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The Revised Fibromyalgia Impact Questionnaire (FIQR) 

The original FIQ was subdivided into 3 domains; the "functional" domain, the "overall" domain and the "symptom" domain. Over the intervening years several deficiencies in the original FIQ became apparent; these deficiencies have been addressed in the FIQR. These 3 domains have been retained in the FIQR:

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
9 questions were developed for the functional domain of the FIQR.
 

1. Brush or comb your hair
2. Walk continuously for 20 minutes
3. Prepare a homemade meal
4. Vacuum, scrub or sweep floors
5. Lift and carry a bag full of groceries
6. Climb one flight of stairs
7. Change bed sheets
8. Sit in a chair for 45 minutes
9. Go shopping for groceries

2. The original overall domain asked a question regarding whether patients could work, including housework. This introduced a an interpretation dilemma, 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.

     1. Fibromyalgia prevented me from accomplishing goals for the week
       2. I was completely overwhelmed by my fibromyalgia symptoms

3. The symptom domain was modified by adding a question about tenderness. Tenderness is a universal feature of fibromyalgia patients; but has not been incorporated into FM related questionnaires, including the original FIQ. This omission is corrected in the FIQR; with this question it should be possible to compare objective measures of tenderness (e.g. the myalgic score) against the patient's report of this symptom. Three additional symptoms were added to the FIQR, to take into account some newer clinical findings. These new questions related to memory, balance and environmental sensitivity; here are the 10 symptom domain questions:

     1. Please rate your level of pain
       2. Please rate your level of energy
       3. Please rate your  level of stiffness
       4. Please rate the quality of your sleep
       5. Please rate your level of depression
       6. Please rate your level of memory problems
       7. Please rate your level of anxiety
   
   8. Please rate your level of tenderness to touch
       9. Please rate your level of balance problems
     10. Please rate your level of sensitivity to loud noises, bright lights, odors and cold

4. 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.

                                                                   Scoring the FIQR

The psychometric properties of the FIQR were rigorously evaluated in the original 2009 publication, which compared FIQR  scoring in healthy controls, patients with RA, patients with SLE, and patients with 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). This has been used to compare the diagnostic specificity of the individual question in the FIQR/SIQR in patients with FM, RA and SLE.
 


Comparison with of the FIQR with the Original FIQ

The FIQR can be compared with publications using the original FIQ, as the total scores for the 2 questionnaires show a good correlation (r=0.88, P<0.001),  - see graph from 2009 publication:
 

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”.

    

        Related links

                            FIQR paper form  SIQR paper form FIQR 2009  publication The original FIQ  

                                                        BACK  Scoring the FIQR
 


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