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The Fibromyalgia Impact Questionnaire is frequently used by doctors and researchers to
gauge the impact of fibromyalgia on patients' lives. It has been evaluated for reliability
and validity in the fibromyalgia population, making this a highly credible evaluation tool.
To use this questionnaire, you will need to print this page or keep track of your answers
on paper.
For questions 1 through 11, use the following scale to characterize how you did overall
for the past week.
(If you don't normally do something that's asked about, skip the question.)
Always = 0
Most = 1
Occasionally = 2
Never = 3
In the last week, were you able to:
- Do shopping? ________
- Do laundry with a washer and dryer? ________
- Prepare meals? ________
- Wash dishes/cooking utensils by hand? ________
- Vacuum a rug? ________
- Make beds? ________
- Walk several blocks? ________
- Visit friends or relatives? ________
- Do yard work? ________
- Drive a car? ________
- Climb stairs? ________
Scoring For the first 11 questions:
- Add up all of the numbers you entered
- Divide the total by the number of questions you answered
- Multiply that number by 3.33
Your score is: ________
For question 12 your answer will be a number between 0 and 7
12. Of the past 7 days, how many days did you feel good? ________
Scoring For Question 12:
Find your answer and assign it the following amount:
- Answer of 0 = 7 points
- Answer of 1 = 6 points
- Answer of 2 = 5 points
- Answer of 3 = 4 points
- Answer of 4 = 3 points
- Answer of 5 = 2 points
- Answer of 6 = 1 points
- Answer of 7 = 0 points
Multiply the number of points by 1.43
Your score is: ________
For question 13 your answer will be a number between 0 and 7
13. How many days in the past week did you miss work, including housework, because
of fibromyalgia? ________
Scoring For Question 13:
Use the number you entered as the number of points. Multiply the
number of points by 1.43
Your score is: ________
For questions 14 through 20, rank your answer between 0 and 10.
14. When you worked, how much did pain or other fibromyalgia symptoms interfere with
your ability to do your work, including housework? _______
(0 = no problem with work, 10 = great difficulty with work)
15. How bad has your pain been? ________
(0 = no pain, 10 = very severe pain)
16. How tired have you been? ________
(0 = no tiredness, 10 = very tired)
17. How have you felt when you get up in the morning? ________
(0 = awoke well rested,
10 = awoke very tired)
18. How bad has your stiffness been? ________
(0 = no stiffness, 10 = very stiff)
19. How nervous or anxious have you felt? ________
(0 = not anxious, 10 = very anxious)
20. How depressed or blue have you felt? ________
(0 = not depressed, 10 = very depressed)
Fibromyalgia Impact Questionnaire Scoring
Add the four scores above for your total score. Here is what your personal FIQ score means:
Low (Under 25)
Below Average (26-50)
Average to High (50-69)
Severe (70+)
Tips:
- The higher your total score, the more impact fibromyalgia is having on your life.
- The average person with fibromyalgia scores around 50 points. A score of 70 or higher
is considered severe.
FM/CFS/ME RESOURCES is taking a FIQ poll. Please help us by
taking this poll today. View current results for this poll.
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