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Last name: revised fibromyalgia impact questionnaire ( fiqr) first name: age: duration of fm symptoms ( years) time since fm was first diagnosed ( years) : directions: for each of the following 9 questions check the box that best indicates how much your fibromyalgia made pdf it difficult to perform each of the following activities during the past 7 days. directions: for each of the following 9 questions check the box from 0 ( no difficulty) to 10 ( very difficult) that best indicates how much your fibromyalgia made it difficult to perform each of the following activities during the past 7 days. the fiqr is a disease- specific questionnaire, designed for use in patients with fibromyalgia. section i: activity level.
higher scores indicate more severe impact the fiqr is administered by self- report; the patient may either fill out the form or complete the form online. revised fibromyalgia impact questionnaire ( fiqr) last name: first name: age: duration of fm symptoms ( years) : time since fm was first diagnosed ( years) : directions: for each of the following 9 questions check the box that best indicates how pdf much your fibromyalgia made it difficult to perform each of the following activities during the past 7 days. the total score can range from 0 - 100. brush or comb your hairnever never q q q q q q q q q q q alwaysno pain q q q q q q q q q fiqr pdf q q unbearable pain.
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