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GPs may diagnose fibromyalgia better using patient-reported questionnaire – even without brief physical

  [ 14 votes ]   [ 1 Comment ]
www.ProHealth.com • December 15, 2011


Article:
Development and Testing of the Fibromyalgia Diagnostic Screen for Primary Care
– Source: Journal of Women’s Health, Dec 14, 2011

By Lesley M Arnold, Leslie J Crofford, et al.

[Note: the screen mentioned here apparently refers to the "Arnold Fibromyalgia Diagnostic Screen." A report on multicenter testing of its component questions, presented at the 2011 ACR/ARHP conference in Chicago, is found HERE. We are unsure how it may differ if at all from the “ACR Preliminary Diagnostic Criteria for FM & Measurement of Symptom Severity” published in May 2010.]

Abstract:
Background: The Fibromyalgia Diagnostic Screen* was developed for use by primary care clinicians to assist in the diagnostic evaluation of fibromyalgia, a disorder that predominantly affects women.

Methods: The screen was designed to have a patient-completed questionnaire and a clinician-completed section, which included a brief physical examination pertinent to the differential diagnosis of fibromyalgia.

The items in the questionnaire were based on patient focus groups and clinician and patient Delphi exercises, which resulted in a ranking of the most common and troublesome fibromyalgia symptoms.

One hundred new chronic pain patients (pain more than 30 days) and their primary care physicians completed the screen.

The patients were grouped as fibromyalgia or nonfibromyalgia by an independent fibromyalgia specialist, who was blind to screen responses.

Logistic regression was used to model the probability of fibromyalgia as a function of physician-reported and patient-reported variables.

Best subset regression was used to identify a subset of symptoms that were summed to form a single measure. Receiver operating characteristic (ROC) analysis was then used to select thresholds for continuous variables. The symptom and clinical variables were combined to create candidate prediction rules that were compared in terms of sensitivity and specificity to select the best criterion.

Results: Two final models were selected based on overall accuracy in predicting fibromyalgia: One used the patient-reported questionnaire only, and the other added a subset of the physical examination items to this patient questionnaire.

Conclusion:
A patient-reported questionnaire with or without a brief physical examination may improve identification of fibromyalgia patients in primary care settings.

Source:
  Journal of Women’s Health, Dec 14, 2011. PMID:22165952, by Arnold LM, Stanford SB, Welge JA, Crofford LJ. University of Cincinnati College of Medicine , Cincinnati, Ohio; University of Kentucky, Lexington, USA. [Email: Lesley.arnold@uc.edu]




Discuss This Article Post a Comment 


Patient-reported questionnaire helping GPs diagnose Fibro
Posted by: ppmickey
Dec 21, 2011
I can see this happening where a patient has to wait a long time to be seen by the physician. However, most physicians are in and out so quickly that you don't get to ask all the questions you have on your list. Physicians usually wouldn't have time to read a questionnaire before seeing you. It's all they can do to keep up with blood test results, x-ray results and if you have any other conditions along with Fibro and/or CFS, your appointment runs over into someone else's appointment.

I think it's a marvelous idea, but with all the paperwork a physician has, it may be impossible to keep up with. There usually isn't enough time allotted for patients with multiple conditions to see the doctor and you know he's thinking about how many patients he has to see before lunch or how late is it going to take before the office closes for the day, no matter how much he might like you as a person. When a physician is first starting out they have time for this, but as their practice grows and has to be capped-off, I can see this going by the wayside. My doctor has actually done research on my conditions and I have been so very impressed that he has taken his own time to look into things that may be helpful for my conditions.

ppmickey
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