VALIDITY AND AGREEMENT OF THE THAI SELF-REPORTED QUESTIONNAIRE BASED ON THE ACTTION-APS PAIN TAXONOMY FIBROMYALGIA DIAGNOSTIC CRITERIA IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN
DOI:
https://doi.org/10.55374/jseamed.v9.238Keywords:
fibromyalgia, diagnosis, questionnaire, validity, agreementAbstract
Background: Fibromyalgia (FM) is a chronic widespread pain syndrome that leads to functional impairment and poor quality of life. The American College of Rheumatology (ACR) diagnostic criteria, introduced in 2016, have been widely used. However, the ACTTION-American Pain Society Pain Taxonomy (AAPT) group introduced new, shorter criteria in 2018 to simplify the diagnosis. The FM self-administered questionnaire (FSQ), based on the ACR 2016, had good validity; however, studies on the shorter and more user-friendly AAPT criteria were needed.
Objectives: This study aimed to develop a Thai version of the short AAPT criteria for the FM self-administered questionnaire (AAPT-FSQ) and to assess its validity and agreement with the ACR 2016.
Methods: AAPT criteria were translated into Thai. Of the 128 patients with chronic musculoskeletal pain for more than three months at the Rehabilitation Medicine outpatient clinic were asked to complete a self-questionnaire that included the Thai AAPT-FSQ, Thai Fatigue Severity Scale (FSS), and Thai Pittsburgh Sleep Quality Index (PSQI). Lastly, FM diagnosis for each participant was done by physiatrists based on the ACR 2016 diagnostic criteria.
Results: Construct validity showed strong correlations between AAPT pain sites and Widespread Pain Index (rs = 0.78, p < 0.001); AAPT sleep problems and Thai PSQI (rs = 0.64, p < 0.001), and AAPT fatigue problems and Thai FSS (rs = 0.67, p < 0.001). Diagnosis agreement between the AAPT and ACR 2016 criteria was 90.6%, with a substantial Kappa coefficient of 0.67 (p < 0.001), indicating good concordance. The sensitivity and specificity were 48.3% (95% CI: 29.4%–67.5%) and 99.0% (95% CI: 94.5%–100.0%), respectively.
Conclusion: The Thai AAPT-FSQ had good construct validity and agreement in patients with chronic musculoskeletal pain. Due to its shorter criteria and simplicity, it may serve as a practical self-administered questionnaire for FM.
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References
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RL, et al. Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46: 319-29. DOI: https://doi.org/10.1016/j.semarthrit.2016.08.012
Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 2013; 17: 356. DOI: https://doi.org/10.1007/s11916-013-0356-5
Itthipongsathorn N, Phonghanyudh T, Nitikornatiwat P. Prevalence of fibromyalgia at the physical medicine and rehabilitation out patient clinic in Phramongkutklao Hospital. J Thai Rehabil Med 2016; 26: 24-30.
Prateepavanich P, Kattinanon D, Suwannakin A. The Prevalence of Fibromyalgia in Chronic Myofascial Pain Syndrome Patients. J Thai Rehabil Med 2017; 27: 71-6.
Giorgi V, Sirotti S, Romano ME, Marotto D, Ablin JN, Salaffi F, et al. Fibromyalgia: one year in review 2022. Clin Exp Rheumatol 2022; 40: 1065-72. DOI: https://doi.org/10.55563/clinexprheumatol/if9gk2
Martinez-Lavin M. Centralized nociplastic pain causing fibromyalgia: an emperor with no cloths? Clin Rheumatol. 2022; 41: 3915-7. DOI: https://doi.org/10.1007/s10067-022-06407-5
Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, et al. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns 2008; 73: 114-20. DOI: https://doi.org/10.1016/j.pec.2008.06.005
Siracusa R, Paola RD, Cuzzocrea S, Impellizzeri D. Fibromyalgia: pathogenesis, mechanisms, diagnosis and treatment options update. Int J Mol Sci 2021; 22. DOI: https://doi.org/10.3390/ijms22083891
Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. report of the multicenter criteria committee. Arthritis Rheum 1990; 33: 160-72. DOI: https://doi.org/10.1002/art.1780330203
Sarzi-Puttini P, Giorgi V, Atzeni F, Gorla R, Kosek E, Choy EH, et al. Fibromyalgia position paper. Clin Exp Rheumatol 2021; 39 Suppl 130: 186-93. DOI: https://doi.org/10.55563/clinexprheumatol/i19pig
Choy E, Perrot S, Leon T, Kaplan J, Petersel D, Ginovker A, et al. A patient survey of the impact of fibromyalgia and the journey to diagnosis. BMC Health Serv Res 2010; 10: 102. DOI: https://doi.org/10.1186/1472-6963-10-102
Perrot S, Choy E, Petersel D, Ginovker A, Kramer E. Survey of physician experiences and perceptions about the diagnosis and treatment of fibromyalgia. BMC Health Serv Res 2012; 12: 356. DOI: https://doi.org/10.1186/1472-6963-12-356
Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, et al. AAPT diagnostic criteria for fibromyalgia. J Pain 2019; 20: 611-28. DOI: https://doi.org/10.1016/j.jpain.2018.10.008
Wongthanavimok N, Chewachutirungruang C, Hathaiareerug C, Phongamwong C. Reliability, validity and agreement of the Thaiself-reported fibromyalgia survey questionnaire among patients with chronic musculoskeletal pain. J Southeast Asian Med Res 2023; 7: e0172. DOI: https://doi.org/10.55374/jseamed.v7.172
Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213. DOI: https://doi.org/10.1016/0165-1781(89)90047-4
Methipisit T, Mungthin M, Saengwanitch S, Ruangkana P, Chinwarun Y, Ruangkanchanasetr P, et al. The Development of sleep questionnaires Thai Version (ESS, SA-SDQ, and PSQI): linguistic validation, reliability analysis and cut-off level to determine sleep related problems in Thai population. J Med Assoc Thai 2016; 99: 893-903.
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121-3. DOI: https://doi.org/10.1001/archneur.1989.00520460115022
Sawasdee A, Preechawoong S, Jitpanya C. Relationships between pain, sleep ouality, depressive symptoms, and fatigue in post stroke patients. Kuakarun Journal of Nursing 2018; 24: 7–22.
Donner A, Eliasziw, M. A goodness-of-fit approach to inference procedures for the kappa statistic: Confidence interval construction, significance-testing and sample size estimation. Stat Med 1992; 11: 1511-9. DOI: https://doi.org/10.1002/sim.4780111109
Kang JH, Choi SE, Xu H, Park DJ, Lee JK, Lee SS. Comparison of the AAPT fibromyalgia diagnostic criteria and modified FAS criteria with existing ACR criteria for fibromyalgia in Korean patients. Rheumatol Ther 2021; 8: 1003-14. DOI: https://doi.org/10.1007/s40744-021-00318-8
Salaffi F, Di Carlo M, Farah S, Atzeni F, Buskila D, Ablin JN, et al. Diagnosis of fibromyalgia: comparison of the 2011/2016 ACR and AAPT criteria and validation of the modified fibromyalgia assessment status. Rheumatology (Oxford). 2020; 59: 3042-9. DOI: https://doi.org/10.1093/rheumatology/keaa061

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