Development and Initial Validation of a Brief Self-Report Measure of Cognitive Dysfunction in Fibromyalgia


      • A brief measure of perceived cognitive function in fibromyalgia was developed.
      • It is the Multidimensional Inventory of Subjective Cognitive Impairment (MISCI).
      • The 10-item MISCI demonstrated excellent internal consistency reliability.
      • The MISCI is normally distributed and has low rates of ceiling and floor effects.
      • The MISCI showed good construct validity in correlations with legacy measures.


      Pain is often the focus of research and clinical care in fibromyalgia (FM); however, cognitive dysfunction is also a common, distressing, and disabling symptom in FM. Current efforts to address this problem are limited by the lack of a comprehensive, valid measure of subjective cognitive dysfunction in FM that is easily interpretable, accessible, and brief. The purpose of this study was to leverage cognitive functioning item banks that were developed as part of the Patient Reported Outcomes Measurement Information System (PROMIS) to devise a 10-item short form measure of cognitive functioning for use in FM. In study 1, a nationwide (U.S.) sample of 1,035 adults with FM (age range = 18–82, 95.2% female) completed 2 cognitive item pools. Factor analyses and item response theory analyses were used to identify dimensionality and optimally performing items. A recommended 10-item measure, called the Multidimensional Inventory of Subjective Cognitive Impairment (MISCI) was created. In study 2, 232 adults with FM completed the MISCI and a legacy measure of cognitive functioning that is used in FM clinical trials, the Multiple Ability Self-Report Questionnaire (MASQ). The MISCI showed excellent internal reliability, low ceiling/floor effects, and good convergent validity with the MASQ (r = −.82).


      This paper presents the MISCI, a 10-item measure of cognitive dysfunction in FM, developed through classical test theory and item response theory. This brief but comprehensive measure shows evidence of excellent construct validity through large correlations with a lengthy legacy measure of cognitive functioning.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Akaike H.
        A new look at the statistical model identification.
        IEEE Trans Automat Contr. 1974; 19: 716-723
        • Arnold L.M.
        • Crofford L.J.
        • Mease P.J.
        • Burgess S.M.
        • Palmer S.C.
        • Abetz L.
        • Martin S.A.
        Patient perspectives on the impact of fibromyalgia.
        Patient Educ Couns. 2008; 73: 114-120
        • Arnold L.M.
        • Gendreau R.M.
        • Palmer R.H.
        • Gendreau J.F.
        • Wang Y.
        Efficacy and safety of milnacipran 100 mg/day in patients with fibromyalgia: Results of a randomized, double-blind, placebo-controlled trial.
        Arthritis Rheum. 2010; 62: 2745-2756
        • Bennett R.M.
        • Bushmakin A.G.
        • Cappelleri J.C.
        • Zlateva G.
        • Sadosky A.B.
        Minimal clinically important difference in the Fibromyalgia Impact Questionnaire.
        J Rheumatol. 2009; 36: 1304-1311
        • Bennett R.M.
        • Friend R.
        • Jones K.D.
        • Ward R.
        • Han B.K.
        • Ross R.L.
        The Revised Fibromyalgia Impact Questionnaire (FIQR): Validation and psychometric properties.
        Arthritis Res Ther. 2009; 11: R120
        • Bennett R.M.
        • Jones J.
        • Turk D.C.
        • Russell I.J.
        • Matallana L.
        An internet survey of 2,596 people with fibromyalgia.
        BMC Musculoskelet Disord. 2007; 8: 27
        • Burckhardt C.S.
        • Clark S.R.
        • Bennett R.M.
        The Fibromyalgia Impact Questionnaire: Development and validation.
        J Rheumatol. 1991; 18: 728-733
        • Campbell D.T.
        • Fiske D.W.
        Convergent and discriminant validation by the multitrait-multimethod matrix.
        Psychol Bull. 1959; 56: 81-105
      1. Cella D, Gershon R: Assessment Center user manual. Available at: Accessed May 21, 2011

        • Cella D.
        • Riley W.
        • Stone A.
        • Rothrock N.
        • Reeve B.
        • Yount S.
        • Amtmann D.
        • Bode R.
        • Buysse D.
        • Choi S.
        • Cook K.
        • Devellis R.
        • DeWalt D.
        • Fries J.F.
        • Gershon R.
        • Hahn E.A.
        • Lai J.S.
        • Pilkonis P.
        • Revicki D.
        • Rose M.
        • Weinfurt K.
        • Hays R.
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
        • Cella D.
        • Yount S.
        • Rothrock N.
        • Gershon R.
        • Cook K.
        • Reeve B.
        • Ader D.
        • Fries J.F.
        • Bruce B.
        • Rose M.
        The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap cooperative group during its first two years.
        Med Care. 2007; 45: S3-S11
        • Clauw D.J.
        • Mease P.
        • Palmer R.H.
        • Gendreau R.M.
        • Wang Y.
        Milnacipran for the treatment of fibromyalgia in adults: A 15-week, multicenter, randomized, double-blind, placebo-controlled, multiple-dose clinical trial.
        Clin Ther. 2008; 30: 1988-2004
        • Crooks V.A.
        Exploring the altered daily geographies and lifeworlds of women living with fibromyalgia syndrome: A mixed-method approach.
        Soc Sci Med. 2007; 64: 577-588
        • Dennis N.L.
        • Larkin M.
        • Derbyshire S.W.
        “A giant mess”—Making sense of complexity in the accounts of people with fibromyalgia.
        Br J Health Psychol. 2013; 18: 763-781
        • Dick B.D.
        • Verrier M.J.
        • Harker K.T.
        • Rashiq S.
        Disruption of cognitive function in fibromyalgia syndrome.
        Pain. 2008; 139: 610-616
      2. Fibromyalgia Impact Questionnaire Revised (FIQR): Interpretation of FIQR results. Available at:

        • Gershon R.
        • Rothrock N.E.
        • Hanrahan R.T.
        • Jansky L.J.
        • Harniss M.
        • Riley W.
        The development of a clinical outcomes survey research application: Assessment Center(SM).
        Qual Life Res. 2010; 19: 677-685
        • Gershon R.C.
        • Rothrock N.
        • Hanrahan R.
        • Bass M.
        • Cella D.
        The use of PROMIS and Assessment Center to deliver patient-reported outcome measures in clinical research.
        J Appl Meas. 2010; 11: 304-314
        • Glass J.M.
        • Park D.C.
        • Minear M.
        • Crofford L.J.
        Memory beliefs and function in fibromyalgia patients.
        J Psychosom Res. 2005; 58: 263-269
        • Grace G.M.
        • Nielson W.R.
        • Hopkins M.
        • Berg M.A.
        Concentration and memory deficits in patients with fibromyalgia syndrome.
        J Clin Exp Neuropsychol. 1999; 21: 477-487
        • Henriksen M.
        • Lund H.
        • Christensen R.
        • Jespersen A.
        • Dreyer L.
        • Bennett R.M.
        • Danneskiold-Samsoe B.
        • Bliddal H.
        Relationships between the Fibromyalgia Impact Questionnaire, tender point count, and muscle strength in female patients with fibromyalgia: A cohort study.
        Arthritis Rheum. 2009; 61: 732-739
        • Ihaka R.
        R: Past and Future History.
        The University of Auckland, Auckland, New Zealand1988
        • Jones K.D.
        • King L.A.
        • Mist S.D.
        • Bennett R.M.
        • Horak F.B.
        Postural control deficits in people with fibromyalgia: A pilot study.
        Arthritis Res Ther. 2011; 13: R127
        • Katz R.S.
        • Heard A.R.
        • Mills M.
        • Leavitt F.
        The prevalence and clinical impact of reported cognitive difficulties (Fibrofog) in patients with rheumatic disease with and without fibromyalgia.
        J Clin Rheumatol. 2004; 10: 53-58
        • Leavitt F.
        • Katz R.S.
        Distraction as a key determinant of impaired memory in patients with fibromyalgia.
        J Rheumatol. 2006; 33: 127-132
        • Leavitt F.
        • Katz R.S.
        Development of the Mental Clutter Scale.
        Psychol Rep. 2011; 109: 445-452
        • Mease P.J.
        • Arnold L.M.
        • Crofford L.J.
        • Williams D.A.
        • Russell I.J.
        • Humphrey L.
        • Abetz L.
        • Martin S.A.
        Identifying the clinical domains of fibromyalgia: Contributions from clinician and patient Delphi exercises.
        Arthritis Rheum. 2008; 59: 952-960
        • Mease P.J.
        • Clauw D.J.
        • Gendreau R.M.
        • Rao S.G.
        • Kranzler J.
        • Chen W.
        • Palmer R.H.
        The efficacy and safety of milnacipran for treatment of fibromyalgia. A randomized, double-blind, placebo-controlled trial.
        J Rheumatol. 2009; 36: 398-409
        • Meng X.L.
        • Rosenthal R.
        • Rubin D.B.
        Comparing correlated correlation-coefficients.
        Psychol Bull. 1992; 111: 172-175
        • Munguia-Izquierdo D.
        • Legaz-Arrese A.
        Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia.
        Clin Exp Rheumatol. 2007; 25: 823-830
        • Park D.C.
        • Glass J.M.
        • Minear M.
        • Crofford L.J.
        Cognitive function in fibromyalgia patients.
        Arthritis Rheum. 2001; 44: 2125-2133
      3. Samejima F: Estimation of latent ability using a response pattern of graded scores. In: Psychometrika Monograph No 17, 1969

        • Schilling S.G.
        ORDFAC: A Computer Program for Ordinal Factor Analysis.
        University of Michigan, Ann Arbor2005
        • Schilling S.G.
        • Bock R.D.
        High-dimensional maximum marginal likelihood item factor analysis by adaptive quadrature.
        Psychometrika. 2005; 70: 1-23
        • Schwartz G.E.
        Estimating the dimension of a model.
        Ann Stat. 1978; 6: 461-464
        • Seidenberg M.
        • Haltiner A.
        • Taylor M.A.
        • Hermann B.B.
        • Wyler A.
        Development and validation of a Multiple Ability Self-Report Questionnaire.
        J Clin Exp Neuropsychol. 1994; 16: 93-104
        • Silverman S.L.
        • Martin S.A.
        Assessment tools and outcome measures used in the investigation of fibromyalgia.
        in: Wallace D.J. Clauw D.J. Fibromyalgia & Other Central Pain Syndromes. Lippincott Williams & Wilkins, Philadelphia, PA2005: 309-319
        • Sletvold H.
        • Stiles T.C.
        • Landro N.I.
        Information processing in primary fibromyalgia, major depression and healthy controls.
        J Rheumatol. 1995; 22: 137-142
        • Suhr J.A.
        Neuropsychological impairment in fibromyalgia—Relation to depression, fatigue, and pain.
        J Psychosom Res. 2003; 55: 321-329
        • Tesio V.
        • Torta D.M.
        • Colonna F.
        • Leombruni P.
        • Ghiggia A.
        • Fusaro E.
        • Geminiani G.C.
        • Torta R.
        • Castelli L.
        Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence.
        Arthritis Care Res (Hoboken). 2015; 67: 143-150
        • Thissen D.
        • Chen W.H.
        • Bock R.D.
        MULTILOG7: Multiple Category Item Analysis and Test Scoring Using Item Response Theory.
        Scientific Software International, Inc, Chicago2003
        • Wagner L.I.
        • Lai J.S.
        • Cella D.
        • Sweet J.J.
        • Forrestal S.
        Chemotherapy-related cognitive deficits: Development of the FACT-Cog instrument.
        Ann Behav Med. 2004; 27: S10
        • Wagner L.I.
        • Sabatino T.
        • Cella D.
        • Robert J.
        • Lurie H.
        Cognitive Function During Cancer Treatment: The FACT-Cog Study.
        Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago2005: 10-15
        • Williams D.A.
        • Arnold L.M.
        Measures of fibromyalgia: Fibromyalgia Impact Questionnaire (FIQ), Brief Pain Inventory (BPI), Multidimensional Fatigue Inventory (MFI-20), Medical Outcomes Study (MOS) Sleep Scale, and Multiple Ability Self-Report Questionnaire (MASQ).
        Arthritis Care Res (Hoboken). 2011; 63: S86-S97
        • Williams D.A.
        • Clauw D.J.
        • Glass J.M.
        Perceived cognitive dysfunction in fibromyalgia syndrome.
        J Musculoskelet Pain. 2011; 19: 66-75
        • Wilson H.D.
        • Robinson J.P.
        • Turk D.C.
        Toward the identification of symptom patterns in people with fibromyalgia.
        Arthritis Rheum. 2009; 61: 527-534
        • Wolfe F.
        • Ross K.
        • Anderson J.
        • Russell I.J.
        • Hebert L.
        The prevalence and characteristics of fibromyalgia in the general population.
        Arthritis Rheum. 1995; 38: 19-28