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Fibromyalgia Impact Assessment

FIQ-Fibromyalgia Impact Questionnaire

  • Fibromyalgia is defined as chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.

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.
2 Do laundry with washer & dryer
Score 0 - If you were Always able to do the activity.
3 Prepare meals
4 dishes/cooking utensils by hand
Score 1 - If you were Mostly able to do the activity.
5 Clean the house
Score 1 - If you were Mostly able to do the activity.
6 Make the bed
7 Walk several blocks
Score 2 - If you were Occasionaly able to do the activity.
8 Visit friends and relatives
Score 2 - If you were Occasionaly able to do the activity.
9 Do yard work
10 Drive a car
Score 3 - If you were Never able to do the activity.
11 Climb stairs
Score 3 - If you were Never able to do the activity.
Total number of questions answered (Q1–11)
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?
No problem with work
0 1 2 3 4 5 6 7 8 9 10
to Great difficulty with work
SCORE 0
15 How bad has your pain been?
No pain
0 1 2 3 4 5 6 7 8 9 10
to Very severe pain
SCORE 0
16 How tired have you been ?
No tiredness
0 1 2 3 4 5 6 7 8 9 10
to Very tired
SCORE 0
17 How have you felt when you getup in the morning?
Awoke well rested
0 1 2 3 4 5 6 7 8 9 10
to Awoke Very tired
SCORE 0
18 How bad has your stiffness been?
No Stiffness
0 1 2 3 4 5 6 7 8 9 10
to Very stiff
SCORE 0
19 How nervous or anxious have you felt?
Not Anxious
0 1 2 3 4 5 6 7 8 9 10
to Very anxious
SCORE 0
20 How depressed or blue have you felt?
Not depressed
0 1 2 3 4 5 6 7 8 9 10
to Very depressed
SCORE 0
Your FIQ Total 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+.