Provider's Office
The FIQR is the
recommended questionnaire for following the progress of patients
with a diagnosis of fibromyalgia.
The SIQR is useful for
following the progress of most patients with musculoskeletal
disorders.
Here are the 21 questions in the FIQR:
1.
Brush
or comb your hair
2.
Walk
continuously for 20 minutes
3.
Prepare a homemade meal
4.
Vacuum, scrub or sweep floors
5.
Lift
and carry a bag full of groceries
6.
Climb
one flight of stairs
7.
Change bed sheets
8.
Sit
in a chair for 45 minutes
9.
Go
shopping for groceries
10.
Fibromyalgia prevented me from accomplishing goals for the week
11.
I was
completely overwhelmed by my fibromyalgia symptoms
12.
Please rate your level of pain
13.
Please rate your level of energy
14.
Please rate your level of stiffness
15.
Please rate the quality of your sleep
16.
Please rate your level of depression
17.
Please rate your level of memory problems
18.
Please rate your level of anxiety
19.
Please rate your level of tenderness to touch
20.
Please rate your level of balance problems
21.
Please rate your level of sensitivity to loud noises, bright lights,
odors and cold
Completion / scoring times:
|
* |
Patient
completion time is approximately 2 minutes |
|
* |
Hand scoring takes
approximately 1 minute |
|
* |
Internet scoring is instantaneous
and the completed form with score can be printed out. |
|