FIQR Score Calculator      
  The Fibromyalgia Impact Questionnaire (FIQR) consists of 21 questions that are divided into 3 domains:
1. Nine questions about function
2. Two  questions global
impact
3. Ten questions about
symptoms
It takes about 2 minutes to complete the questionnaire.
To register each question's score use the slider  -  you can also point and click instead of "sliding"
The lowest score is registered when the slider is at the far left, and the highest (most severe) score is
registered when the slider is at the far right
The total FIQR score is given below the questions and the scores for the 3 domains are also calculated
 
   
   
   
   
   
  Name (first name, last name):      
  Gender:
Female Male
         
  Age:  
         
  Duration of FM: 
         
  1. Function:
 
For each of the following 9 questions
move the slider to the postion that best indicates how much fibromyalgia
 made it difficult to perform the following
activities during the past 7 days
    If you didn't perform an activity in the last 7 days, rate the difficulty for the last time you did perform the activity 
    If you can’t perform an activity, move the slider to the
right hand end (very difficult)
 
   
   
 
   
   
  Brush or comb your hair        No difficulty
  Very difficult  
  Walk continously for 20 minutes       No difficulty
  Very difficult  
  Prepare a homemade meal      No difficulty
  Very difficult  
  Vacuum, scrub or sweep floors      No difficulty
  Very difficult  
  Lift and carry a bag of groceries      No difficulty
  Very difficult  
  Climb one flight of stairs      No difficulty
  Very difficult  
  Change bed sheets      No difficulty
  Very difficult  
  Sit in a chair for 45 minutes      No difficulty
  Very difficult  
  Go shopping for groceries      No difficulty
  Very difficult  
               
  2. Global impact:            
               
  For each of the following 2 questions, check the box that best describes the overall      
impact of your fibromyalgia over the last 7 days:
               
  Fibromyalgia prevented me attaining my goals for the week                   Never
  Always  
  I was completely overwhelmed by my fibromyalgia symptoms                  Never
  Always  
             
  3.Symptoms:

For each of the following 10 questions, move the slider to the postion that best indicates
the
intensity of these common fibromyalgia symptoms over the past 7 days:
 
   
   
               
  Your level of pain                     No pain
  Unbearable pain  
  Your level of energy          Lots of energy
  No energy  
  Your level of stiffnes                No stiffness
  Severe stiffness  
  The quality of your sleep     Awoke well rested
  Awoke very tired  
  Your level of depression           No depression
  Very depressed  
  Your level of memory problems           Good memory
  Very poor memory  
  Your level of anxiety             Not anxious
  Very anxious  
  Your level of tenderness to touch           No tenderness
  Very tender  
  Your level of balance problems           No imbalance
  Severe imbalance  
  Your level of sensitivity to  loud noises, bright light, odors and cold           No sensitivity
  Extreme sensitivity  
             
                                FIQR total score:      
                                    Functional subscore:    
                                        Impact subscore:    
                                   Symptom subscore: