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. 2011 Aug 22:9:71.
doi: 10.1186/1477-7525-9-71.

The comparative burden of mild, moderate and severe fibromyalgia: results from a cross-sectional survey in the United States

Caroline Schaefer  1 , Arthi Chandran, Meghan Hufstader, Rebecca Baik, Michael McNett, Don Goldenberg, Robert Gerwin, Gergana Zlateva
Affiliations

The comparative burden of mild, moderate and severe fibromyalgia: results from a cross-sectional survey in the United States

Caroline Schaefer et al. Health Qual Life Outcomes. .

Abstract

Background: Fibromyalgia (FM) is characterized by chronic, widespread pain, fatigue, and other symptoms; yet few studies have comprehensively assessed its humanistic burden. This observational study evaluates the impact of FM severity on patients' symptoms, health-related quality of life (HRQoL), and productivity in the United States.

Methods: 203 FM subjects were recruited from 20 physician offices. Subjects completed a questionnaire including the EuroQol 5D (EQ-5D), Fibromyalgia Impact Questionnaire (FIQ), Multidimensional Assessment of Fatigue (MAF), Medical Outcomes Study Sleep Scale (MOS-SS), and Hospital Anxiety and Depression Scale (HADS) and questions about demographics, pain and other symptoms, HRQoL and productivity. FIQ total scores were used to define FM severity, with 0- < 39, 39- < 59, and 59-100, representing mild, moderate, and severe FM, respectively. Sites recorded subjects' clinical characteristics and FM treatment on case report forms using medical records. Summary statistics were calculated for continuous variables and frequency distributions for categorical variables. Differences across FM severity groups were evaluated using the Kruskal-Wallis or Chi-square tests. Statistical significance was evaluated at the 0.05 level.

Results: Mean (SD) age was 47.9 (10.9); 95% were female. Most (92%) were prescribed medication for FM; 24% and 66% reported moderate and severe FM, respectively. Mean (SD) scores were: 6.3 (2.1) for pain intensity; 0.35 (0.35) for EQ-5D; 30.7 (14.2) for MAF; 57.5 (18.4) for MOS-SS Sleep Problems Index; 10.2 (4.8) for HADS anxiety and 9.4 (4.4) for HADS depression. Subjects with worse FM severity reported significantly increased pain severity, HRQoL, fatigue, sleep disturbance, anxiety and depression (p < 0.001). Overall, 50% of subjects reported some disruption in their employment due to FM; this differed across severity levels (p < 0.001). Employed subjects missed a mean (SD) of 1.8 (3.9) workdays during the past 4 weeks; this also differed across severity levels (p = 0.03).

Conclusions: FM imposes a substantial humanistic burden on patients in the United States, and leads to substantial productivity loss, despite treatment. This burden is higher among subjects with worse FM severity.

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Figures

Figure 1
Figure 1
Impact of Fibromyalgia on HRQoL: Mean Study Sample EQ-5D Scores Compared to US General Population. Source: Subject Questionnaire and Fryback et al, 2007 (US Norm for age range 45-54) [28]. Note: Higher scores indicate better HRQoL.
Figure 2
Figure 2
Impact of Fibromyalgia on Sleep: Mean Study Sample MOS-SS Scores Compared to US General Population. Source: Subject Questionnaire and Hays et al, 2005 (US Norms for age range 18-94) [26]. Note: Higher scores indicate more of the concept being measured. Higher scores represent worse outcomes on all scales except for sleep adequacy, where higher scores represent better outcomes.
Figure 3
Figure 3
Impact of Fibromyalgia on Employment: Overall and by Severity Level. Source: Subject Questionnaire. * P-value < 0.001 (Chi-square test; mild vs. moderate vs. severe by impact of FM on employment status).
See this image and copyright information in PMC

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