Multidimensional Health Status Assessment & Fibromyalgia

MULTIDIMENSIONAL HEALTH STATUS ASSESSMENT

AIMS and AIMS ll are examples of multidimensional instruments that can be used in patients with FMS. AIMS is a lengthy instrument to administer, taking over 20 minutes, and thus it is regarded as being unsuitable for routine use in clinical care of patients with FMS. 109. The nine sub-scales assess mobility, physical activity, dexterity, household activities, activities of daily living, anxiety, depression, social activity, and pain. AIMS ll provides further useful information on satisfaction, patient preference, work status, income level, comorbidity, and disease attribution. 68.This instrument offers useful global information in the research setting. The Sickness Impact Profile (SIP) inquires into 136 items relating to 12 categories of patient status. 16. Three of the categories (ambulation, body care and movement/mobility) contribute to a physical dimension, four categories (emotional, behavior, social interaction, alertness behavior, and communication) contribute to a psychosocial dimension. Five categories are independent (work, sleep and rest, eating, home management, and recreation and pastimes). The SIP is a self-administered instrument that takes up to 30 minutes to complete. It has not been validated for use in patients with FMS; it mainly is used for those with low back pain problems. The McMaster Health index Questionnaire (MHlQ) assesses physical function in terms of physical activities, self-care activities, mobility, communication, and global physical activity. 27 A social index combines general well-being, work or social role performance, material welfare, support, participation with friends and family, and global social function. The emotional index measures feelings about personal relationships, self esteem, thoughts concerning the future, critical life events, and global emotional function. The 59 items are self-administered and are designed to measure the quality of life for patients with rheumatoid disease. This instrument has not seemingly been applied to FMS patients but includes many important variables that would be relevant to this condition.

The Health Assessment Questionnaire (HAQ) in its long form contains 330 items relating to pain, global severity, income, job change, cost of medical care, side effects of therapy, and physical function. 40. The more commonly used short HAQ comprises 24 questions on activities of daily living and mobility. The answers use a summated index between O and 3 on a continuous scale. Although it only assesses physical function, it takes only a few minutes to complete and has been extremely useful in various forms for the study of patients with FMS. 109. The modified Version of HAQ (MHAQ) evaluates physical function through only eight questions and adds new scales for change in function, satisfaction, and pain in the performance of each of these activities. This questionnaire takes roughly 5 minutes to complete. MHAQ and HAQ are comparable in regard to reliability and validity x4 and are suitable for use in FMS patients. The CLINHAQ. 107. is a further advance comprising the AIMS psychologic scales and global severity scale as well as the short HAQ instrument. A pain diagram and VAS pain, fatigue, gastric, and sleep scales are included, as well as an assessment of work capacity. This doubles the time required for administration from around 2 1/2 to 5 minutes, but it is still very useful in the clinic. This instrument has been widely used in a variety of rheumatologic disorders, including FMS, 109.and appears ideal for following FMS patients in the clinic.

The Fibromyalgia impact Questionnaire (FIQ) has been developed as a simple instrument specifically designed to reflect change in a FMS patient's general status over a time, up to several years. The instrument lists 10 questions and takes approximately 5 minutes to complete. 23. The questions are designed to quantitate functional disability, pain intensity, sleep disorder, muscular stiffness, anxiety, depression, and overall sense of well-being. Visual analogue scales inquire into pain, fatigue, morning stiffness, stiffness severity, depression, and anxiety. A VAS assesses how pain might interfere with work ability, and days missed from work in the past week are added. Ten separate questions rated on a four-point Likert scale assess general function. This simple instrument has a good test-retest reliability and, in comparison to the relevant AIMS scales, shows high reliability and construct and content validity. 23 The instrument appears useful for longitudinal studies, particularly when interventions are being assessed and when a multidisciplinary approach is present.

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Patient's Pain Communication Tool