Does the Revised Fibromyalgia Impact Questionnaire Correlates with the Patient’s Opinion for the Monitoring of Fibromyalgia Syndrome?

Research Article

Austin Rheumatol. 2016; 1(1): 1001.

Does the Revised Fibromyalgia Impact Questionnaire Correlates with the Patient’s Opinion for the Monitoring of Fibromyalgia Syndrome?

Martinez JE* and Pironel AN

Department of Medicine, Pontifical Catholic University of Sao Paulo, Sorocaba, Brazil

*Corresponding author: José Eduardo Martinez, Department of Medicine, Pontifical Catholic University of Sao Paulo, Street Portugal, 63 Sorocaba, SP CEP 18045- 280, Brazil

Received: October 13, 2016; Accepted: November 03, 2016; Published: November 05, 2016


Introduction: Fibromyalgia (FM) is a chronic widespread musculoskeletal pain syndrome with cognitive, emotional and social impact. The clinical picture consists mainly of subjective symptoms. Therefore, questionnaires to assess its impact and the ones to evaluate quality of life have become useful tools to monitor this syndrome. The revised Fibromyalgia Impact Questionnaire (FIQr) is a specific questionnaire that has been used in published clinical studies.

Objective: To evaluate the usefulness of FIQr for monitoring patients compared to their own opinion.

Methods: It was studied 21 patients treated at the Outpatient Clinics Setting of the Pontifical Catholic University of Sao Paulo. Patients fulfilled the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia. It was applied the FIQr and a Likert scale on patient’s opinion regarding their evolution. It was considered a clinical state change when the FIQr scores ranged 20% up or down. Descriptive statistics were used.

Results: Nineteen percent of patients (19.04%) agreed on the evolution to the variation observed in FIQr. Conclusion: It was concluded that the patient’s opinion about their evolution and FIQr measure different variables. The FIQr is a comprehensive tool that addresses issues that cannot be valued in the subjective assessment of the patient in the same proportion. So, it seems important the simultaneous use of both instruments.

Keywords: Fibromyalgia; Clinical Evolution; The Fibromyalgia Impact Questionnaire


Fibromyalgia (FM) is a chronic generalized musculoskeletal pain syndrome present in 3 to 5 % of the global population. The other core symptoms are fatigue and non-restorative sleep. This clinical picture is often associated with other functional syndromes such as migraine, miofascial pain syndrome and irritable bowel syndrome [1,2].

Although, its complete etiopathogeny is unknown, the most frequently proposed mechanism of disease involves central pain processing disturbance with central sensitization and a chronic distress process [3].

The scientific literature on this syndrome had a major increase after the publication of the Classification Criteria for Fibromyalgia of the American College of Rheumatology (ACR) in 1990. It establishes that a patient to be included in researches shall present with widespread pain according to a specific definition for more than 3 months and also 11 of 18 specific tender points on palpation [2].

The impact of FM on quality of life has been recognized in the literature as an important feature at the patient’s lives since the syndrome description [4]. This impact is generated by the symptoms intensity, mainly pain and fatigue and the interference on patient’s ability to perform daily life activities. It also causes work limitation, lower vitality and worst integration on society. The association with depression and anxiety can be an important aggravating factor [5,6].

The use of questionnaires to measure the impact of the disease has been recognized as an important tool in medical practice. They allow a valid assessment of FM subjective symptoms and their impact [5-7]. Their use also allows approaching a new theory that poses FM as a continuous and not a discrete clinical entity.

In 1991, Burckhardt et al published a specific instrument for assessing FM called The Fibromyalgia Impact Questionnaire” (FIQ). It was translated and validated in Brazil in 2006 [7,8]. This questionnaire is composed by three main dimensions: functional capacity, occupational and symptoms severity [7]. It ranges from 0 to 100 where 100 is the worst possible scenario [7].

In 2009, a new version of the same questionnaire, entitled “Revised Fibromyalgia Impact Questionnaire” (FIQr) was published. It was translated, culturally adapted and validated to Brazil by the Commission for fibromyalgia, pain and other soft tissue injuries of the Brazilian Society of Rheumatology [9]. Although it was very well accepted by the FM researches, one question persists. Can the FIQ replace patient’s own opinion about his/her evolution as a parameter to change the therapeutic planning?.

The objective of this research was to evaluate the usefulness of monitoring of patients with the FIQr compared to patient’s opinion on their follow up.

Materials and Methods

It was studied 21 women who had fulfilled the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia. They are being treated at the Rheumatology Outpatient Clinic of the Pontifical Catholic University of Sao Paulo (PUC-SP), located at Sorocaba, which is a city far 100 kilometers from the capital of the state, São Paulo.

The following research instruments were used: three points Likert scales about evolution of the severity of the syndrome and the intensity of pain (worsened - unchanged - improved) and the FIQr.

The instruments were applied at two consecutive visits with a minimum interval of three months. It was analyzed the coincidence of improvement or worsening measured by the two instruments. It was considered a minimal clinically significant variation of 20% for the FIQr total score.

The Research Ethics Committee of the PUC-SP approved the research protocol and the patient post informed consent formulary.


All patients are female with a mean age of 42.6 =/- 5,3 years old. Most of them have studied over 8 years of formal schooling (15 patients). Table 1 describes the results for each patient in relation to their perceptions on the syndrome evolution by the two tools used. Using the FIQr scores the majority of patients were considered unchanged (80,9%) followed by the ones that showed worst scores. The patient’s perception showed different results since the majority of patients reported that there was an improvement followed by the ones that considered themselves to be worse.