Living with Fibromyalgia (FM): The Salience ofClinical Subgroups

Fibromyalgia (FM) is an elusive syndrome that affects 2% of the United States population, with health care costs exceeding $20 billion in 1998. FM alters lives with its symptoms and by interfering with everyday life. This dissertation explored the association between subgroups of women with FM and their functional status. The first study examined the effectiveness of an Internet-based health promotion intervention to improve the clinical outcomes for two subgroups of women with FM: those with high Fibromyalgia Impact Questionnaire (FIQ) scores (n = 5) and those with low FIQ scores (n = 5). Single subject design and grouped data revealed that the intervention had mixed results for the two subgroups. The clinical response to the intervention depended on the method of analysis (individual versus group) and the target behavior of interest. The second study examined the associations among objective and subjective measures, and two target outcomes: physical activity and functional status (FIQ total score), and then used the data to classify FM subgroups (n = 72). Using Exhaustive Chi-square Automatic Interaction Detector (Exhaustive CHAID), we developed two models. Model I, with the target outcome of physical activity, yielded 9 distinct subgroups, whose members had characteristics that were significantly associated with very unfavorable to very favorable physical activity outcomes. Model II, with the target outcome of the FIQ total score, yielded 5 distinct subgroups whose members had characteristics that were significantly associated with very unfavorable to very favorable functional status outcomes. The third study used qualitative and quantitative methods to identify clinically relevant triggers of FM flares, experienced by three subgroups women with low (n = 6), average (n = 5), and high (n = 4) FM impact, to explore the effect of triggers on their functional status. Using mixed methods, we were able to substantiate, quantify, and qualify the affects of FM on the lives of persons with FM and the direct consequences of those affects on activities. Overall activity, FM symptoms, and weather were the most prominent triggers. Findings from these studies suggest that the influence of FM on functional status affects women differently based on subgroup membership