FM/CFS/ME RESOURCES - REVISED FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQR)

 

Search Site 
DATABASE INFO
Disability Attornies
Find A Doctor
Drugs Used In FM & CFS/ME
In-Person Support Groups

INFORMATION
Abbreviations
Archived Poll Results
Candles of Hope
CMP Info.
Family and Friends
Financial Help
FM/CFS/ME Facts
Letter To Loved Ones
Living With FM & CFS/ME
Newly Diagnosed
Rate Your Meds  -  Results
Recommend Doctor
Researchers Spotlight

QUIZ & SURVEY
Take Quiz
Quiz Winners
Patient Surveys

REVISED FIBROMYALGIA IMPACT QUESTIONNAIRE (FIQR)

To use this questionnaire, you will need to print this page or keep track of your answers on paper.


Last Name:
First Name:
Age: Duration of FM symptoms (years): Time since FM was first diagnosed (years):

Directions: For each of the following 9 questions check the box that best indicates how much your fibromyalgia made it difficult to perform each of the following activities during the past 7 days. If you did not perform a particular activity in the last 7 days, rate the difficulty for the last time you performed the activity. If you can't perform an activity, check the last box.

In the last week, were you able to:

Brush or comb your hair No difficulty Very difficult
Prepare a homemade meal No difficulty Very difficult
Vacuum, scrub or sweep floors No difficulty Very difficult
Lift and carry a bag full of groceries No difficulty Very difficult
Climb one flight of stairs No difficulty Very difficult
Change bed sheets No difficulty Very difficult
Sit in a chair for 45 mins No difficulty Very difficult
Go shopping for groceries No difficulty Very difficult
  SUB-TOTAL

Directions: For each of the following 2 questions, check the box that best describes the overall impact of your fibromyalgia over the last 7 days:

Fibromyalgia prevented me from accomplishing goals for the week Never Always
I was completely overwhelmed by my fibromyalgia symptoms Never Always
  SUB-TOTAL

Directions: Directions: For each of the following 10 questions, select the box that best indicates your intensity of these common fibromyalgia symptoms over the past 7 days.

Please rate your level of pain No pain Unbearable pain
Please rate your level of energy Lots of energy No energy
Please rate your level of stiffness No stiffness Severe stiffness
Please rate your quality of your sleep Awoke well rested Awoke very tired
Please rate your level of depression No depression Very depressed
Please rate your level of memory problems Good memory Very poor memory
Please rate your level of anxiety Not anxious Very anxious
Please rate your level of tenderness to touch No tenderness Very tender
Please rate your level of balance problems No imbalance Severe imbalance
Please rate your level of sensitivity to loud noises, bright lights, odors and cold No sensitivity Extreme sensitivity
  SUB-TOTAL

FIQR TOTAL



SCORING THE FIQR

There are just 3 steps:

  • Step 1. Sum the scores for each of the three domains (function, overall, and symptoms).

  • Step 2. Divide domain 1 score by three, divide domain 2 score by one (that is, it is unchanged), and divide domain score 3 by two.

  • Step 3. Add the three resulting domain scores to obtain the total Revised Fibromyalgia Impact Questionnaire (FIQR) score.

Missing Answers

If you are not using computerized input which demands the completion of each question before the next in line can be tackled (e.g. a paper questionnaire), you will need to compensate for unanswered questions. In such cases we recommend the use of the following "weighting" factor:

If only x questions from the first section (function) were answered, one would weigh the summated score of the x questions by 9/x (as there are 9 items in the function set of questions) Likewise the second section (overall impact) would have a weighting of 2/x (there are only 2 items) and the third section (symptoms) would have a weighting of 10/x (there are 10 items).


Addendum

Sometimes one or two items of the first domain (i.e. function), cannot be answered because a subject has not performed that activity within the past 7 days or is physically unable to perform that activity. We therefore recommend using the following amendment of the sentinel question for the first domain:

"Check the box that best indicates how much your fibromyalgia made it difficult to perform each of the following 9 activities during the past 7 days. If you did not perform a particular activity in the last 7 days, rate the difficulty for the last time you performed the activity. If you can't perform an activity, check the last box".

Return to top of page

Source:

Return to Top