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Permission to use the Fibromyalgia Impact Questionnaire for Academic Research and Clinical Evaluation of Fibromyalgia Patients
 

 
 

Free academic and clinical use of the Fibromyalgia Impact Questionnaire (FIQ) is based on your agreement to the following understandings plus completion of the registration form:

 

1. The FIQ and all translations and derivations are under copyright protection with all rights reserved to the Authors.

 

2. This academic license of the FIQ will not be used for Industry Sponsored Studies or similar Commercial Uses.

 

3. The original 1991 FIQ was modified in 1997, when 1 item (climb stairs) was added to the physical function subscale, hashmarks were added to the visual analogue scales to make scoring easier, and the words "including housework" were added to the 2 work-related items so that housework was recognized as a legitimate type of work. To avoid any confusion between both versions, each version will be numbered as follows: 

·    FIQ 1991 will be version 1.0. 

·    FIQ 1997 revised will be version 2.1.

 For any new study, use of the FIQ 2.1 shall be required.

 

5. No changes to the wording or phrasing of the FIQ can occur without written permission from the Authors. If any changes are made to the wording or phrasing of any FIQ item without permission, the document cannot be considered the FIQ, and subsequent analyses and/or comparisons to other FIQ data will not be considered appropriate.

 

6. Any publication resulting from use of the FIQ shall reference the following 2 publications:
(i) 
Burckhardt, C.S., Clark, S.R., Bennett, R.M.:  The fibromyalgia impact questionnaire (FIQ):    
    development and validation.    J
Rheumatol. 18:728-733, 1991.
(ii) Bennett RM, The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version,
    operating characteristics and uses.  Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):154-62.

7. Queries relating to this academic license should be addressed to MAPI at trust@mapi.fr.

 REGISTRATION FOR AN ACADEMIC LICENSE

 A license to use the FIQ for non-commercial purposes can be obtained on-line by completing 
 this registration form.

 I agree to the above stipulations and request an academic license to use the FIQ:
 

 Last name of licensee  
First name of licensee  
Professional address  
City / State / Zip /Country  
Email address of licensee  
Name of project   
Estimated date of onset (mm/yr)   
Estimated date of finish (mm/yr)  

 

   

     
 

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