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An instrument developed to assess the current health status of women with the fibromyalgia syndrome in clinical and research settings1.
The FIQ was developed from information gathered from patient reports, functional status instruments, and clinical observations.
This instrument measures physical functioning, work status (missed days of work and job difficulty), depression, anxiety, morning tiredness,
pain, stiffness, fatigue, and well-being over the past week.
This website is a reference and should not be considered as a complete reference of all instruments used in research studies.
For permission to use the instruments users should contact the instrument developers listed within the reference. Furthermore,
the instruments described under the tabs are not endorsed by the ACR/ARHP.
Fibromyalgia Information Foundation (FIF): FIF
The original Fibromyalgia Impact Questionnaire(FIQ) was developed in the
late 1980s by Drs. Carol Burckhardt, Sharon Clark and Robert
Bennett at Oregon Health & Science University in Portland, Oregon USA. At that time the clinical features of fibromyalgia were just being described,
and the FIQ was an attempt to capture the total spectrum of problems related to fibromyalgia and the responses to therapy. The FIQ was first
published in 1991 and since that time has been extensively used as an index of disease activity and therapeutic efficacy. Its development is
described in separate reviews by Dr. Burckhardt and
Dr. Bennett. Several issues regarding ethocultural usage, symptom relevance and arcane
scoring became apparent and these issues have been addressed in the revised version FIQR.
Number of items in scale: The version from 19911 consisted of 10 items with 10 sub-items in the physical function scale (total items + sub-items = 19).
The modified version from 1997 consists of 20 items with 11 physical function items (total items + sub-items = 30). The 2009
version consists of 21 items across the 3 domains of Function (n = 9), Overall Impact (n = 2), and Symptoms (n = 10).
Subscales: Subscales from the 1991 version1 include physical function (10 sub-items), feel good (1 item), missed work (1 item),
do job (1 item), pain (1 item), fatigue (1 item), rested (1 item), stiffness (1 item), anxiety (1 item), and depression (1 item).
The modified version contains the same subscales with the changes noted above.
The FIQ was developed in and for adult patients with fibromyalgia.
A modified version of the FIQ was used in patients with post-Lyme disease syndrome15. This version includes 2 additional items
that evaluate problems with memory and concentration and with self-care.
World Health Organization (WHO) ICF Components: Original FIQ and 1997 and 2002 modifications d5202 (caring for hair), d4500 (walking short distances),d6300 (preparing a simple meal), d6402 (cleaning living area),
d430 (lifting and carrying an object), d4551 (climbing), d6408 (doing housework), d4153 (maintaining a sitting position),
d6200 (shopping), d2302 (completing daily routine), b1809 (experience of self and time function), b2800 (generalized pain),
b1300 (energy level), b7800 (sensation of muscle stiffness), b1343 (quality of sleep), b152 (emotional function), b1470
Additions to FIQR: b144 (memory function), b2702 (sensitivity to pressure), b2531 (vestibular function of balance), b2708 (sensory function
related to temperature and other stimuli)
Method: Self-administered questionnaire; easy to complete.
Training: None required; self-explanatory.
Time to administer/complete: Approximately 5 minutes.
Equipment needed: Pen and paper. The FIQR was administered online2.
Availability/cost:License to Use
Scale: In the original 1991 version, the physical impairment items use a 4-point Likert scale response set ranging from "always"
to "never." The "Feel Good" item response set is the number of days of the past week. The "Work Missed" item response is the
number of work days in the past week. The other symptom-based items use 100-mm anchored visual analog scales. In the modified
version, the visual analog scales for the symptom based items are scored in numerical increments from 0 to 10. Score range.
Final score should range from 0 to 80 (if work-related items are not included). This format is recommended in the scoring rubric by authors.
Interpretation of scores: Higher scores indicate greater impact of fibromyalgia on functioning.
In a pooled analysis of 2228 patients with fibromyalgia from three studies,
the estimated minimal clinically important differences in the FIQ total score
(95% confidence interval) was 14% (13; 15) and for FIQ stiffness it was 13% (12; 14).
In the severity analysis a FIQ total score from 0 to <39 was found to represent a mild
effect, >or= 39 to <59 a moderate effect, and >or=59 to 100 a severe effect;
Minimal clinically important difference in the fibromyalgia impact questionnaire2.
Bennett RM, Bushmakin AG, Cappelleri JC, Zlateva G, Sadosky AB. J Rheumatol.
2009 Jun;36(6):1304-11. Epub 2009 Apr 15.
Method of scoring
For the 1991 version the final scores for each scale should range from 0 (no impairment) to 10 (maximum impairment).
Physical Impairment: (Questions 1 a - j) Sum all items and divide the sum by the number of questions answered; multiply this value by 3.33. Feel Good: (Question 2): Reverse scoring (so that a higher number indicates impairment). Then multiply new score by 1.43.
Work Missed: (Question 3) Multiply raw score by 2. Do Job: (Question 4) Raw score is final score. Pain: (Question 5) Raw score is final score. Fatigue: (Question 6) Raw score is final score. Rested: (Question 7) Raw score is final score. Stiffness: (Question 8) Raw score is final score. Anxiety: (Question 9) Raw score is final score. Depression: (Question 10) Raw score is final score.
Modified 2002 version scoring mechanism: Each scale should range from 0 (no impairment) to 10 (maximum impairment). Physical Impairment: The raw scores for each item range from 0 to 3. Questions 1 - 11 are scored. Sum all items and divide the sum by the number of questions answered; multiply this value by 3.33. Feel Good: (Question 12) Reverse scoring (so that a higher number indicates impairment). Then multiple new score by 1.43. Work Missed: (Question 13) Multiply raw score by 1.43.
For each symptom-based item (Questions 14 - 20) the raw score ranges from 0 to 10. If the patient marks between 2 hash marks the item is given a score that includes 0.5. Do Job: (Question 14) Raw score is final score. Pain: (Question 15) Raw score is final score. Fatigue: (Question 16) Raw score is final score. Rested: (Question 17) Raw score is final score. Stiffness: (Question 18) Raw score is final score. Anxiety: (Question 19) Raw score is final score. Depression: (Question 20) Raw score is final score. In each instance, the final score is the sum of the scores for the Physical Impairment, Feel Good, Pain, Fatigue, Rested, Stiffness, Anxiety, and Depression scales (does not include 2 work items.)
For the 2009 FIQR, the scoring is much simpler than the FIQ2. The main improvements are that the summed score for Function is divided by 3, the summed score for Overall Impact is not changed, and the summed score for Symptoms is divided by 2. Then, the total FIQR is the sum of these 3 modified domain scores. The authors point out that the weighting of the 3 domains in the FIQR differs from the FIQ. For the FIQR, 30% of the total score is assigned to "function" with the FIQR (10% in the FIQ), 50% is credited to "symptoms" (70% in the FIQ), and "overall impact" remains the same as the FIQ at 20%. The total maximal score of the FIQR is 100, which is the same as the FIQ.
Time to score:
Brief for the FIQ; varies depending on use of computer to calculate final score. Authors of the FIQR indicate that investigator scoring was completed in 1 minute2.
Training to score: Minimal
Training to interpret: Minimal
Norms available: There are no clear norms available. Means and standard deviations for each of the items are presented in Burckhardt et al1. In the study by Pankoff et al16, 28 patients with fibromyalgia (3 male, 25 female), mean age 51.3 years, were recruited from the community; the mean total FIQ score was 49.7 (SD 11.4). Goldenberg et al17 studied 332 patients with fibromyalgia recruited from a tertiary care center. These subjects were actively seeking employment (mean age 44.3 years, range 22 - 70) and reported mean total FIQ scores of 54.8 (SD 19.6). Martinez et al18 in a study of 44 women with fibromyalgia with mean age 43 years and a mean duration of illness of 5.3 years, reported total mean total FIQ score of 47.28 (SD 13.9). Fitzcharles and Esdaile19 reported mean FIQ scores of 57 (SD = 20.5) in a cross-sectional study of 82 patients with fibromyalgia (mean age = 48 years, SD =10) recruited from a tertiary center and a community site.
Internal consistency. Not reported in original study. In the study by Hedlin et al (3), a Cronbach's alpha of 0.83 was reported. Test-retest/stability. Test-retest correlations using (Pearson's r) ranged from 0.56 (pain) to 0.95 for physical function scale in the original version of the FIQ.
Content/domain/face. Items for the original FIQ were derived from information gathered from patient reports, functional status instruments and clinical observations. On initial testing, a criterion of 25% impairment on the Arthritis Impact Measurement Scale (AIMS) was used to assess content validity of each item. None of the 4 activity of daily living scale items met the criteria. Opening a jar (dexterity), doing own housework, 2 mobility items and 4 of 5 physical functioning qualified. Thirty-eight percent of the patients did not work so the 2 work items did not apply.
Principal components analysis identified 5 factors. The first 10 sub-items of the FIQ loaded on physical function (loadings ranged from 0.50 to 0.95). Factor 2 consisted of work difficulty, feeling good, pain fatigue, rest and stiffness. The rest of the items were separate factors.
Correlations with the subscales of the AIMS were as follows: the FIQ physical function correlated 0.65 with the AIMS lower extremity physical function scale. The FIQ pain, depression and anxiety scales correlated strongly with the respective AIMS scales (r = 0.69, 0.73, 0.76). The FIQ items were significantly correlated with AIMS items (range 0.28 - 0.83). Correlations between the FIQ subscales and the number of tender points ranged from 0.14 (morning tiredness) to 0.74 for work missed.
The FIQR was compared with the original FIQ, which had been validated in many prior studies2. The total score of the FIQR in fibromyalgia patients was 56.58 Â±20 (range: 15-97) statistically different (p=0.03) for the total score for the FIQ was 60.56 Â±18.0 (range: 10-96). However, the strong correlation of 0.88 (p<0. 001) between the FIQR and FIQ suggested "that patients' relative standing on the two scales are very similar"2.
Dunkl et al20 assessed the responsiveness of the modified FIQ in a sample of 99 patients (8 male, 91 female) with fibromyalgia recruited from a university-based outpatient clinic, mean age 46.9 years (SD 7.9). The degree of correlation between change in FIQ scores and change in patient's global rating of symptoms was moderate (Spearman r = 0.51).
The FIQ was developed originally from a fibromyalgia clinic population that was mostly female, and it is possible that the instrument may have a gender bias, especially with items considered to be more likely to be performed by women. Dr. Bennett has pointed out that in Western societies in the 21st century, it is not uncommon for men to make meals, use a dishwasher, make beds and do laundry so the FIQ may be reasonable to administer in males3. No systematic comparison of the FIQ between men and women has been done. Buskilia et al21 reported that the physical functioning subscale of the FIQ did not differ between men and women.
Difficulties with aggregating data on the psychometric characteristics of this instrument reflect the variable use of scoring mechanisms and versions of the instrument in the research literature. Wolfe et al22 suggest there is no ideal functional assessment tool for use in this population. Specifically, Wolfe et al state that the FIQ "systematically underestimated impairment by its handling of activities not usually performed," and express concerns about the non-linearity of the scales. They recommend use of a modified version of the Health Assessment Questionnaire for patients with fibromyalgia. Further examination is needed of the FIQ in clinical trials with specific mention by researchers as to the version used (modified versus original) and scoring rubric implemented.
The FIQ appears to be a relatively useful measure of disease impact in patients with fibromyalgia. Overall, the FIQ has demonstrated good responsiveness to change in clinical studies and a good correlation with similar questionnaires, including the HAQ, AIMS and SF-36.