title: A confirmatory study of the Combined Index of Severity of Fibromyalgia (ICAF*): factorial structure, reliability and sensitivity to change.
abstract: BACKGROUND
  Fibromyalgia (FM) is a complex syndrome that affects many aspects of the patient's life and it is very difficult to evaluate in clinical practice. A recent study has developed the Combined Index of Severity of Fibromyalgia (ICAF), an instrument that evaluates diverse aspects of FM and offers five indices: emotional, physical, active coping, passive coping and total. The objective of this study is to confirm the structure of the ICAF, check its test-retest reliability, assess its sensitivity to change, and compare the results obtained in a sample of patients with fibromyalgia with another sample of healthy controls.
  
  
  METHODS
  A total of 232 patients took part in the study, 228 women and 4 men, with a mean age of 47.73 years of age (SD = 8.61) and a time of disease evolution since diagnosis of 4.28 years (SD = 4.03). The patients from the FM group completed the ICAF. Between one and two weeks later, they again attended the clinic and complete the 59 items on the ICAF (retest) and immediately afterwards they began treatment (according to daily clinical practice criteria). A sample of healthy subjects was also studied as a control group: 110 people were included (106 women and 4 men) with a mean age of 46.01 years of age (SD = 9.35). The study was conducted in Spain.
  
  
  RESULTS
  The results obtained suggest that the four-factor model obtained in the previous study adequately fits the data obtained in this study. The test-retest reliability and internal consistency were all significant and show a high degree of correlation for all the factors as well as in overall score. With the exception of the passive coping factor, all the other scores, including the overall score, were sensitive to change after the therapeutic intervention. The ICAF scores of the patients with fibromyalgia compared with those of the control group were markedly different.
  
  
  CONCLUSIONS
  The findings suggest that the ICAF is a valid, reliable, sensitive to change instrument with the added advantage that it offers some additional domains (factors) that provide very valuable information regarding the most delicate aspects of the patient, which must be addressed at the time of treatment in daily clinical practice.
authors.affiliation: Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain. mvallejo@psi.uned.es
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Vallejo
authors.forename: Javier
authors.initials: J
authors.lastname: Rivera
authors.forename: Joaquim
authors.initials: J
authors.lastname: Esteve-Vives
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005163:Factor Analysis, Statistical; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011594:Psychometrics / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013030:Spain; D011795:Surveys and Questionnaires / Q000592:standards*