Abstract
BackgroundThe World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient’s perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia.MethodsOne hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability.ResultsDisability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire.ConclusionsMost of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).
Highlights
Fibromyalgia (FM) is a chronic pain syndrome with a complex, multifactorial and not completely known etiopathogenesis that affects mainly women
Patients were excluded from the study if they were under age of 18 years or unable to give valid consent, presence of any acute disease that could modify the symptoms, coexistence of another rheumatic disease, psychosis, suicide attempts in the last 3 months, and congenital or acquired disability known
Just one subject (0.8%) was reported without disability and no cases were observed with extreme disability
Summary
Fibromyalgia (FM) is a chronic pain syndrome with a complex, multifactorial and not completely known etiopathogenesis that affects mainly women. Previous studies have reported FM people’s working ability is associated to different variables: pain intensity, Fibromyalgia Impact Questionnaire score, psychological factors (anxiety, depression, and coping strategies) and job associated factors [7,8,9]. From these variables, chronic pain and mood disorders are the most frequently reported. There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient’s perspective. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia
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