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Clinical dimensions of fibromyalgia symptoms and development of a combined index of severity: The CODI index

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Abstract

Background

Although a large body of work indicates that fibromyalgia (FM) is not a discrete entity, few studies have attempted to classify the heterogeneity of FM symptoms. The objectives of the present study were to confirm the existence of two latent dimensions underlying FM symptoms (Core-FM symptoms and Distress) by means of factor analysis techniques, and to develop and validate a new combined index of symptom severity (the CODI).

Methods

We analyzed and combined the baseline scores on six visual analog scales of the FIQ (pain, general fatigue, morning fatigue, stiffness, anxiety, and depression) and on the STAI-T (trait anxiety) of 216 Spanish patients diagnosed with FM (97.7% women) who were participating in a randomized, controlled trial.

Results

The principal component analysis indicated the presence of two correlated factors (labeled as Core-FM symptoms and Distress) that explained 64% of total variance. The subsequent confirmatory factor analysis yielded more empirical support for the two-factor model than the one-factor model (all items loading on one latent dimension). The two factors possessed adequate internal consistency and construct validity given the pattern of significant correlations with the Euroqol items. The Core-FM dimension had a stronger relationship with mobility, self-care, usual activities, and pain/discomfort than with anxiety/depression, whereas the Distress dimension showed the opposite pattern. Finally, summing the standardized scores of the two dimensions, a new combined index of symptom severity (the CODI) was developed.

Conclusion

The clinical implications and utility of the CODI are discussed in relation to previous research on FM.

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Acknowledgments

The FibroQoL research project was funded by a grant from the “Agència d’Avaluació de Tecnologia i Recerca Mèdiques” (AATRM 077/25/06). JVL is grateful to the “Instituto de Salud Carlos III” (Red RD06/0018/0017) for a postdoctoral contract. To date, the Fibroqol study has received two research awards: the “III International award of psychological research in fibromyalgia, Premio Celeste” awarded by the Asociación Vasca de Divulgación de la Fibromialgia “Gaixoen Ahotsa” (ADFM) and the “IV award for innovation in primary care” awarded by the Catalan Department of Health, the Catalan Society of Family and Community Medicine, and the Association of Family and Community Nursing of Catalonia. The authors would like to thank all of the participants and especially Prof. FJ Baron for his help in developing the web calculator. This research was partially funded by grants from the OTRI-UMA (ref 806/423505 code 00334). We would like to acknowledge the FibroQoL group’s valuable assistance in data collection (General practice Gavà 1: Francisco J. Gómez, José L. Caballé, Amelia Prieto, Elena Carrera, Eva Alonso, Laura Pérez, Nuria Gutiérrez, Rosa M. Aranzana, Montserrat Espuga, Jugo Jiménez. General practice Gavà 2: Mariona Soler, Emilia Caramés, Estíbaliz Redondo, Inma García, Ángel Espín, Carmen Almirall, Josep Verdú, Lola Ruiz, Margarita García, Marta Sanavia. General practice Viladecans 2: María C. García, Alicia Valer, Noelia Esplugas, María D. González, Estefanía San Juan, Adela Viniegra, Caterina Calvet, Cristina Montblanc, Rosa Vilafáfila, Pere Simonet, Luis López, Rosa Ramírez, Ángela Muñoz, Carmen Bentue).

Conflict of interest

All authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Departamento de Psiquiatría y Fisioterapia, Universidad de Málaga, Málaga, Spain

    Antonio Cuesta-Vargas

  2. Parc Sanitari Sant Joan de Déu & Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain

    Juan V. Luciano & Antoni Serrano-Blanco

  3. Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain

    Juan V. Luciano, Maria Teresa Peñarrubia-María, Javier García-Campayo, Rita Fernández-Vergel & Antoni Serrano-Blanco

  4. ABS Bartomeu Fabrés Anglada, DAP Baix Llobregat Litoral, Unitat Docent Costa de Ponent, Institut Català de la Salut, Gavà, Spain

    Maria Teresa Peñarrubia-María & Rita Fernández-Vergel

  5. Servicio de Psiquiatría, Hospital Miguel Servet & Universidad de Zaragoza, Zaragoza, Spain

    Javier García-Campayo

  6. Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain

    Manuel Arroyo-Morales

  7. Faculty of Health Sciences, Universidad de Málaga, Av. Martiricos s/n, 29071, Málaga, Spain

    Antonio Cuesta-Vargas

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  1. Antonio Cuesta-Vargas
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The FibroQoL Study Group

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Correspondence to Antonio Cuesta-Vargas.

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Cuesta-Vargas, A., Luciano, J.V., Peñarrubia-María, M.T. et al. Clinical dimensions of fibromyalgia symptoms and development of a combined index of severity: The CODI index. Qual Life Res 22, 153–160 (2013). https://doi.org/10.1007/s11136-012-0134-6

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