Measuring health in patients with fibromyalgia: content comparison of questionnaires based on the International Classification of Functioning, Disability and Health

Overview of Available Functioning Data in Switzerland: Supporting the Use of Functioning as a Health Indicator Alongside Mortality and Morbidity

Objectives

To identify official sources that routinely collect data on functioning in Switzerland, to provide an overview of the existing data and its comparability, and to assess the extent to which the data is suitable for developing a functioning metric and indicator.

Methods

Data sources were identified through an iterative search. Standardized rules were applied to map the functioning information assessed by the sources using a current WHO functioning and disability survey as a reference framework for the content comparison.

Results

Four sources were identified: the Swiss Survey of Health, Ageing and Retirement in Europe (SHARE), the Swiss Health Survey (SHS), the Lausanne cohort 65+ (Lc65+), and the Swiss Household Panel (SHP). All tools addressed sleep functions, energy level, emotional functions, and sensation of pain. Additionally, nine functioning categories were common across three sources.

Conclusion

Population data sources in Switzerland routinely collect comparable functioning data, which can serve as the basis for creating a functioning indicator. Among others, this indicator is relevant to complement mortality and morbidity data and to support both the estimation of rehabilitation and long-term care needs.

Haemophilia item bank based on International Classification of Functioning, Disability and Health: a systematic review

BACKGROUND AND OBJECTIVES

Haemophilia comprises a continuum of blood disorders that often include joint and muscular dysfunction, which may lead to a constellation of activity limitations and participation restrictions. However, there is scant research incorporating functional assessment scales into the common language provided by the International Classification of Functioning, Disability and Health (ICF). This study aims to identify the ICF categories to include in an item bank of functioning aspects relevant for haemophilia.

DESIGN AND METHODS

A systematic search was carried out in July 2021 based on the PubMed MEDLINE, CLINICAL, and Cochrane databases for qualified articles, investigating haemophilia-specific scales and the scales recommended by the World Federation of Haemophilia (WFH) linked to ICF categories between 2001 and 2021. Well-trained healthcare professionals in the haemophilia field and ICF evaluation conducted group discussions to determine the ICF items for haemophilia.

RESULTS

A total of 112 out of 176 items measuring function were collected for the haemophilia ICF item bank, including 32 items for body function (b), 45 items for activity and participation (d), 27 items for environmental factors (e), and 8 items for body structure(s).

INTERPRETATION AND CONCLUSIONS

We recommend that future haemophilia research use the haemophilia-specific ICF item bank, which could capture a whole spectrum of functional measurements and facilitate multidisciplinary and worldwide communication. This study also indicates that further development and analysis of the psychometric properties of the 112 haemophilia-related ICF items is warranted.

Integrating a New Dietetic Care Process in a Health Information System: A System and Process Analysis and Assessment

Managing routinely collected data in health care and public health is important for evaluation of interventions and answering research questions using “real life” and ”big data”. In addition to the technical requirements of information systems, both standardized terminology and standardized processes are needed. The aim of this project was to analyse and assess the integration of standardized terminology and document templates for a dietetic care process (DCP) into the health information system (HIS) in a hospital in Austria. Using an action research approach, the DCP was analysed through four expert interviews and the integration into the HIS through two expert interviews with observations. Key strengths and weaknesses for the main criteria (“integration of the ICF catalogue”, “adaption of the document templates”, “adaption of the DCP”, and the “adaption of the user authorizations”) were presented and proposals for improvement given. The system and process integration of the DCP is possible, and the document templates can be adapted with the software currently in use. Although an increase in resources and finances required is to be expected initially, the integration of a standardized dietetic terminology in combination with a standardized process is likely to improve the quality of care and support outcomes management and research.

Functioning in the fibromyalgia syndrome: validity and reliability of the WHODAS 2.0

BACKGROUND

Fibromyalgia syndrome (FMS) is both a challenging and disabling condition. The International Association for the Study of Pain (IASP) classifies FMS as chronic primary pain, and it can negatively impact individuals' functioning including social, psychological, physical and work-related factors. Notably, while guidelines recommend a biopsychosocial approach for managing chronic pain conditions, FMS assessment remains clinical. The WHODAS 2.0 is a unified scale to measure disability in the light of the International Classification of Functioning, Disability and Health. Thus, this study aimed to evaluate the reliability and validity of the Brazilian version of WHODAS 2.0 for use in individuals with FMS.

METHODS

Methodological study of the validity and reliability of the Brazilian version of the 36-item WHODAS 2.0 with 110 individuals with FMS. The instrument gives a score from 0 to 100, the higher the value, the worse the level of functioning. We assessed participants with Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (0-100), Fibromyalgia Impact Questionnaire (FIQ) (0-10) and Beck Depression Inventory instrument (BDI) (0-63). The construct validity, internal consistency, and test-retest stability. We used SF-36, FIQ and BDI to study construct validity analysis. For statistical analysis, we performed the intraclass correlation (ICC), Spearman correlation, and Cronbach's alpha, with a statistical level of 5%.

RESULTS

Most participants were female (92.27%), aged 45 (± 15) years. The test-retest reliability analysis (n = 50) showed stability of the instrument (ICC = 0.54; ρ = 0.84, p < 0.05). The test-retest correlation between the domains was moderate to strong (ρ > 0.58 and < 0.90). Internal consistency was satisfactory for total WHODAS 2.0 (0.91) and also for domains, ranging from 0.44 to 0.81. The construct validity showed satisfactory values with all moderately correlated with WHODAS 2.0 instruments (> 0.46 and < 0.64; p < 0.05). WHODAS 2.0 evaluates the functioning encompassing components of health-related quality of life, functional impact, and depressive symptoms in those with FMS.

CONCLUSIONS

WHODAS 2.0 is a reliable and valid instrument to evaluate functioning of Brazilians with FMS. It provides reliable information on individuals' health through of a multidimensional perspective, that allows for individual-centered care.

Instrumentos da prática clínica com versão em português e a abrangência de seus conteúdos usando a CIF como referência: uma revisão sistemática

RESUMO A prática clínica tem sido subsidiada por instrumentos que permitem acessar e registrar informações de funcionalidade e saúde dos indivíduos. Uma forma de conhecer qual conteúdo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) os instrumentos contemplam é usá-la como referência para auxiliar o profissional na escolha do mais adequado para acessar informações biopsicossociais. O objetivo foi identificar instrumentos da prática clínica em saúde que tiveram seu conteúdo ligado com a CIF e a existência de versão na língua portuguesa deles. Para tanto foi realizada uma revisão sistemática nas bases de dados SciELO Brasil, Lilacs e PubMed com os descritores “CIF”, “questionário” e “regra de ligação” em português e inglês. Três pesquisadores independentes realizaram a seleção, e o nível de concordância foi obtido pelo coeficiente Kappa. Os critérios de elegibilidade foram: estudos primários de ligação de conteúdo de questionários, escalas, índices e checklists com a CIF publicados após 2001 em língua portuguesa ou inglesa. Foram incluídos 61 artigos, sendo 19 de origem brasileira. Dos 250 instrumentos ligados à CIF, 158 (63,2%) apresentaram versão em português sendo que dos 37 que mais se repetiram nos estudos, dois não apresentam essa versão. O coeficiente Kappa mostrou concordância entre moderada e boa (p<0,001). Este estudo apresentou um panorama da ligação de conteúdo de instrumentos da prática clínica à CIF identificando quais têm versão em língua portuguesa, o que contribuirá para o potencial fortalecimento da abordagem biopsicossocial dos profissionais de saúde.

Application of the refinements of ICF linking rules to the Visual Analogue Scale, Roland Morris questionnaire and SF-36

The Visual Analogue Scale (VAS), Roland Morris Disability Questionnaire (RMDQ), Short Form Health Survey (SF-36) are broadly used and had their content linked to ICF by the linking rules of 2002 and 2005. In 2016 were refined and were not applied yet. To apply the refinements of ICF linking rules to VAS, RMDQ, and SF-36. Two health professionals identified the meaningful concepts and linked to the most precise ICF categories and a third triggered in divergences. The degree of agreement was calculated by kappa statistic. There was almost perfect agreement (Kappa=0.93 p<0,001). The main concept of VAS was linked to ICF category b280, the 24 main concepts of RMDQ linked to b28013, and 27 additional linked to other categories. The SF-36 had 36 main concepts and 30 additional concepts identified which 27 were definable by the ICF and 17 do not. From the total of ICF linked concepts, 39 refer to Body Functions, 57 to Activities and Participation and 4 to Environmental Factors. The refinements of linking rules propitiated more clarity in the process to identify, to link instruments content with ICF and to expose the results. Thus, increased the number of identified and linked concepts as well as the categories in the instruments.

Reliability and Construct Validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments in Women with Fibromyalgia

Objective

The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to standardize measurement of clinically relevant patient-reported outcomes. This study evaluated the reliability and construct validity of select PROMIS static short-form (SF) instruments in women with fibromyalgia.

Design

Analysis of baseline data from the Fibromyalgia Activity Study with TENS (FAST), a randomized controlled trial of the efficacy of transcutaneous electrical nerve stimulation.

Setting

Dual site, university-based outpatient clinics.

Subjects

Women aged 20 to 67 years diagnosed with fibromyalgia.

Methods

Participants completed the Revised Fibromyalgia Impact Questionnaire (FIQR) and 10 PROMIS static SF instruments. Internal consistency was calculated using Cronbach alpha. Convergent validity was examined against the FIQR using Pearson correlation and multiple regression analysis.

Results

PROMIS static SF instruments had fair to high internal consistency (Cronbach α = 0.58 to 0.94, P  < 0.05). PROMIS 'physical function' domain score was highly correlated with FIQR 'function' score (r = -0.73). The PROMIS 'total' score was highly correlated with the FIQR total score (r = -0.72). Correlations with FIQR total score of each of the three PROMIS domain scores were r = -0.65 for 'physical function,' r = -0.63 for 'global,' and r = -0.57 for 'symptom' domain. PROMIS 'physical function,' 'global,' and 'symptom' scores explained 58% of the FIQR total score variance.

Conclusions

Select PROMIS static SF instruments demonstrate convergent validity with the FIQR, a legacy measure of fibromyalgia disease severity. These results highlight the potential utility of select PROMIS static SFs for assessment and tracking of patient-reported outcomes in fibromyalgia.

Clinical profile of patients with fibromyalgia syndrome

Abstract Introduction: The new diagnostic criteria for fibromyalgia (FM) include the presence of chronic, widespread pain associated with other symptoms such as fatigue, sleep disturbance, anxiety and depression. All these symptoms should be considered when thinking and clinical decision making of physiotherapists dealing with FM. However, it is clear that the other symptoms that accompany the pain are often neglected. Objective: To measure the levels of fatigue, sleep disturbances, anxiety and depression in patients with FM and compare them to levels found in healthy controls. Methods: Forty-six women diagnosed with FM and 30 healthy controls participated in the study. The levels of each of the symptoms were assessed by four validated questionnaires in Brazil (Piper Fatigue Scale - Revised, Pittsburgh Sleep Quality Index, Beck Anxiety Inventory and the Beck Depression Inventory). Statistical analysis was performed using GraphPad Prism software and all tests used a significance level of 5% (α = 0.05). Results: FM patients had significantly elevated levels of fatigue (p = 0.0005), sleep disturbances (p = 0.003), anxiety (p = 0.0012) and depression (p = 0.0003) compared to healthy controls. Symptoms fatigue and depression correlated strongly and positively with one another and with other symptoms evaluated. Conclusion: The other symptoms that comprise the clinical picture of FM need be considered not only in order to recover the health of patients, but above all in an attempt to preserve it and promote it.

Refinements of the ICF Linking Rules to strengthen their potential for establishing comparability of health information

Purpose The content of and methods for collecting health information often vary across settings and challenge the comparability of health information across time, individuals or populations. The International Classification of Functioning, Disability and Health (ICF) contains an exhaustive set of categories of information which constitutes a unified and consistent language of human functioning suitable as a reference for comparing health information. Methods and results In two earlier papers, we have proposed rules for linking existing health information to the ICF. Further refinements to these existing ICF Linking Rules are presented in this paper to enhance the transparency of the linking process. The refinements involve preparing information for linking, perspectives from which information is collected and the categorization of response options. Issues regarding the linking of information not covered or unspecified within the ICF are also revisited in this paper. Conclusion: The ICF Linking Rules are valuable for enhancing comparability of health information to ensure that information is available in a consistent manner to serve as a foundation for evidence-based decision-making across all levels of health systems. The refinements presented in this paper enhance transparency in, and ultimately reliability of the process of, linking health information to the ICF. Implications for Rehabilitation The International Classification of Functioning, Disability and Health (ICF) constitutes a unified and consistent language of human functioning suitable as a reference for comparing health information. Comparability of information is essential to ensure that the widest range of information is available in a consistent manner for any decision-maker at all levels of the health system. The refined ICF Linking Rules presented in this article outline the method to establish comparability of health information based on the ICF.

Identification of common content between the questionnaire of the Health Survey (ISA-SP) and the International Classification of Functionality, Disability, and Health

The purpose of this paper was to identify the common contents between São Paulo's Health Survey Questionnaire (Physical Disability and Emotional Health Blocks) and the International Classification of Functionality, Disability, and Health. The first stage of the research consisted of the search for the modules of São Paulo's Health Survey, which addressed the issue of disability, and the passages about this theme were highlighted and inserted into a new file. In the second stage, the significant contents were extracted. In the last one, these contents were codified to the codes of the International Classification of Functionality, Disability, and Health by two independent researchers. For the descriptive statistical analysis, crude numbers, percentages, and simple frequencies were used. The degree of agreement between the two professionals was calculated using Kappa's coefficient and the confidence interval. The most common domains were those about functions and body structures and about activities and participation, in which the domain of environmental factors presented a lower frequency of approach.

The impact of buprenorphine transdermal delivery system on activities of daily living among patients with chronic low back pain: an application of the international classification of functioning, disability and health

OBJECTIVES

The buprenorphine transdermal delivery system (BTDS) is indicated for reduction of pain in moderate to severe chronic low back pain (CLBP), which can affect patients' ability to perform routine activities of daily living (ADLs). This post hoc analysis of clinical trial data examines the impact of BTDS treatment on CLBP patients' ability to perform ADLs that relate to functioning with low back pain.

METHODS

Data are drawn from a multicenter, enriched enrollment, randomized, placebo-controlled, double-blind 12-week trial of BTDS for pain control among opioid-naive patients with moderate to severe CLBP. The 23 selected ADLs are those that (1) appear in the Low Back Pain Core Set of the International Classification of Functioning, Disability and Health and (2) link to the content of 3 patient-reported outcome instruments administered during the trial. Logistic regression models estimated the odds ratios (ORs) of BTDS patients' ability to perform each ADL at 12 weeks, controlling for baseline ability, relative to placebo.

RESULTS

The ORs for 10 ADLs related to sleeping, lifting, bending, and working reached multiplicity-adjusted statistical significance and indicated a greater ability to perform ADLs among BTDS users than among the placebo group. These 10 ORs ranged from 1.9 (no physical health-related restrictions on the kind of work performed) to 2.4 (being able to sleep undisturbed by pain).

DISCUSSION

These results suggest that for patients with moderate to severe CLBP, 12 weeks use of BTDS improves the ability to carry out certain ADLs related to sleeping, lifting, bending, and working.

Work, family and social environment in patients with Fibromyalgia in Spain: an epidemiological study: EPIFFAC study

Background

Fibromyalgia (FM) is a condition characterized by widespread pain, estimated to affect 2.4% of the Spanish population. Nowadays, there are no consistent epidemiological studies on the actual impact of the disease on work and family of these patients in a representative manner; therefore, the purpose of the study is to analyze the impact on family, employment and social environment in a representative sample of patients with FM attending Primary Public Care Centers in Spain.

Methods

We carried out an epidemiological study, with a probability sampling procedure, stratified, relative to the municipality size and the number of health centres, seeking territorial representation. The survey was conducted using a self-administered structured questionnaire.

Results

A sample of 325 patients with FM was studied in 35 Primary Health Care Centers (PHCCs). The sample is composed of 96.6% of women, 51.9 (8) years of mean (standard deviation- sd) age. Ninety-three percent of the patients have worked throughout their life. Mean (sd) age onset of symptoms was 37 (11) years and diagnosis of FM was established 6.6 (8) years later.

Family Environment: Fifty-nine percent of patients have difficulties with their partner. Forty-four percent of the patients report to be fairly or totally dependent on a family member in household chores. The household income decreased a mean (sd) of 708 (504) Euros/month in 65% of the patients. In 81% of the patients, there was an increase in extra expenses related to the disease with a mean (sd) of 230 (192) Euros/month.

Working environment: At the moment of the study, 45% of the patients had work activity (34% were working and 11% were at sick leave), 13% were unemployed seeking job and 42% were not in the labor force. Twenty-three percent of patients had some degree of permanent work disability pension.

Social Environment: The degree of satisfaction with health care professionals was low and twenty-six percent of the patients were members of specific patients associations.

Conclusions

This study finds that people with FM who visit PHCCs of Spain experience a high impact on families and employment with heavy loss of ability to work.

The Relationship between Mechanical Hyperalgesia Assessed by Manual Tender Point Examination and Disease Severity in Patients with Chronic Widespread Pain: A Cross-Sectional Study

The clinical utility of tender point (TP) examination in patients reporting chronic widespread pain (CWP) is the subject of contemporary debate. The objective of this study was to assess the relationship between mechanical hyperalgesia assessed by manual TP examination and clinical disease severity. 271 women with CWP were recruited from a clinical setting. Data collection included patient-reported symptoms, health-related quality of life variables, and observation-based measures of functional ability, muscle strength, 6-minute walk, and pressure pain thresholds measured by cuff algometry. TP examination was conducted according to ACR-guidelines. Relationships between disease variables and TP count (TPC) were analyzed with logistic regression in a continuum model, allowing the TPC to depend on the included disease variables and two regression models carried out for a TPC threshold level, varying between 1 and 17. The threshold analyses indicated a TPC threshold at 8, above which a large number of disease variables became consistently significant explanatory factors, whereas none of the disease variables reached a significance level in the continuum model. These results support the premise that the presence of mechanical hyperalgesia influences symptomatology in CWP and that the severity of clinical expression is related to a threshold of TPs, rather than being part of a continuum.

Important aspects of participation and participation restrictions in people with a mild intellectual disability

PURPOSE

This study explored a possibility to assess the concepts of participation and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) by combining self-ratings of the perceived importance with the actual performance of different everyday activities in people with a mild intellectual disability.

METHOD

Structured interviews regarding 68 items from the ICF activity/participation domain were conducted (n = 69). The items were ranked by perceived importance, performance and by combined measures. Furthermore, the measures were related to a single question about subjective general well-being.

RESULTS

Rankings of performance highlighted about the same items as "important participation", while rankings of low performance addressed quite different items compared with "important participation restriction". Significant correlations were found between subjective general well-being and high performance (r = 0.56), high performance/high importance (important participation) (r = 0.56), low performance (r = -0.56) and low performance/high importance (important participation restriction; r = -0.55).

CONCLUSIONS

The results support the clinical relevance of the ICF and the studied selection of 68 items. Although performance only may sometimes be a relevant aspect, knowledge about the relationship between the perceived importance and the actual performance is essential for clinical interventions and for research aiming to understand specific needs regarding participation.

IMPLICATIONS FOR REHABILITATION

The concepts of participation and participation restriction are highly relevant in people with a mild intellectual disability. Self-rated performance might be sufficient to assess participation at a group level. In clinical practices, the relationship between the perceived importance and the actual performance of an activity is essential to assess.

Measuring participation outcomes following life-saving medical interventions: the Role Checklist Version 2: Quality of Performance

PURPOSE

To establish the Role Checklist Version 2: Quality of Performance as a measure of past, present and desired future role incumbency, role value and self-perception of the quality of role performance for 10 roles consistent with the ICF Participation Domains.

METHODS

Discuss the literature on the measurement of participation; present a conceptually based case for similarities in content between the RC V2: QP; and illustrate through a case example its efficacy as a balanced measure of performance.

RESULTS

Despite different origins, the ICF domain areas: Chapters 6-9 correspond to the roles included in the RC V2: QP. The measure is shown sensitive to change in quality of performance through insider self-report serving in the case provided, as an early indicator of deterioration in physical status.

CONCLUSION

A balanced measure of the insider and outsider perspective of participation, the case of one liver transplant recipient illustrates how the RC V2: QP serves to reflect participation outcomes thus, adding an available measure of the ICF construct of participation. Implications for Rehabilitation The Role Checklist Version 2: Quality of Performance is consistent with the ICF performance qualifier of participation. The insider view of participation is strengthened in this Second version of the Role Checklist. The Role Checklist Version 2: Quality of Performance provides a general measure of participation that can be used across populations.

Predictors for health improvement in patients with fibromyalgia: a 2-year follow-up study

Fibromyalgia (FM) has a high impact on all aspects of health. The effect from interventions is usually small and characterized by uncertainty. Better insight in predictors for improved health is essential. The present study aimed to understand predictors for patient global impression of change and changes in overall health. Data from a longitudinal cohort of recently diagnosed FM patients (n = 203) were used. Within this cohort, patients were pre-randomized to either a multidisciplinary (n = 108) or an, aerobic exercise (n = 47) program, or usual care (n = 48). Only a limited number of patients started with the programs (n = 86) or participated fully, i.e., attended >70 % of the scheduled sessions (n = 68). Patients completed questionnaires covering all components of the International Classification of Functioning, Disability and Health (ICF) bio-psycho-social model of health, which was used as a framework to structure potential predictors. Principal component analysis was used to reduce the number of potential predictors. Regression analyses were used to explore associations with the outcome variables. Principal component analysis yielded five factors representing areas that covered different ICF components and chapters. "Being employed" and "full participation in a program" were independently associated with a better global impression of change. A longer duration of FM-related symptoms and more limitations in physical areas of body functions were independently associated with a worse impression of overall health. Higher levels of perceived limitations in physical and mental activities were associated with "starting to participate in a program" and with "full participation in a program." Recently diagnosed FM patients that report fewer physical limitations may experience more improvement in health if they are at work and have a positive attitude towards participating in an offered health-care intervention. These findings give support to an active rather than to a care-avoiding attitude of health-care workers in their contacts to these patients.

Participation and social functioning in patients with fibromyalgia: development and testing of a new questionnaire

Background

While there are numerous instruments for capturing the symptoms of fibromyalgia syndrome (FMS) patients, there is a lack of questionnaires capable of measuring in detail FMS patients’ participation and social functioning. It was our aim to develop and methodologically test a new patient questionnaire specific to FMS measuring these concepts (the “Fibromyalgia Participation Questionnaire” FPQ).

Methods

We first conducted a qualitative prestudy (focus groups, N = 38) to identify which impairments FMS patients experience in daily life because of their illness. To analyze the data we developed a coding system that contained 10 supercategories and a total of 105 subcategories. Items for the FPQ were developed from the subcategories. The psychometric analysis was done on a sample of N = 256 FMS patients undergoing inpatient rehabilitation in Germany.

Results

The final version of the FPQ contained 27 items and three scales (participation in social life FPQ-S, 11 items; participation in daily life FPQ-D, 11 items, participation in work-life FPQ-W 5 items). The FPQ displays good distribution properties, all the scales are unidimensional, and the scales fit to the Rasch model. Cronbach’s Alpha range from 0.85 to 0.94. We noted indications of construct validity in that the FPQ correlates as expected with the Fibromyalgia Impact Questionnaire (physical scale), Pain Disability Index and scales from the PROMIS® item banks for satisfaction with participation. The FPQ scales generally reveal greater responsiveness than other instruments. By linking FPQ items to the categories of the International Classification of Functioning, Disability and Health (ICF) we demonstrate content validity.

Conclusions

The FPQ captures participation and social functioning in FMS patients. As its psychometric properties are good, it can be recommended for use in evaluation studies and clinical trials.

Social participation restriction among US adults with arthritis: a population-based study using the International Classification of Functioning, Disability and Health

OBJECTIVE

To examine arthritis impact among US adults with self-reported doctor-diagnosed arthritis using the International Classification of Functioning, Disability and Health (ICF) framework (including the impairments, activity limitations, environmental, and personal factors domains and social participation restriction [SPR] as the outcome) overall and among those with and without SPR, and to identify the correlates of SPR.

METHODS

Cross-sectional 2009 National Health Interview Survey data were analyzed to examine the distribution of the ICF domain components. Unadjusted and multivariable-adjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were estimated to identify the correlates of SPR. Analyses using SAS, version 9.2 survey procedures accounted for the complex sample design.

RESULTS

SPR prevalence was 11% of adults with arthritis (5.7 million). After initial multivariable adjustment by ICF domain, serious psychological distress (impairments domain; PR 2.5 [95% CI 2.0-3.2]), ≥5 medical office visits (environmental domain; PR 3.4 [95% CI 2.5-4.4]), and physical inactivity (personal domain; PR 4.8 [95% CI 3.6-6.4]) were most strongly associated with SPR. A combined measure (key limitations [walking, standing, or carrying]; PR 31.2 [95% CI 22.3-43.5]) represented the activity limitations domain. After final multivariable adjustment incorporating all ICF domains simultaneously, the strongest associations with SPR were key limitations (PR 24.3 [95% CI 16.8-35.1]), ≥9 hours of sleep (PR 1.6 [95% CI 1.3-2.0]), and income-to-poverty ratio <2.00 and severe joint pain (PR 1.4 [95% CI 1.2-1.6] for both).

CONCLUSION

SPR affects 1 of 9 adults with arthritis. This study is the first to use the ICF framework in a population-based sample to identify specific functional activities, pain, sleep, and other areas as priorities for intervention to reduce negative arthritis impacts on disability, including SPR. Increased use of existing clinical and public health interventions is warranted.

Development of a multidimensional measure of fibromyalgia symptomatology: the comprehensive rating scale for fibromyalgia symptomatology

OBJECTIVE

Fibromyalgia (FM) is characterized by a heterogeneous group of clinical symptoms that are evaluated using a wide variety of instruments. This study sought to develop and validate a new scale, the Comprehensive Rating Scale for Fibromyalgia Symptomatology (CRSFS), to facilitate the joint evaluation of the most frequent symptoms in patients with FM.

METHODS

CRSFS items were based on a literature review and a focus group composed of patients and healthcare professionals. Four samples of patients (FM, non-FM rheumatic pain, depression, and healthy volunteers) were used to study the reliability and validity of the CRSFS. The factor structure of the CRSFS was determined through exploratory and confirmatory factor analyses. The test-retest and inter-examiner reliabilities were evaluated in a subsample of participants with FM. The criterion and convergent construct validity were compared using valid and reliable instruments to assess the impact of FM on quality of life, pain, fatigue, mood, and quality of sleep. The capacity to differentiate groups of patients was examined by comparing the CRSFS scores of the four samples to each other and using receiver operating characteristics curves.

RESULTS

The sample was composed of 240 participants, the mean age was 49.1years (SD=10.4), and 97.5% of them were women. The factor analyses, as well as the tests of reliability and validity, were positive. The final version of the CRSFS consisted of 20 symptoms evaluated using 60 items.

CONCLUSION

The CRSFS is a valid and reliable 4-factor scale that evaluates the most frequent clinical symptoms of patients with FM.

Which aspects of health differ between working and nonworking women with fibromyalgia? A cross-sectional study of work status and health

BACKGROUND

Women with fibromyalgia (FM) describe great difficulties in managing work. Reported work ability in women with FM varies from 34 to 77 percent in studies from different countries. Many factors are suggested to affect the ability to work in women with FM, including pain, fatigue, impaired physical capacity and activity limitations. However, it is difficult to define to which extent symptom severity can be compatible with work. The aim of this study was to investigate which aspects of health differ between working women with FM and nonworking women with FM.

METHODS

A cross-sectional study of 129 women of working age with FM which included clinical assessment, structured interviews, questionnaires and performance-based tests. The women were categorized as working or nonworking. Aspects of health are presented according to the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Working women with FM presented better health than nonworking women with FM in ratings of body function (FIQ pain p < 0.001, FIQ fatigue p = 0.006, FIQ stiffness p = 0.009, HADS-Depression p = 0.007). Ratings of overall health status were also significantly better in working women with FM than in nonworking women with FM (FIQ total, eight-item p = 0.001 and SF-36 PCS p < 0.001). No significant differences were found between working- and nonworking women in tests of physical capacity. FIQ pain was an independent explanatory factor for work in stepwise multiple logistic regression analysis (OR 0.95, CI 0.93- 0.98), p < 0.001.

CONCLUSION

Working women with FM reported better health than nonworking women with FM in terms of pain, fatigue, stiffness, depression, disease specific health status and physical aspects of quality of life, which represent body functions and overall health status. However, they were equally impaired in tests of physical capacity. Moderate pain levels were compatible with work, while severe pain appeared to compromise work. Fatigue was better tolerated, as women scoring severe levels of fatigue worked.

Measuring functioning in people with fibromyalgia (FM) based on the international classification of functioning, disability and health (ICF)--a psychometric analysis

OBJECTIVES

Instruments to assess functioning in patients with FM vary considerably in their content and are often symptom-specific. This study aimed to examine whether it is feasible to construct a psychometric-sound clinical instrument to measure functioning in FM based on the Brief ICF-Core-Set for chronic widespread pain (CWP).

METHODS

Two hundred and fifty six people with FM completed the Brief ICF-Core-Set. The Rasch model was used for analysis. Once ordering of response options of ICF categories was ensured, the following properties were studied: fit of the ICF categories to the Rasch model, the targeting between ICF categories and a person's abilities, unidimensionality, and reliability.

RESULTS

Six ICF categories were rescored due to disordered thresholds. Five ICF categories were removed due to high model-misfit and differential item functioning (DIF) for gender. Scores from 46 participants were excluded due to extreme scores. The ICF categories included display consistency with an underlying unidimensional construct, are free of DIF for age, disease duration and gender, display excellent overall reliability, and cover a range of functioning difficulties.

CONCLUSIONS

This study illustrates that it is possible to measure functioning as a unidimensional construct based on selected ICF categories from the components body functions, as well as activities and participation of the Brief ICF-Core-Set for CWP in patients with FM.

The validity and reliability of the Turkish version of the Revised Fibromyalgia Impact Questionnaire

The Revised Fibromyalgia Impact Questionnaire (FIQR) attempts to address the limitations of the Fibromyalgia Impact Questionnaire (FIQ). As there is no Turkish version of the FIQR available, we aimed to investigate the validity and reliability of a Turkish translation of the FIQR in Turkish female fibromyalgia (FM) patients. After translating the FIQR into Turkish, it was administered to 87 female patients with FM. All of the patients filled out the questionnaire together with a Turkish version of the FIQ, hospital anxiety and depression scales (HADS), short form-36 (SF-36). The tender-point count (TPC) was also calculated from tender points identified by thumb palpation. One week later, FM patients filled out the Turkish FIQR at their second visit. The test-retest reliability of the Turkish FIQR questions ranged from 0.714 to 0.898. The test and retest reliability of total FIQR score was 0.835. Cronbach's alpha was 0.89 for FIQR visit 1 (the first assessment) and 0.91 for FIQR visit 2 (the second assessment), indicating acceptable levels of internal consistency for both assessments. The total scores of the FIQR and FIQ were significantly correlated (r = 0.87, P < 0.01). Significant correlations for construct validity were also obtained between the FIQR total and domain scores and the FIQ, the HADS and the subscales of the SF-36 (FIQR total versus SF-36 physical component score and mental component score were r = -0.63, P < 0.01 and r = -0.51, P < 0.01, respectively). The Turkish FIQR is a reliable and valid instrument for measuring health status in FM, showing sufficient reliability and construct validity. It may be utilized for both clinical practice and research use in the Turkish-speaking population in place of FIQ, since its Turkish version has problems in the wording, omissions, concepts, and scoring from the original FIQ.

Uncovering indicators of the international classification of functioning, disability, and health from the 39-item Parkinson's disease questionnaire

The 39-item Parkinson's disease questionnaire (PDQ-39) is the most widely used patient-reported rating scale in Parkinson's disease (PD). However, recent studies have questioned its validity and it is unclear what scores represent. This study explored the possibility of regrouping PDQ-39 items into scales representing the International Classification of Functioning, Disability, and Health (ICF) components of Body Functions and Structures (BF), Activities and Participation (AP), and Environmental (E) factors. An iterative process using Rasch analysis produced five new items sets, two each for the BF and AP components and one representing E. Four of these were found to represent clinically meaningful variables: Emotional Impairment (BF), Gross Motor Disability (AP), Fine Motor Disability (AP), and Socioattitudinal Environment (E) with acceptable reliability (0.73-0.96) and fit to the Rasch model (total item-trait chi-square, 8.28-33.2; P > .05). These new ICF-based scales offer a means to reanalyze PDQ-39 data from an ICF perspective and to study its health components using a widely available health status questionnaire for people with PD.

Introducing a new health-related quality of life outcome tool for metastatic disease of the spine: content validation using the International Classification of Functioning, Disability, and Health; on behalf of the Spine Oncology Study Group

STUDY DESIGN

A systematic review of Health Related-Quality of Life Outcomes (HRQOL) in metastatic disease of the spine and content validation of a new Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ).

OBJECTIVE

To identify HRQOL questionnaires previously reported for spinal metastases and to validate the content of the new SOSGOQ based on the International Classification of Function and Disability (ICF).

SUMMARY OF BACKGROUND DATA

Literature on metastatic tumors of the spine and clinical outcomes is limited and generally of poor quality. The SOSG has developed a "quality of life" outcome tool specific for patients with metastatic of the spine. The ICF is a universal framework allowing content exploration, comparison, and validation of all questionnaires relating to HRQOL.

METHODS

A systematic review identified 141 studies. Reported outcome tools were enumerated. The most commonly used (ESAS, Karnofsky Scale, and Oswestry Disability Index) and the SOSGOQ were linked to the ICF. Descriptive statistics examined the frequency and specificity of the ICF linkage. Linkage reliability was evaluated by interinvestigator percentage agreement.

RESULTS

The SOSGOQ contains 56 concepts, with all 4 domains of the ICF represented. Four concepts could not be linked. There was 100% interobserver agreement (IOA) for total number of concepts and for those "not covered." Hundred percent of concepts had "First and Second" level linkage. Hundred percent IOA exists at both "Component" and "First Level" linkage. There was 96.1% IOA at "Second Level". Thirty-three concepts linked to Third Level with 96.9% IOA. Ten concepts linked at the Fourth Level with 100% IOA.

CONCLUSION

The SOSGOQ includes all domains relevant for measurement of function and disability and its content validity is confirmed by linkage with the ICF. This new questionnaire has superior content capacity to measure disease burden of patients with metastatic disease of the spine than any instruments previously identified in the literature.

Fibromyalgia syndrome module at OMERACT 9: domain construct

The objective of the module was to (1) establish a core domain set for fibromyalgia (FM) assessment in clinical trials and practice, (2) review outcome measure performance characteristics, (3) discuss development of a responder index for assessment of FM in clinical trials, (4) review objective markers, (5) review the domain of cognitive dysfunction, and (6) establish a research agenda for outcomes research. Presentations at the module included: (1) Results of univariate and multivariate analysis of 10 FM clinical trials of 4 drugs, mapping key domains identified in previous patient focus group: Delphi exercises and a clinician/researcher Delphi exercise, and breakout discussions to vote on possible essential domains and reliable measures; (2) Updates regarding outcome measure status; (3) Update on objective markers to measure FM disease state; and (4) Review of the issue of cognitive dysfunction (dyscognition) in FM. Consensus was reached as follows: (1) Greater than 70% of OMERACT participants agreed that pain, tenderness, fatigue, patient global, multidimensional function and sleep disturbance domains should be measured in all FM clinical trials; dyscognition and depression should be measured in some trials; and stiffness, anxiety, functional imaging, and cerebrospinal fluid biomarkers were identified as domains of research interest. (2) FM domain outcome measures have generally proven to be reliable, discriminative, and feasible. More sophisticated and comprehensive measures are in development, as is a responder index for FM. (3) Increasing numbers of objective markers are being developed for FM assessment. (4) Cognitive dysfunction assessment by self-assessed and applied outcome measures is being developed. In conclusion, a multidimensional symptom core set is proposed for evaluation of FM in clinical trials. Research on improved measures of single domains and composite measures is ongoing.

The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties

Introduction

The Fibromyalgia Impact Questionnaire (FIQ) is a commonly used instrument in the evaluation of fibromyalgia (FM) patients. Over the last 18 years, since the publication of the original FIQ, several deficiencies have become apparent and the cumbersome scoring algorithm has been a barrier to widespread clinical use. The aim of this paper is to describe and validate a revised version of the FIQ: the FIQR.

Methods

The FIQR was developed in response to known deficiencies of the FIQ with the help of a patient focus group. The FIQR has the same 3 domains as the FIQ (that is, function, overall impact and symptoms). It differs from the FIQ in having modified function questions and the inclusion of questions on memory, tenderness, balance and environmental sensitivity. All questions are graded on a 0–10 numeric scale. The FIQR was administered online and the results were compared to the same patient's online responses to the 36-Item Short Form Health Survey (SF-36) and the original FIQ.

Results

The FIQR was completed online by 202 FM patients, 51 rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) patients (31 RA and 20 SLE), 11 patients with major depressive disorder (MDD) and 213 healthy controls (HC). The mean total FIQR score was 56.6 ± 19.9 compared to a total FIQ score of 60.6 ± 17.8 (P < 0.03). The total scores of the FIQR and FIQ were closely correlated (r = 0.88, P < 0.001). Each of the 3 domains of the FIQR correlated well with the 3 related FIQ domains (r = 0.69 to 0.88, P < 0.01). The FIQR showed good correlation with comparable domains in the SF-36, with a multiple regression analysis showing that the three FIQR domain scores predicted the 8 SF-36 subscale scores. The FIQR had good discriminant ability between FM and the 3 other groups; total FIQR scores were HC (12.1 ± 11.6), RA/SLE (28.6 ± 21.2) and MDD (17.3 ± 11.8). The patient completion time was 1.3 minutes; scoring took about 1 minute.

Conclusions

The FIQR is an updated version of the FIQ that has good psychometric properties, can be completed in less than 2 minutes and is easy to score. It has scoring characteristics comparable to the original FIQ, making it possible to compare past FIQ results with future FIQR results.

Societal and patient burden of fibromyalgia syndrome

Fibromyalgia syndrome (FMS) is an under-diagnosed disorder of unknown aetiology, characterized by chronic widespread muscular pain, often accompanied by somatic and psychological symptoms. Several studies have described the impact of FMS on patients' functionality, disability and quality of life. Other studies have reported on the burden to patients, healthcare payers and society. This review brings the existing evidence together and concludes that the patient burden of fibromyalgia is very high in comparison with many other conditions. The burden to healthcare payers and society is important as well, and can be mostly explained by factors not directly related to the treatment of FMS. Data suggest that the cost before diagnosis may even be higher than the cost after diagnosis. It is very likely that the combination of symptoms not only complicates the recognition and treatment of FMS, but also magnifies the burden of FMS. Despite the complex and controversial construct of this syndrome, the results in terms of patient, healthcare payer and societal burden are quite consistent.

Treatment options and patient perspectives in the management of fibromyalgia: future trends

Fibromyalgia (FM) is a common, complex, and difficult to treat chronic widespread pain disorder, which usually requires a multidisciplinary approach using both pharmacological and non-pharmacological (education and exercise) interventions. It is a condition of heightened generalized sensitization to sensory input presenting as a complex of symptoms including pain, sleep dysfunction, and fatigue, where the pathophysiology could include dysfunction of the central nervous system pain modulatory systems, dysfunction of the neuroendocrine system, and dysautonomia. A cyclic model of the pathophysiological processes is compatible with the interrelationship of primary symptoms and the array of postulated triggers associated with FM. Many of the molecular targets of current and emerging drugs used to treat FM have been focused to the management of discrete symptoms rather than the condition. Recently, drugs (eg, pregabalin, duloxetine, milnacipran, sodium oxybate) have been identified that demonstrate a multidimensional efficacy in this condition. Although the complexity of FM suggests that monotherapy, non-pharmacological or pharmacological, will not adequately address the condition, the outcomes from recent clinical trials are providing important clues for treatment guidelines, improved diagnosis, and condition-focused therapies.