Table 1

The Revised Fibromyalgia Impact Questionnaire

Domain 1 directions: For each of the following nine questions, check the

    one
box that best indicates how much your fibromyalgia made it difficult to do each of the following activities over the past 7 days:


Brush or comb your hair

No difficulty □ □ □ □ □ □ □ □ □ □ □ Very difficult

Walk continuously for 20 minutes

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 minutes

No difficulty □ □ □ □ □ □ □ □ □ □ □ Very difficult

Go shopping for groceries

No difficulty □ □ □ □ □ □ □ □ □ □ □ Very difficult

Domain 2 directions: For each of the following two questions, check the

    one
box that best describes the overall impact of your fibromyalgia over the past 7 days:


Fibromyalgia prevented me from accomplishing goals for the week

Never □ □ □ □ □ □ □ □ □ □ □ Always

I was completely overwhelmed by my fibromyalgia symptoms

Never □ □ □ □ □ □ □ □ □ □ □ Always

Domain 3 directions: For each of the following 10 questions, check the

    one
box that best indicates the intensity of your 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 the quality of your sleep

Awoke 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


Scoring: 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 score.

Bennett et al. Arthritis Research & Therapy 2009 11:R120   doi:10.1186/ar2783

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