Disability and rehabilitation · 2026
Disability stratification in fibromyalgia: symptom burden, centrally acting medication exposure, and functional outcomes in a multisite cohort.
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Miller Hayes W, Abousaway Roba B, Luong Minh N, Osuna-Diaz Michelle M, Sebastian Katherine R, Yu Lianbo, Mikulik Zhanna, Rodriguez-Saona Luis, Hackshaw Kevin V
Аннотация
PURPOSE: To determine whether disability stratification identifies clinically meaningful differences in symptom burden, centrally acting medication exposure, and health-related functioning in fibromyalgia, and to identify independent clinical correlates of physical functioning.
MATERIALS AND METHODS: We analyzed a harmonized multisite cohort of 1,126 adults with physician-confirmed fibromyalgia from two U.S. academic centers. Among 976 participants with FIQR/SIQR-equivalent disability scores, high disability was defined as the upper quartile (≥65.92; n = 244). Symptom burden included CSI, BDI-II, and MPQ measures. Physical functioning was assessed using a four-domain SF-36 physical health composite. Multivariable regression identified independent correlates of physical functioning.
RESULTS: High disability was associated with greater pain, central sensitization-associated symptoms, depressive symptoms, body mass index, and centrally acting medication burden, with worse functioning across all SF-36 domains (all p < 0.001). Pain showed the strongest correlation with disability (ρ = 0.72), followed by CSI (ρ = 0.59) and BDI-II (ρ = 0.48). In 875 complete cases, pain, CSI, BDI-II, body mass index, and medication burden were independently associated with worse physical functioning (adjusted R2=0.445).
CONCLUSIONS: Disability stratification captures clinically meaningful fibromyalgia heterogeneity beyond pain alone and may support rehabilitation-oriented assessment and future precision rehabilitation research.
MATERIALS AND METHODS: We analyzed a harmonized multisite cohort of 1,126 adults with physician-confirmed fibromyalgia from two U.S. academic centers. Among 976 participants with FIQR/SIQR-equivalent disability scores, high disability was defined as the upper quartile (≥65.92; n = 244). Symptom burden included CSI, BDI-II, and MPQ measures. Physical functioning was assessed using a four-domain SF-36 physical health composite. Multivariable regression identified independent correlates of physical functioning.
RESULTS: High disability was associated with greater pain, central sensitization-associated symptoms, depressive symptoms, body mass index, and centrally acting medication burden, with worse functioning across all SF-36 domains (all p < 0.001). Pain showed the strongest correlation with disability (ρ = 0.72), followed by CSI (ρ = 0.59) and BDI-II (ρ = 0.48). In 875 complete cases, pain, CSI, BDI-II, body mass index, and medication burden were independently associated with worse physical functioning (adjusted R2=0.445).
CONCLUSIONS: Disability stratification captures clinically meaningful fibromyalgia heterogeneity beyond pain alone and may support rehabilitation-oriented assessment and future precision rehabilitation research.