FIQ-Fibromyalgia Impact Questionnaire
- Fibromyalgia is defined as chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.
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Purpose -
To assess the current health (i.e., physical function, symptoms) of patients with fibromyalgia in clinical and research settings. -
Disclaimer -
This website is a reference and should not be considered as a complete reference of all instruments used in research studies. - The self calculating Questionnaire has been developed from existing FIQ by arthritsicare.co.in
Institute of Rheumatology and Pain - www. arthritiscare.co.in | ||||||
FIQ - FIBROMYALGIA IMPACT QUESTIONAIRE | ||||||
Instructions: For questions 1 through 11, please score 0-3 to best describe how you did overall for the past week. If you don't normally do something that is asked, do not answer the question. | ||||||
Were you able to: | SCORE | |||||
1 | Do shopping | Score 0 - If you were Always able to do the activity. |
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2 | Do laundry with washer & dryer | |||||
3 | Prepare meals | |||||
4 | Wash dishes/cooking utensils by hand | Score 1 - If you were Mostly able to do the activity. |
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5 | Clean the house | |||||
6 | Make the bed | |||||
7 | Walk several blocks | Score 2 - If you were Occasionaly able to do the activity. |
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8 | Visit friends and relatives | |||||
9 | Do yard work | |||||
10 | Drive a car | Score 3 - If you were Never able to do the activity. |
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11 | Climb stairs | |||||
Total number of questions answered | ||||||
12 | Of 7 days in the past week, how many days did you Not feel good? | |||||
13 | How many days last week did you miss work, including housework, because of fibromyalgia? | |||||
Instructions: For the remaining items, on a scale of 0-10 give point that best indicates how you felt overall for the past week. | ||||||
14 | When you worked, how much did the pain or other symptoms of your fibromyalgia interfere with your ability to do your work, including housework? |
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No problem with work
to Great difficulty with work
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15 | How bad has your pain been? | |||||
No pain
to Very severe pain
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16 | How tired have you been ? | |||||
No tiredness
to Very tired
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17 | How have you felt when you getup in the morning? | |||||
Awoke well rested
to Awoke Very tired
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18 | How bad has your stiffness been? | |||||
No Stiffness
to Very stiff
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19 | How nervous or anxious have you felt? | |||||
Not Anxious
to Very anxious
|
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20 | How depressed or blue have you felt? | |||||
Not depressed
to Very depressed
|
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Your Score | ||||||
1. The higher the total score, the greater impact FM is having on the person’s life. | ||||||
2. The average FM patient scores 50. Severely afflicted patients score 70+. |