Self-reported disability in women with fibromyalgia from a tertiary care center

Horta-Baas, Gabriel; Romero-Figueroa, Maria del Socorro

doi:10.1186/s42358-019-0086-4

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Sumário

Research • Adv. rheumatol. 59 • 2019 • https://doi.org/10.1186/s42358-019-0086-4 copy

Self-reported disability in women with fibromyalgia from a tertiary care center

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The 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.

Methods:

One 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.

Results:

Disability 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.

Conclusions:

Most 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).

Keywords:
Fibromyalgia; Chronic pain; Mood disorders; Affective symptoms; Disabled persons; Disability evaluation; WHODAS

		Mild (n = 13)	Moderate (n = 54)	Severe (n = 47)	Total (n = 114)	P value	Size effect
Age in years		48.2 ± 5.9	49.9 ± 7.2	46.8 ± 6.4	48.4 ± 6.8	0.07	0.02^a a Omega squared = 0.01–0.059 is a low association. 0.06–0.13 is a medium association. ≥0.14 is a large association.
Years of education		10 ± 3.5	10.2 ± 3.6	10.1 ± 3.2	10.1 ± 3.4	0.98	0.01^a a Omega squared = 0.01–0.059 is a low association. 0.06–0.13 is a medium association. ≥0.14 is a large association.
Time since onset of pain (months)		48 (24)	48 (64)	36 (42)	48 (60)	0.22	0.02^b b Epsilon squared
Time since FM diagnosis (months)		36 (46)	34 (36)	12 (36)	24 (42)	0.08	0.03^b b Epsilon squared
Body mass index		29.1 ± 4.5	28.4 ± 3.1	28.9 ± 3.7	28.7 ± 3.5	0.72	0.01^a a Omega squared = 0.01–0.059 is a low association. 0.06–0.13 is a medium association. ≥0.14 is a large association.
Pain Intensity		5.0 ± 2.3	6.2 ± 2.1	7.3 ± 1.6	6.5 ± 2.1	< 0.001	0.12^a a Omega squared = 0.01–0.059 is a low association. 0.06–0.13 is a medium association. ≥0.14 is a large association.
Number of drugs		2.3 ± 1.1	2.12 ± 1.2	2.08 ± 1.2	2.1 ± 1.2	0.85	0.01^a a Omega squared = 0.01–0.059 is a low association. 0.06–0.13 is a medium association. ≥0.14 is a large association.
Pharmacological treatment		11 [84.6]	49 [90.7]	39 [82.9]	99 [86.8]	0.49	–
	Celecoxib	5 [38.4]	21 [38.8]	9 [19.1]	35 [30.7]	0.08
	Nonsteroidal anti-inflammatory drugs	3 [23.0]	9 [16.6]	13 [27.6]	25 [21.9]	0.41
	Pregabalin or Gabapentin	6 [46.1]	30 [55.5]	24 [51.0]	60 [52.6]	0.79
	Antidepressants	9 [69.2]	27 [50.0]	29 [61.7]	65 [57.0]	0.31
	Tramadol-acetaminophen	5 [38.4]	19 [35.1]	13 [27.6]	37 [32.4]	0.64
	Benzodiazepines	0 [0]	7 [12.9]	4 [8.5]	11 [9.6]	0.34
	Quetiapine	0 [o]	0 [o]	2 [4.2]	2 [1.7]	0.23
Medication adherence
	Non-pharmacological treatment	2 [15.3]	5 [9.2]	8 [17.0]	15 [13.0]	0.35
	Adherent	5 [38.4]	26 [48.1]	17 [36.1]	48 [42.1]
	Non-adherent	2 [¹⁵15. van Houdenhove B, Neerinck E, Onghena P, Lysens R, Vertommen H. Premorbid “overactive” lifestyle in chronic fatigue syndrome and fibromyalgia :an etiological factor or proof of good citizenship? J Psychosom Res. 2001;51:571–6.–³3. Henriksson C, Burckhardt C. Impact of fibromyalgia on everyday life: a study of women in the USA and Sweden. Disabil Rehabil. 1996;18:241–8.]	19 [35.1]	17 [36.1]	38 [33.0]
	Unknown	4 [30.7]	4 [7.4]	5 [10.6]	13 [11.3]

Domains	Mean ± Standard deviation	Median (25th percentile-75th percentile)	Minimum - maximum score
Lifeactivities (Household)	54.8 ± 24.0	50 (40–70)	0–100
Mobility	50.0 ± 20.4	50 (37.5–68.7)	6.2–100
Participation	48.2 ± 19.0	45.8 (37.5–62.5)	8.3–87.5
Life activities (School/Work)	43.7 ± 21.0	42.8 (28.5–57.1)	0–85.7
Cognition	40.8 ± 19.5	40 (30–55)	0–90
Getting along	35.3 ± 26.8	33.3 (8.3–50)	0–100
Self-care	28.6 ± 23.2	30 (10–50)	0–90
Global score	43.8 ± 16.5	43.4 (31.5–55.4)	4.3–81-5

	Explanatory variables	Adjusted Odds Ratio (OR)	P value	95% Confidence Interval		Pseudo R²	Brand test
Model 1	Alexithymia	4.02	0.003	1.60	10.05	0.13	0.79
	Pain Intensity	1.42	0.001	1.16	1.74
Model 2	Alexithymia	3.58	0.004	1.49	8.64	0.07	0.30
	Depression	2.15	0.066	0.95	4.87
Model 3	Alexithymia	3.96	0.005	1.66	9.44	0.06	0.41
	Anxiety	1.66	0.25	0.69	3.98
Model 4	Alexithymia	3.71	0.006	1.46	9.39	0.13	0.42
	Pain Intensity	1.40	0.001	1.14	1.72
	Depression	1.61	0.27	0.68	3.81
Model 5	Alexithymia	3.28	0.014	1.27	8.46	0.15	0.11
	Pain Intensity	1.39	0.001	1.13	1.71
	Depression	1.76	0.20	0.73	4.28
	Work status	1.99	0.11	0.85	4.64
	Age in years	0.97	0.52	0.92	1.04

Dependent variable	Predictor variables	Odds Ratio	95% Confidence Interval	Standard error	P value
Cognition	Alexithymia	3.26	1.36–7,83	1.45	0.008
	Depression	2.85	1.22–6.66	1.23	0.015
	Pain intensity	1.06	0.89–1.27	0.09	0.47
Mobility	Pain intensity	1.35	1.09–1.66	0.14	0.004
	Alexithymia	3.26	1.36–7.83	1.45	0.008
	Depression	1.10	0.46–2.60	0.48	0.82
Self-care	Pain intensity	1.36	1.13–1.64	0.12	0.001
	Alexithymia	2.78	1.23–6.29	1.15	0.014
	Depression	1.40	0.64–3.07	0.56	0.39
Getting along	Depression	2.57	1.16–5.69	1.12	0.020
	Alexithymia	2.64	1.14–6.08	1.04	0.023
	Pain intensity	1.04	0.87–1.24	0.09	0.60
Life activities (Household)	Pain intensity	1.22	1.00–1.49	0.12	0.041
	Alexithymia	3.04	1.25–7.40	1.38	0.014
	Depression	1.45	0.60–3.48	0.64	0.39
Participation	Pain intensity	1.26	1.04–1.53	0.12	0.018
	Alexithymia	2.87	1.18–6.96	1.29	0.019
	Depression	1.97	0.84–4.62	0.85	0.11

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[1] *Correspondence: gabho@hotmail.com