Improving the primary care physicians' decision making for fibromyalgia in clinical practice: development and validation of the Fibromyalgia Detection (FibroDetect®) screening tool

Abstract

BackgroundFibromyalgia diagnosis is a challenging and long process, especially among primary care physicians (PCPs), because of symptom heterogeneity, co-morbidities and clinical overlap with other disorders. The purpose was to develop and validate a screening tool in French (FR), German (DE) and English (UK) to help PCPs identify patients with fibromyalgia.MethodsThe FibroDetect questionnaire was simultaneously developed in FR, DE and UK based on information obtained from a literature review, focus groups conducted with clinicians, and face-to-face interviews with fibromyalgia patients (FR, DE and UK, n = 23). The resulting tool was comprehension-tested in patients with diagnosed or suspected fibromyalgia (n = 3 and n = 2 in each country, respectively). Acceptability and applicability were assessed and the tool modified accordingly, then assessed in clinical practice. A scoring method was created using an iterative process based on statistical and clinical considerations with American College of Rheumatology + (ACR+) patients and ACR– patients (n = 276), and validated with fibromyalgia and non-fibromyalgia patients (n = 312).ResultsThe FibroDetect included 14 questions assessing patients’ pain and fatigue, personal history and attitudes, symptoms and impact on lives. Six questions were retained in the final scoring, demonstrating satisfactory discriminative power between ACR + and ACR- patients with area under the Receiver Operating Characteristic curve of 0.74. The predictive accuracy of the tool increased to 0.86 for fibromyalgia and non-fibromyalgia patient detection, with a sensitivity of 90% and a specificity of 67% for a cut-off of 6 on the score.ConclusionsThe FibroDetect is a self-administered tool that can be used as a screening classification surrogate to the ACR criteria in primary care settings to help PCPs detect potential fibromyalgia patients among a population complaining of chronic widespread pain.

A simple screening test to recognize fibromyalgia in primary care patients with chronic pain

“…24 Past studies have incorporated the concepts of widespread pain, tenderness, and patient rated severity of symptoms in algorithms for FM diagnosis . 13,25,26 This current study follows a similar algorithm but offers a shorter but more practical screen for identifying those at risk for having FM. Thus, we are recommending 2 simple assessments to be added to the routine evaluation of any chronic pain patient.…”

Fibromyalgia: management strategies for primary care providers

“…However, although she previously participated in regular aerobic exercise, she has not exercised in the past 9 months due to always feeling tired. With further enquiry, Susan remembers that during her childhood, her mother also had similar complaints are currently under evaluation for use in primary care, including the Fibromyalgia Diagnostic Screen (55,84) and the FibroDetect â tool (85). Both appear to have good sensitivity and specificity, and may facilitate the identification of patients with FM in the primary care setting, although further validation in diverse settings is required.…”

Fibromyalgia diagnosis: a review of the past, present and future

“…This resulted in delayed treatment and potentially suboptimal medical care. Thus, many experts strongly believe that medical societies should stop stigmatizing these patients, recognize their conditions and help them with the best available scientific evidence [7,49]. Most believe that establishing the diagnosis of FM is the first step of successful management [50].…”

“…In order to compensate this limitation, more studies are focused in developing potential screening tools to help diagnose FM and assessments tools to rate the severity of FM [57]. Baron et al developed a self-administered tool called 'FibroDetect' to screen for potential FM patients [49]. The authors suggested that the tool could be used as a surrogate screening classification to ACR criteria in the primary care settings.…”