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Self Assessment

MSK Disease Screening

SF Health Surveys - SF - 12
Clinical Disease Activity Index

Osteoporosis Risk Test

Fibromyalgia Impact Assessment
Fibromyalgia Screening Tool

Health Assessment Questionaire

 

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
3 Prepare meals  
4 Wash dishes/cooking utensils by hand Score 1 - If you were Mostly able to do
the activity.
5 Clean the house
6 Make the bed  
7 Walk several blocks Score 2 - If you were Occasionaly able to do
the activity.
8 Visit friends and relatives
9 Do yard work  
10 Drive a car Score 3 - If you were Never able to do
the activity.
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?
No problem with work
010
to Great difficulty with work
15 How bad has your pain been?
No pain
010
to Very severe pain
16 How tired have you been ?
No tiredness
010
to Very tired
17 How have you felt when you getup in the morning?
Awoke well rested
010
to Awoke Very tired
18 How bad has your stiffness been?
No Stiffness
010
to Very stiff
19 How nervous or anxious have you felt?
Not Anxious
010
to Very anxious
20 How depressed or blue have you felt?
Not depressed
010
to Very depressed
  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+.