Assessment of anxiety and quality of life in fibromyalgia patients
Keywords:
Fibromyalgia, Quality of life, Anxiety, Questionnaires, PainAbstract
CONTEXT: Fibromyalgia is a syndrome characterized by chronic, diffuse musculoskeletal pain, and by a low pain threshold at specific anatomical points. The syndrome is associated with other symptoms such as fatigue, sleep disturbance, morning stiffness and anxiety. Because of its chronic nature, it often has a negative impact on patients’ quality of life. OBJECTIVE: To assess the quality of life and anxiety level of patients with fibromyalgia. TYPE Of STUDY: Cross-sectional. SETTING: Rheumatology outpatient service of Hospital das Clínicas (Medical School, Universidade de São Paulo). METHODS: This study evaluated 80 individuals, divided between test and control groups. The test group included 40 women with a confirmed diagnosis of fibromyalgia. The control group was composed of 40 healthy women. Three questionnaires were used: two to assess quality of life (FIQ and SF-36) and one to assess anxiety (STAI). They were applied to the individuals in both groups in a single face-to-face interview. The statistical analysis used Student’s t test and Pearson’s correlation test (r), with a significance level of 95%. Also, the Pearson chi-squared statistics test for homogeneity, with Yates correction, was used for comparing schooling between test and control groups. RESULTS: There was a statistically significant difference between the groups (p = 0.000), thus indicating that fibromyalgia patients have a worse quality of life and higher levels of anxiety. The correlations between the three questionnaires were high (r = 0.9). DISCUSSION: This study has confirmed the efficacy of FIQ for evaluating the impact of fibromyalgia on the quality of life. SF-36 is less specific than FIQ, although statistically significant values were obtained when analyzed separately, STAI showed lower efficacy for discriminating the test group from the control group. The test group showed worse quality of life than did the control group, which was demonstrated by both FIQ and SF-36. Even though STAI was a less efficient instrument, it presented significant results, showing that fibromyalgia patients presented higher levels of anxiety, both on the state and trait scales. Thus, patients with fibromyalgia had higher levels of tension, nervousness, preoccupation and apprehension, and higher propensity towards anxiety. CONCLUSION: The three instruments utilized showed efficiency in evaluating fibromyalgia patients. FIQ was found to be the most efficient instrument for discriminating and assessing the impact of fibromyalgia on their quality of life. It can be concluded that such patients have a worse quality of life and higher levels of anxiety.
Downloads
References
Wolfe F, Smythe HA, Yunus MB, et al. The American Col- lege of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72.
Caidahl K, Lurie M, Bake B, Johansson G, Wetterqvist H. Dyspnoea in chronic primary fibromyalgia. J Inter Med. 1989;226(4):265-70.
Lurie M, Caidahl K, Johansson G, Bake B. Respiratory func- tion in chronic primary fibromyalgia. Scand J Rehabil Med. 1990;22(3):151-5.
Weiss DJ, Kreck T, Albert RK. Dyspnea resulting from fibro- myalgia. Chest. 1998;113(1):246-9.
Matsutani LA, Marques AP, Carvalho CRF, Ferreira EAG. Dispnéia na Fibromialgia. In press, 2004.
Martinez JE, Atra E, Ferraz MB, de Silva PSB. Fibromialgia: aspectos clínicos e socioeconômicos. Rev Bras Reumatol. 1992;32(5):225-30.
Wolf F, Aarflot T, Bruusgaard D, et al. Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia. Scan J Rheumatol. 1995;24(2):112-8.
Henriksson C, Burckhardt C. Impact of fibromyalgia on ev- eryday life: a study of women in the USA and Sweden. Disabil Rehabil. 1996;18(5):241-8.
Gaskin ME, Greene AF, Robinson ME, Geisser ME. Negative affect and the experience of chronic pain. J Psychosom Res. 1992;36(8):707-13.
White KP, Speechley M, Harth M, Ostbye T. Comparing self- reported function and work disability in 100 community cases of fibromyalgia syndrome versus controls in London, Ontario: the London Fibromyalgia Epidemiology Study. Arthritis Rheum. 1999;42(1):76-83.
Krag NJ, Norregaard J, Larsen JK, Danneskiold-Samsøe B. A blinded, controlled evaluation of anxiety and depressive symptoms in patients with fibromyalgia, as measured by standardized psycho- metric interview scales. Acta Psychiatr Scand. 1994;89(6):370-5.
Martinez JE, Atra E, Fontana AM, et al. Aspectos psicológicos em mulheres com fibromialgia. [Psychological aspects in women with fibromyalgia]. Rev Bras Reumatol. 1992;32(2):51-60.
Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Semin Arthritis Rheum. 1981;11(1):151-71.
Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia im- pact questionnaire: development and validation. J Rheumatol. 1991;18(5):728-33.
Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.
Ciconelli RM. Tradução para o português e validação do questioná- rio genérico de avaliação da qualidade de vida “Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)”. [thesis] São Paulo (SP): Universidade Federal de São Paulo; 1997.
Bombardier C, Melfi CA, Paul J, et al. Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med Care. 1995;33(4 Suppl):AS131-44.
Dias RC. Impacto de um protocolo de Fisioterapia sobre a qualidade de vida de idosos com osteoartrite de joelhos. [thesis] São Paulo (SP): Universidade Federal de São Paulo; 1999.
Spielberger DC, Gorsuch LR, Lushene ER. Inventário de Ansiedade Traço-Estado. Rio de Janeiro: Cepa; 1979.
Pássaro AC. A identificação do nível de dor e ansiedade em gestantes [monograph]. São Paulo (SP): Faculdade de Medicina, Universidade de São Paulo; 1997.
Goldenberg DL, Mossey CJ, Schmid CH. A model to assess severity and impact of fibromyalgia. J Rheumatol. 1995;22(12):2313-8.
Hawley DJ, Wolfe F. Pain, disability, and pain/disability relation- ships in seven rheumatic disorders: a study of 1.522 patients. J Rheumatol. 1991;18(10):1552-7.
Martinez JE, Barauna Filho IS, Kubokawa KM, Cevasco G, Pedreira IS, Machado LAM. Avaliação da qualidade de vida de pacientes com fibromialgia através do “Medical Outcome Survey 36 Item Short-Form Study”. Res Bras Reumatol. 1999;39:312-16.
Martinez JE, Ferraz MB, Sato EI, Atra E. Avaliação seqüencial do impacto fibromialgia e artrite reumatóide na qualidade de vida. [Sequential evaluation of the impact of fibromyalgia and rheumatoid arthritis in the quality of life]. Rev Bras Reumatol. 1994;34(6):309-16.
White KP, Nielson WR, Harth M, Ostbye T, Speechley M. Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative commu- nity adult sample. J Rheumatol. 2002;29(3):588-94.
Bennett RM, Burckhardt CS, Clark SR, O’Reilly CA, Wiens AN, Campbell SM. Group treatment of fibromyalgia: a 6-month outpatient program. J Rheumatol. 1996;23(3):521-8.
Gowans SE, deHueck A, Voss S, Richardson M. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res. 1999;12(2):120-8.
Burckhardt CS, Mannerkorpi K, Hedenberg L, Bjelle A. A random- ized, controlled clinical trial of education and physical training for women with fibromyalgia. J Rheumatol. 1994;21(4):714-20.
Gowans SE, deHueck A, Voss S, Silaj A, Abbey SE, Reynolds WJ. Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Arthritis Rheum. 2001;45(6):519-29
Valim V. Estudo dos efeitos do condicionamento aeróbio e do alongamento na fibromialgia. [This study was to com- pare flexibility with aerobic physical fitness and improving symptoms]. [thesis] São Paulo (SP): Universidade Federal de São Paulo; 2001.
Mengshoel AM, Haugen M. Health status in fibromyalgia – a followup study. J Rheumatol. 2001;28(9):2085-9.
Buskila D, Neumann L, Alhoashle A, Abu-Shakra M. Fibromyalgia syndrome in men. Semin Arthritis Rheum. 2000;30(1):47-51.
Gowans SE, DeHueck A, Abbey SE. Measuring exercise-induced mood changes in fibromyalgia: a comparison of several measures. Arthritis Rheum. 2002;47(6):603-9.
Schlenk EA, Erlen JA, Dunbar-Jacob J, et al. Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36. Qual Life Res. 1998;7(1):57-65.
Martinez JE, Barauna Filho IS, Kubokawa K, Pedreira IS, Mach- ado LA, Cevasco G. Evaluation of the quality of life in Brazilian women with fibromyalgia, through the medical outcome survey 36 item short-form study. Disabil Rehabil. 2001;23(2):64-8.
Garratt AM, Ruta DA, Abdalla MI, Russell IT. Responsiveness of the SF-36 and a condition-specific measure of health for patients with varicose veins. Qual Life Res. 1996;5(2):223-34.
Gliklich RE, Hilinski JM. Longitudinal sensitivity of a generic and specific health measures in chronic sinusitis. Qual Life Res. 1995;4(1):27-32.
