Symptom clusters in fibromyalgia: potential utility in patient assessment and treatment evaluation.
BACKGROUND
Recent evidence points to the likelihood of heterogeneity in the presentation and, perhaps, etiology of fibromyalgia (FM). A clearer understanding of the symptomatology and consideration of potential FM subtypes could add insights regarding this condition.


OBJECTIVE
The aim of this study was to determine whether clusters could be identified among 20 symptoms that participants in a prior online study identified and to elucidate the underlying structure of resultant clusters.


METHODS
Factor analysis was used on data from a study sponsored by the National Fibromyalgia Association in which 2,569 persons with FM responded to an online survey during a 3-day period in 2005.


RESULTS
In this well-educated, primarily Caucasian sample, morning stiffness, fatigue, and not feeling rested in the morning were the symptoms with the highest severity scores. A series of exploratory factor analyses and subsequent confirmatory factor analysis with Cronbach's alpha testing led to a five-factor model with the following domains containing 17 symptoms: Somatic, Distress, Fibromyalgia Core, Dyscognition, and Sleep Problems.


CONCLUSIONS
The findings support the heterogeneity of the FM experience and the presence of symptom clusters within the greater spectrum of symptoms comprising the FM syndrome. These observations suggest the possibility of tailoring interventions based upon individual patient symptomatology. Further work is needed to develop symptom inventories that can be used in clinical trials as outcome metrics and by healthcare providers to describe clinical burden and effect of treatments.
Rutledge
Dana N
DN
Department of Nursing, California State University, Fullerton, CA, USA. drutledge@fullerton.edu
Mouttapa
Michele
M
Wood
Patrick B
PB
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001294:Attitude to Health; D002140:California; D016000:Cluster Analysis; D003072:Cognition Disorders / Q000209:etiology; D003863:Depression / Q000209:etiology; D005163:Factor Analysis, Statistical; D005221:Fatigue / Q000209:etiology; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D010146:Pain / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires