FIQR Questions

The FIQR is made up of 3 domains; functional (9 questions) , overall (2 questions) and symptoms (9 questions).
Here are the instructions given to subjects for answering each of the 3 domains along with the 21 questions that
make up the FIQR:

Functional domain: 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.

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

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

10.  Fibromyalgia prevented me from accomplishing goals for the week

11.  I was completely overwhelmed by my fibromyalgia symptoms

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

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

The SIQR (symptom impact questionnaire), which is used for patients with diagnoses other than fibromyalgia, is exactly the same as the FIQR but omits the word "fibromyalgia" in the questions
 

Completion time: These questions are completed in about 2 minutes by most patients

Scoring: The scoring takes approximately 1 minute; see SCORING