
activity within the past 7 days or is physically unable to
perform that activity. We therefore recommend using the
following amendment of the sentinel question for the first domain:
“Check the
box that best indicates
how much your fibromyalgia made it difficult to perform each of
the following 9 activities during the past 7 days. If you did
not perform a particular activity in the last 7 days, rate the
difficulty for the last time you performed the activity.
If you can’t perform an activity, check the last box”.
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