El cuestionario general de salud (GHQ-28) en pacientes con fibromialgia: propiedades psicométricas y adecuación / The general health questionnaire (GHQ-28) in patients with fibromyalgia: Psychometric characteristics and adequacy

La fibromialgia es un síndrome que incluye síntomas como dolor generalizado musculoesquelético, problemas emocionales y cognitivos, así como dificultades de adaptación. El Cuestionario General de Salud (GHQ-28) ha sido ampliamente usado, aunque apenas existen datos sobre su utilización en pacientes de fibromialgia. Se han estudiado 301 pacientes de esta patología, analizándose la bondad del cuestionario y su estructura y obteniéndose altos niveles en ansiedad (X=1.5), disfunción social (X=1.56) y síntomas somáticos del GHQ-28 (X=1.67). La fiabilidad es adecuada (α de Cronbach = .94). La estructura factorial analizada de cuatro factores se ajusta a la propuesta por los autores del cuestionario. Se concluye que el GHQ-28 ha sido útil para explorar la sintomatología psicológica en los pacientes de fibromialgia

Fibromyalgia is a syndrome that involves multiple symptoms, including widespread musculoskeletal pain, emotional and cognitive problems, and adjustment difficulties. The General Health Questionnaire (GHQ-28) has been widely used, even if little data exist on its use in patients with fibromyalgia. A sample of 301 patients with fibromyalgia was studied, analyzing the goodness of the questionnaire and its structure. High anxiety levels (X = 1.5), social dysfunction (X= 1.56) and somatic symptoms of GHQ-28 (X= 1.67) were obtained. The reliability is adequate (Cronbach's α = .94) and the factor structure of four factors analyzed conforms to that proposed by the authors of the questionnaire. The conclusion is that GHQ-28 has been useful to explore the psychological symptoms in patients with fibromyalgia

[Use of the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression in fibromyalgia patients]. / Uso del cuestionario Hospital Anxiety and Depression Scale (HADS) para evaluar la ansiedad y la depresión en pacientes con fibromialgia.

INTRODUCTION: The HADS is a questionnaire widely used to evaluate anxiety and depression, although its use in fibromyalgia patients has not yet been reported. The aim of this study is to know the usefulness of the HADS to evaluate the emotional aspects related to fibromyalgia patients. METHODS: This paper studies a sample of 301 fibromyalgia patients. The scientific goodness of the questionnaire is analyzed, and its structure is compared with other models by confirmatory factor analysis. Two external severity indices are used, number of tender points and patient's employment situation. RESULTS: The results show higher levels of anxiety than in other disorders, adequate reliability and a three-factor model with better statistical fit. Nevertheless, this structure was not shown more useful than the two-factor structure for the external criteria studied. CONCLUSIONS: The HADS has been shown to be a useful tool for exploring the presence of anxiety and depression in fibromyalgia patients and that the number of tender points does not seem to be related to the severity of the psychological aspects measured by the HADS in our sample, while there does seem to be a correspondence between psychological condition and absence from work.

Fibromyalgia Health Assessment Questionnaire, evaluación de la sensibilidad al cambio

Objetivo. Analizar la sensibilidad al cambio del cuestionario Fibromyalgia Health Assessment Questionnaire (FHAQ) en un grupo de pacientes con fibromialgia (FM). Métodos. Estudio observacional, prospectivo longitudinal, incluido en el Proyecto ICAF (Índice combinado de afectación en pacientes con fibromialgia), realizado en 15 centros españoles. Se estudió de forma consecutiva a 232 pacientes con FM con una edad media de 47 años, el 98,3% mujeres, que se evaluaron en una visita basal y 3 meses después de que se les instaurara un tratamiento según práctica médica habitual. El análisis estadístico incluyó: comparación de medias, respuesta media estandarizada (RME), medida basal estándar (DE), coeficiente de correlación intraclase (R), error estándar de medida (EEM), diferencia mínima detectable (DMD) y proporción de cambio real. Resultados. La diferencia de puntuación media del FHAQ en la visita basal y a los 3 meses fue de 0,098 (IC del 95%, 0,034-0,16) con una p<0,003. Sin embargo, la RME fue de 0,21 (cambio pequeño); DE=0,57, R=0,81, EEM=0,25, DMD=0,69. La proporción de cambio real fue del 17% (39 pacientes). No obstante, el sentido del cambio fue positivo en 28 casos (menor puntuación a los 3 meses) y negativo en los otros 11 (mayor puntuación a los 3 meses). Conclusiones. La puntuación a los 3 meses fue significativamente mejor que la basal, pero con los resultados de este estudio no se puede considerar que el FHAQ sea suficientemente sensible al cambio como para recomendar su uso en estudios longitudinales. El hecho, conocido, de que muchos pacientes pueden empeorar con el tratamiento empleado ha ido en detrimento de la valoración psicométrica del FHAQ (AU)

Objective. To analyze the sensitivity to change of the Fibromyalgia Health Assessment Questionnaire (FHAQ) in a group of patients with fibromyalgia (FM). Methods. Observational, prospective and longitudinal study related to the project ICAF was taken part in 15 Spanish centers. 232 patients were included and diagnosed of FM: 98.3% were women, the mean age was 47years old, they were analyzed at a basal visit and 3months visit, afterwards an appropriated treatment was prescribed. The statistical analysis was performed including: mean comparison, mean standardized response (RME), basal standard media (DE), intraclass correlation coefficient (R), standard error of the mean (EEM), minimal detectable difference (DMD) and percentage change in real. Results. The difference in mean comparison of the FHAQ in the baseline visit and the 3monts visit was of 0,098 (IC 95%: 0,034-0,16), with a P<.003. Nevertheless the RME was 0.21, a slightly change, the DE=0.57, R=0.81, EEM=0.25, and the DMD=0.69. The percentage change in real was 17% (39 patients). But the sense of the change was positive in 28cases (less punctuation in the 3monts visit) and negative in other 11cases (higher punctuation in the 3monts visit). Conclusions. The punctuation in the 3months visit was significant better than the basal, but the results of this study do not let it to consider that the FHAQ have enough change susceptibility to recommend it in longitudinal studies. The well knowing fact, some patients can become worse with the treatment prescribed would be to the detriment of the FHAQ psychometric value (AU)

Estrategias de prescripción de fármacos en el tratamiento de pacientes con fibromialgia / Drug prescription strategies in the treatment of patients with fibromyalgia

Objetivo. Analizar las diferentes estrategias de prescripción seguidas por reumatólogos especializados en FM. Métodos. Estudio prospectivo, multicéntrico, con 2 visitas separadas 3 meses en el que se instaura un tratamiento farmacológico en condiciones de práctica clínica habitual. Se analizó fundamentalmente la prescripción de benzodiacepinas, hipnóticos, antidepresivos y anticonvulsivantes. La evaluación clínica se realizó mediante el cuestionario ICAF (Índice combinado de afectación en pacientes con fibromialgia). Se determinaron las estrategias más frecuentes y se calculó el tamaño del efecto para analizar su eficacia. Resultados. Se incluyó a 232 pacientes con FM atendidos en 15 consultas de reumatología. Las estrategias más comunes fueron la introducción aislada de un anticonvulsivante (17,7%) o un antidepresivo (14,7), que produjeron mejorías clínicas estadísticamente significativas. La estrategia más eficaz (tamaño del efecto próximo a 1) fue la introducción simultánea de ambos fármacos (6,5%), que aumentó en un 50% el tamaño del efecto de antidepresivos y en un 100% el de anticonvulsivantes. La estrategia de no realizar ningún cambio en el número de fármacos fue la más frecuente (35,8%) pero no mostró mejoría clínica significativa. Otras estrategias fueron muy poco frecuentes y no han sido analizadas. Conclusión. Las estrategias de prescripción de fármacos anticonvulsivantes o antidepresivos de manera aislada o en combinación producen una mejoría clínica significativa en los pacientes con FM. La estrategia más eficaz es la introducción de ambos fármacos simultáneamente. La menos eficaz es no realizar ningún cambio (AU)

Objective. To analyze prescription strategies followed by rheumatologist specialized in FM treatment. Methods. A prospective, multicentric, 3-month follow-up study with two visits. The drug treatment was started following usual clinical practice conditions. Prescription of benzodiazepines, hypnotics, anticonvulsants and antidepressants were those mainly studied. Clinical evaluation was performed by the ICAF (Combined index of affection in patients with fibromyalgia) questionnaire. The most frequent strategies and their size effect were calculated. Results. A total of 232 patients attending 15 rheumatology centers were included. The introduction of an anticonvulsant or an antidepressant were the most common drug strategies followed in 17.7% and 14.7% of patients, respectively. Both strategies produced a statistically significant clinical improvement. The most effective strategy (with an effect size of nearly 1) was the introduction of both drugs (6.5% patients), which increased the antidepressants effect size in 50% and 100% for anticonvulsants. The strategy of no change in the number of drug prescriptions was the most frequent (35.8% patients) but no significant clinical improvement was found in these patients. Some other strategies were very uncommon and have not been analyzed in this study. Conclusion. The introduction of anticonvulsants or antidepressants, in an isolated or combined form, produces a significant clinical improvement in FM patients. The most effective drug strategy is the introduction of both drugs at the same time. The least effective strategy is not to change the number of drug prescriptions (AU)

Drug prescription strategies in the treatment of patients with fibromyalgia.

OBJECTIVE: To analyze prescription strategies followed by rheumatologist specialized in FM treatment. METHODS: A prospective, multicentric, 3-month follow-up study with two visits. The drug treatment was started following usual clinical practice conditions. Prescription of benzodiazepines, hypnotics, anticonvulsants and antidepressants were those mainly studied. Clinical evaluation was performed by the ICAF (Combined index of affection in patients with fibromyalgia) questionnaire. The most frequent strategies and their size effect were calculated. RESULTS: A total of 232 patients attending 15 rheumatology centers were included. The introduction of an anticonvulsant or an antidepressant were the most common drug strategies followed in 17.7% and 14.7% of patients, respectively. Both strategies produced a statistically significant clinical improvement. The most effective strategy (with an effect size of nearly 1) was the introduction of both drugs (6.5% patients), which increased the antidepressants effect size in 50% and 100% for anticonvulsants. The strategy of no change in the number of drug prescriptions was the most frequent (35.8% patients) but no significant clinical improvement was found in these patients. Some other strategies were very uncommon and have not been analyzed in this study. CONCLUSION: The introduction of anticonvulsants or antidepressants, in an isolated or combined form, produces a significant clinical improvement in FM patients. The most effective drug strategy is the introduction of both drugs at the same time. The least effective strategy is not to change the number of drug prescriptions.

Fibromyalgia Health Assessment Questionnaire: sensitivity to change.

OBJECTIVE: To analyze the responsiveness of the Fibromyalgia Health Assessment Questionnaire (FHAQ) in a group of patients with fibromyalgia (FM). METHODS: Observational, prospective and longitudinal study related to the project ICAF was taken part in 15 Spanish centers. 232 patients were included and diagnosed of FM: 98.3% were women, the mean age was 47 years old, they were analyzed at a basal visit and 3 months visit, afterwards an appropriated treatment was prescribed. The statistical analysis was performed including: mean comparison, mean standardized response (RME), basal standard media (DE), intraclass correlation coefficient (R), standard error of the mean (EEM), minimal detectable difference (DMD) and percentage change in real. RESULTS: The difference in mean comparison of the FHAQ in the baseline visit and the 3 months visit was of 0.098 (95% CI: 0.034­0.16), with a P<.003. Nevertheless the RME was 0.21, a slightly change, the DE=0.57, R=0.81, EEM=0.25, and the DMD=0.69. The percentage change in real was 17% (39 patients). But the sense of the change was positive in 28 cases (less punctuation in the 3 months visit) and negative in other 11 cases (higher punctuation in the 3 months visit). CONCLUSIONS: The punctuation in the 3 months visit was significant better than the basal, but the results of this study do not let it to consider that the FHAQ have enough change susceptibility to recommend it in longitudinal studies. The well knowing fact, some patients can become worse with the treatment prescribed would be to the detriment of the FHAQ psychometric value.

A confirmatory study of the Combined Index of Severity of Fibromyalgia (ICAF*): factorial structure, reliability and sensitivity to change.

BACKGROUND: Fibromyalgia (FM) is a complex syndrome that affects many aspects of the patient's life and it is very difficult to evaluate in clinical practice. A recent study has developed the Combined Index of Severity of Fibromyalgia (ICAF), an instrument that evaluates diverse aspects of FM and offers five indices: emotional, physical, active coping, passive coping and total. The objective of this study is to confirm the structure of the ICAF, check its test-retest reliability, assess its sensitivity to change, and compare the results obtained in a sample of patients with fibromyalgia with another sample of healthy controls. METHODS: A total of 232 patients took part in the study, 228 women and 4 men, with a mean age of 47.73 years of age (SD = 8.61) and a time of disease evolution since diagnosis of 4.28 years (SD = 4.03). The patients from the FM group completed the ICAF. Between one and two weeks later, they again attended the clinic and complete the 59 items on the ICAF (retest) and immediately afterwards they began treatment (according to daily clinical practice criteria). A sample of healthy subjects was also studied as a control group: 110 people were included (106 women and 4 men) with a mean age of 46.01 years of age (SD = 9.35). The study was conducted in Spain. RESULTS: The results obtained suggest that the four-factor model obtained in the previous study adequately fits the data obtained in this study. The test-retest reliability and internal consistency were all significant and show a high degree of correlation for all the factors as well as in overall score. With the exception of the passive coping factor, all the other scores, including the overall score, were sensitive to change after the therapeutic intervention. The ICAF scores of the patients with fibromyalgia compared with those of the control group were markedly different. CONCLUSIONS: The findings suggest that the ICAF is a valid, reliable, sensitive to change instrument with the added advantage that it offers some additional domains (factors) that provide very valuable information regarding the most delicate aspects of the patient, which must be addressed at the time of treatment in daily clinical practice.

Evaluación de la capacidad funcional en fibromialgia. Análisis comparativode la validez de constructo de tres escalas / Assessment of functional capacity in fibromyalgia. Comparative analysis of construct validity of three functional scales

Objetivo Comparar la validez de constructo de tres cuestionarios de capacidad funcional en pacientes con fibromialgia. Pacientes y métodos Estudio multicéntrico transversal: 301 pacientes procedentes de consultas externas de reumatología de 15 centros en España completaron los cuestionarios Health Assessment Questionnaire (HAQ), Fibromyalgia Health Assessment Questionnaire (FHAQ) y la escala de función física del Fibromyalgia Impact Questionnaire (FF-FIQ), y se compararon sus puntuaciones en grupos extremos de capacidad funcional definida por las medidas externas: test de 6 minutos marcha, test de fatiga de Borg, test de flexibilidad lumbar y evaluación global de la movilidad del paciente. Se calcularon las correspondientes diferencias estandarizadas. Finalmente, se determinaron coeficientes de correlación entre las puntuaciones de los tres cuestionarios. Resultados Los tres cuestionarios mostraron una aceptable validez de constructo, pero los resultados del FF-FIQ fueron inferiores. La correlación entre HAQ y FHAQ fue muy elevada (0,92) y, solamente moderada entre estos dos y el FF-FIQ (0,59). Conclusiones HAQ y FHAQ miden más adecuadamente la verdadera capacidad funcional de los pacientes que el FF-FIQ. El FHAQ, por su brevedad (solo 8 ítems) podría sustituir al HAQ en algunas ocasiones (AU)

Objective To compare the construct validity of three functional capacity questionnaires in patients with fibromyalgia. Patients and methods Transversal multicentric study of 301 patients from fifteen rheumatology outpatient clinics in Spain. Scores of Health Assessment Questionnaire (HAQ), Fibromyalgia Health Assessment Questionnaire (FHAQ) and the physical function scale of the Fibromyalgia Impact Questionnaire (PF-FIQ) were compared with extreme groups of patients defined by four external indirect measures: 6Min Walk Test, a modified Borg Fatigue Scale, Lumbar Spine Flexion Test and Patient Global Passive Mobility Assessment. Standardized differences were determined and correlation coefficients were calculated between the three questionnaires scores. Results All three questionnaires showed good construct validity, but the results obtained with the PF-FIQ were poorer. Correlations between HAQ and FHAQ were very high (0.92), but correlations between these two questionnaires and PF-FIQ were only moderate (0.59). Conclusions HAQ and FHAQ are more valid measures of functional capacity than the PF-FIQ. HAQ could be substituted by FHAQ in some settings because of its shorter format (only 8 items) (AU)

Development of a self-reporting tool to obtain a combined index of severity of fibromyalgia (ICAF).

BACKGROUND: Fibromyalgia is a syndrome with heterogeneous symptoms. The evaluation in the clinical setting usually fails to cover the complexity of the syndrome. This study aims to determine how different aspects of fibromyalgia are inter-related when measured by means of a self-reporting tool. The objective is to develop a more complete evaluation model adjusted to the complexity and multi-dimensional nature of the syndrome. METHODS: Application was made of the Fibromyalgia Impact Questionnaire, the Hospital Anxiety and Depression Scale, the Brief Pain Inventory, the Fatigue Assessment Scale, the Health Assessment Questionnaire, the General Health Questionnaire (GHQ-28), the Chronic Pain Coping Inventory, the Arthritis Self-efficacy Scale and the Sleep Quality Scale. An assessment was made, on the basis of clinical interviews, case histories and specific tests, of the patient sociodemographic data, comorbidity, physical exploration and other clinical indexes. An exploratory factor analysis was made, with comparisons of the clinical index scores in extreme groups of patients. RESULTS: The ICAF composed of 59 items was obtained, offering four factors that explain 64% of the variance, and referred to as Emotional Factor (33.7%), Physical-Activity (15%), Active Coping (9%) and Passive Coping (6.3%). A t-test between the extreme scores of these factors in the 301 patients revealed statistically significant differences in occupational status, medically unexplained syndromes, number of tender points, the six-minutes walk test, comorbidity and health care costs. CONCLUSIONS: This study offers a tool allowing more complete and rapid evaluation of patients with fibromyalgia. The test intrinsically evaluates the emotional aspects: anxiety and depression, and their impact upon social aspects. It also evaluates patient functional capacity, fatigue, sleep quality, pain, and the way in which the patient copes with the disease. This is achieved by means of a self-assessment questionnaire based on elements from well known tests.

[Assessment of functional capacity in fibromyalgia. Comparative analysis of construct validity of three functional scales]. / Evaluación de la capacidad funcional en fibromialgia. Análisis comparativode la validez de constructo de tres escalas.

OBJECTIVE: To compare the construct validity of three functional capacity questionnaires in patients with fibromyalgia. PATIENTS AND METHODS: Transversal multicentric study of 301 patients from fifteen rheumatology outpatient clinics in Spain. Scores of Health Assessment Questionnaire (HAQ), Fibromyalgia Health Assessment Questionnaire (FHAQ) and the physical function scale of the Fibromyalgia Impact Questionnaire (PF-FIQ) were compared with extreme groups of patients defined by four external indirect measures: 6Min Walk Test, a modified Borg Fatigue Scale, Lumbar Spine Flexion Test and Patient Global Passive Mobility Assessment. Standardized differences were determined and correlation coefficients were calculated between the three questionnaires scores. RESULTS: All three questionnaires showed good construct validity, but the results obtained with the PF-FIQ were poorer. Correlations between HAQ and FHAQ were very high (0.92), but correlations between these two questionnaires and PF-FIQ were only moderate (0.59). CONCLUSIONS: HAQ and FHAQ are more valid measures of functional capacity than the PF-FIQ. HAQ could be substituted by FHAQ in some settings because of its shorter format (only 8 items).

Normal initial magnetic resonance imaging in aseptic bone necrosis of the knee.

Magnetic resonance imaging (MRI) is considered the most sensitive tool for the detection of osteonecrosis at early stages. We report about 3 patients with high suspicion of osteonecrosis at the knees in whom an initial MRI was normal, but the condition was apparent in a subsequent study. The time between the initial insult and the appearance of diagnostic alterations in MR studies remains undefined and, in patients at risk an initial MRI, if done too early, may fail to detect this condition.

Propuesta de una versión de consenso del Fibromyalgia Impact Questionnaire (FIQ) para la población española / Proposal for a consensus version of the Fibromyalgia Impact Questionnaire (FIQ) for the Spanish population

Objetivo: Lograr una versión actualizada y de consenso del Fibromyalgia Impact Questionnaire (FIQ) para la población española, el Cuestionario de Impacto de la Fibromialgia (CIF). Material y métodos: La confección del CIF se llevó a cabo con participación de todos los grupos de investigadores de las 4 versiones españolas previas del FIQ y teniendo en consideración la reciente versión actualizada del original. Se aplicó el CIF a una muestra de pacientes con fibromialgia para explorar la comprensibilidad de sus ítems y comparar las puntuaciones del cuestionario con 2 índices compuestos: “semiobjetivo” y “subjetivo” de gravedad de la fibromialgia. Se determinaron los correspondientes coeficientes de correlación de Spearman. Resultados: Se exponen las principales modificaciones introducidas en el cuestionario. Algunos pacientes confundieron las respuestas al subítem “j” y al ítem 3, los restantes ítems y subítems no plantearon problemas. Los coeficientes de correlación entre las puntuaciones del CIF y los índices semiobjetivo y subjetivo fueron de 0,57 y 0,76, respectivamente (p < 0,001). Conclusión: Se propone el CIF como versión española actualizada y de consenso del FIQ (AU)

Objective: To obtain an updated FIQ consensus version for patients in Spain, the Cuestionario de Impacto de la Fibromialgia (CIF). Material and methods: The CIF elaboration was carried out with the participation of all the groups of researchers in the 4 previous FIQ Spanish versions, and taking into account the recent updated version of the original FIQ. The CIF was completed by a sample of fibromialgia patients to explore how comprensible its items are and to compare its global score with 2 fibromialgia composite severity indexes, one semi-objective and one subjective. The corresponding Spearman correlation coefficients were determined. Results: The main modifications introduced in the questionnaire are shown. Some patients were confused in their responses to subitem “j” and item 3, but not with regard to the remaining items or subitems. Correlation coeficients between the CIF and the semi-objective and subjective fibromialgia severity indexes were 0.57 and 0.76 respectively (P< 001). Conclusion: The CIF is proposed as an updated Spanish version of the FIQ (AU)

[Proposal for a consensus version of the Fibromyalgia Impact Questionnaire (FIQ) for the Spanish population]. / Propuesta de una versión de consenso del Fibromyalgia Impact Questionnaire (FIQ) para la población española.

OBJECTIVE: To obtain an updated FIQ consensus version for patients in Spain, the Cuestionario de Impacto de la Fibromialgia (CIF). MATERIAL AND METHODS: The CIF elaboration was carried out with the participation of all the groups of researchers in the 4 previous FIQ Spanish versions, and taking into account the recent updated version of the original FIQ. The CIF was completed by a sample of fibromialgia patients to explore how comprensible its items are and to compare its global score with 2 fibromialgia composite severity indexes, one semi-objective and one subjective. The corresponding Spearman correlation coefficients were determined RESULTS: The main modifications introduced in the questionnaire are shown. Some patients were confused in their responses to subitem "j" and item 3, but not with regard to the remaining items or subitems. Correlation coeficients between the CIF and the semi-objective and subjective fibromialgia severity indexes were 0.57 and 0.76 respectively (P<001). CONCLUSION: The CIF is proposed as an updated Spanish version of the FIQ.

Evaluación de pacientes con fibromialgia. Estudio comparativo de 4 versiones españolas del Fibromyalgia Impact Questionnaire (FIQ) / Evaluation of patients with fibromyalgia. Comparative study of 4 Spanish versions of the Fibromyalgia Impact Questionnaire (FIQ)

Objetivo: Describir y comparar el proceso de adaptación transcultural de las 4 versiones españolas validadas del Fibromyalgia Impact Questionnaire (FIQ). Material y métodos: a) Cuestionarios. La primera versión (FIQ1) se presentó como tesis doctoral en 1988; la segunda (FIQ2) se publicó en una revista española de psicología; la tercera (FIQ3), en una revista en inglés y la última (FIQ4) apareció en noviembre de 2004 en la Revista Española de Reumatología. b) Método. Para cada una de las versiones se evaluó: 1) la equivalencia semántica respecto al FIQ original; 2) el nivel de desarrollo de las versiones, siguiendo un método estandarizado basado en el Índice GRAQoL (IG); y 3) el impacto de publicación. Resultados: El FIQ4 mostró una mayor equivalencia semántica. El nivel de desarrollo, a través del IG, arrojó los siguientes resultados: FIQ1, 56%; FIQ2, 50%; FIQ3, 75%; FIQ4, 31%. Sólo los trabajos del FIQ3 fueron publicados en revistas indexadas en Medline. Conclusión: La versión española FIQ3 presenta un mayor nivel de desarrollo, con una equivalencia semántica aceptable con respecto al original, y ha logrado un mayor impacto y visibilidad(AU)

Objective: To describe and compare the process of transcultural adaptation in the 4 validated Spanish versions of the Fibromyalgia Impact Questionnaire (FIQ). Material and methods: a) Questionnaires. The first version (FIQ1) appeared as a doctoral thesis in 1988; the second (FIQ2) was published in a Spanish psychology journal; the third (FIQ3) was published in an English language journal; and the last (FIQ4) appeared in November 2004 in the Revista Española de Reumatología. b) Methods. In each of the versions the following were assessed: 1) the semantic equivalence with respect to the original FIQ, 2) each version’s degree of development following a standardized method based on the GRAQoL Index (GI), and 3) the impact of publication. Results: The FIQ4 showed a greater semantic equivalency. The degree of development shown by the GI produced the following results: FIQ1, 56%; FIQ2, 50%; FIQ3, 75%; FIQ4, 31%. Only the FIQ3 results were published in Medline-indexed journals. Conclusion: The Spanish FIQ3 version presents a greater degree of development and an acceptable semantic equivalency with respect to the original, and has achieved a greater impact(AU)

[Evaluation of patients with fibromyalgia. Comparative study of 4 Spanish versions of the Fibromyalgia Impact Questionnaire (FIQ)]. / Evaluación de pacientes con fibromialgia. Estudio comparativo de 4 versiones españolas del Fibromyalgia Impact Questionnaire (FIQ).

OBJECTIVE: To describe and compare the process of transcultural adaptation in the 4 validated Spanish versions of the Fibromyalgia Impact Questionnaire (FIQ). MATERIAL AND METHODS: a) Questionnaires. The first version (FIQ1) appeared as a doctoral thesis in 1988; the second (FIQ2) was published in a Spanish psychology journal; the third (FIQ3) was published in an English language journal; and the last (FIQ4) appeared in November 2004 in the Revista Española de Reumatología. b) Methods In each of the versions the following were assessed: 1) the semantic equivalence with respect to the original FIQ, 2) each version's degree of development following a standardized method based on the GRAQoL Index (GI), and 3) the impact of publication. RESULTS: The FIQ4 showed a greater semantic equivalency. The degree of development shown by the GI produced the following results: FIQ1, 56%; FIQ2, 50%; FIQ3, 75%; FIQ4, 31%. Only the FIQ3 results were published in Medline-indexed journals. CONCLUSION: The Spanish FIQ3 version presents a greater degree of development and an acceptable semantic equivalency with respect to the original, and has achieved a greater impact.