fibromyalgia syndrome ( fms ) is a prevalent chronic pain condition among middle - aged females 
 and is characterized by chronic widespread pain .
various comorbid symptoms of fms include 
 fatigue , cognitive disturbances , depression , sleep impairments , and weight gain , to name but 
 a few .
it is a challenging disorder , and thus assessment and diagnosis might pose some 
 difficulties in various health care settings .
patients may visit their general practitioners 
 repeatedly with numerous symptoms before a diagnosis of fms is made1 , 2 .
patients are encountered at not only primary but also secondary health care settings and by 
 various subspecialities including rheumatologists , pain specialists , physiatrists , and 
 psychologists .
this has led to debate about whether fms is a clinical or epidemiological 
 disease3 .
the 1990 american college of rheumatology ( acr ) criteria included 2 major sections : history 
 of widespread pain and pain in 11 of 18 tender points on digital palpation .
debates over 
 reliability , validity , and number of tender points required to make a diagnosis were 
 settled .
many controversies arose over tender points4 , and some authors argued against tender points , claiming that they 
 are a measure of general stress3 , 5 , 6 .
it 
 was then suggested that dealing with the symptoms rather than tender points would be more 
 realistic and that use of 1990 criteria should be stopped7 .
the acr 2010 criteria eliminated the controversial tender point examination and included 
 the following headings : widespread pain index , including 19 pain locations , and symptom 
 severity score for 3 symptoms plus the extent of 41 somatic symptoms in general .
2010 
 criteria further modified to the 2011 modified criteria ( 2011modcr ) with 6 self - reported 
 symptoms instead of 41 somatic symptoms .
the most recently developed criteria are the 
 alternative diagnostic criteria ( acr 2013altcr ) , which include more pain locations than the 
 2011modcr ( 28 instead of 19 ) and 10 symptoms instead of 6 . compared to the 2011modcr ,
the 
 acr 2013altcr have comparable diagnostic sensitivity , better specificity , and a smaller 
 number needed to diagnose8 . in addition to the search for best criteria , some other tools were developed for 
 epidemiological studies such as the london fibromyalgia study screening questionnaire or 
  survey criteria .
 however , they included only items related to pain and fatigue , neglecting 
 other aspects of the condition9 .
to 
 address these problems , some screening procedures have been suggested ; however , they have 
 been argued against due to psychometric validation problems and sensitivity and specificity 
 issues10 .
thus , a need for a short , easy - to - use , psychometrically validated screening tool has arisen 
 in both clinical and research settings .
the french rheumatic pain study group decided to 
 develop a short , psychometrically sound , self - reported screening tool considering the major 
 symptoms and aspects of fms9 .
the original 
 version of the fibromyalgia rapid screening tool ( first ) was demonstrated to have excellent 
 discriminative properties , especially divergent validity in terms of psychological aspect , 
 which is an important property for an fms screening tool9 . the spanish version of the first
was also demonstrated to have 
 acceptable internal consistency , reliability , and criterion validity10 .
we aimed to study the reliability and validity of the turkish version of the first by 
 correlating this tool with the acr 2013altcr and the hospital anxiety and depression scale 
 ( hads ) .
two hundred and sixty - nine patients ( 257 females and 12 males ) with an average age ( years ) 
 of 48.29  12.78 ( range 2279 ) were included in the study .
the principles of the declaration of helsinki were followed 
 and the study protocol was approved by the uludag university ethical committee ( no : 
 fr - hyh-19 ) .
subjects were recruited from outpatient physical medicine and rehabilitation 
 clinics from 9 medical faculty hospitals and ministry of health research and training 
 hospitals .
a convenience sample of patients with chronic diffuse pain was included in the study . 

literate patients who could read and understand turkish and who were able to complete the 
 questionnaire were invited to participate in the study .
patients with psychiatric disorders ( severe depression , schizophrenia ) or systemic or 
 neurological disorders that could adversely affect quality of life or social functioning 
 ( such as end - stage heart failure , hemiplegia , spinal cord injury , etc . ) were excluded from 
 the study .
we obtained permission from mapi research trust ( contact information and permission to use : 
 mapi research trust , lyon , france .
e - mail : proinformation@mapi-trust.org-internet : 
 www.proqolid.org . ) cross - cultural adaptation was accomplished according to the suggestions 
 of the mapi research institute in 3 steps : forward translation , backward translation , and 
 patient testing .
the first was translated into turkish by 2 professional native turkish speakers bilingual 
 in turkish and english .
they discussed on the translated forms with the local project 
 manager ( r.c . ) to resolve discrepancies and produced a pooled version , which is the first 
 version of the translation ( step 1 ) .
then , english back - translation was done by the 
 professional native english - speaking translator bilingual in english and turkish .
he 
 translated the first version of the questionnaire back to english without access to the 
 original questionnaire .
the local project manager compared the backward version with the 
 original during a meeting with the backward translator and prepared the second version ( step 
 2 ) .
the second version was tested on 5 patients , all of whom were native turkish speakers , 
 and comprehension was determined through face - to - face interviews . after this final step , a 
 third version of the questionnaire
patients were asked to complete the questionnaire including the first , 2013altcr , and hads . 

they completed the first twice ; the time interval for the 2 first scales was 6 hours .
the 
 first includes 6 items , and a score of 1 is given for the response of  yes  and 0 if the 
 response is  no  for each item .
the total score is calculated as the sum of scores ; the 
 cut - off value is designated as 5/69 .
the examiners were physiatrists and they were blinded to the results of first and hads .
we 
 used the acr 2013altcr8 , which includes 
 the pain location inventory ( pli ) including 28 sites and the symptom impact questionnaire 
 ( siqr ) consisting of 10 symptom items ( pain ; energy ; stiffness ; sleep ; depression ; memory 
 problems ; anxiety ; tenderness to touch ; balance problems ; and sensitivity to loud noises , 
 bright colors , odors , and cold ) .
pli score is between 0 and 28 , and the siqr range is 0100 
 divided by 2 . for a patient to fulfill the acr 2013altcr criteria , the symptoms and pain 
 locations should have been persistent for at least 3 months , pli17 and siqr21 .
one for anxiety and the 
 other for depression  and is a questionnaire completed by the patient .
each item has 4 
 possible answers ( range 03 ) , and the maximum possible score is 21 .
the validity and 
 reliability of the turkish version of the hads was demonstrated previously11 . concurrent validity of anxiety subscale 
 with spielberger s trait anxiety inventory , correlation coefficient was 0.7544 and of 
 depression subscale with beck depression inventory it was 0.7237 .
testing the reliability of 
 had scale , cronbach alfa coefficient for anxiety subscale was 0.8525 and for depression 
 subscale it was 0.778411 .
we analyzed the data using the statistical package for the social sciences ( spss ) version 
 16 ( chicago , il , usa ) .
the reliability of the 
 hads was tested using cronbach s alpha coefficient . for criterion validity of the first , we 
 used the acr 2013altcr for comparison .
the 
 concordance between the acr 2013altcr and the first was evaluated using a mcnemar test .
the sensitivity , specificity , and positive and negative likelihood ratios of the first were 
 calculated according to acr 2013altcr criteria .
we compared 
 the 2 first measurements using wilcoxon signed rank test , and the 2 measurements were 
 statistically similar ( p=0.169 ) .
one hundred fifty - six ( 58% ) patients had score of 5 , which is the cut - off score for the 
 first ; 116 of these patients ( 74.4% ) were diagnosed as having fms according to acr 2013altcr 
 criteria .
one hundred thirteen patients ( 42% ) had first scores lower than 5 , and 93 of these 
 patients ( 82.3% ) did not meet the 2013altcr criteria .
the first was not statistically 
 different from the acr 2013 altcr in defining patients with fms ( table 1table 1.sensitivity , specificity , and positive and negative likelihood ratios of the 
 first to discriminate patients with and without fms according to the 2013 
 altcrvalueconfidence intervalsensitivity83.8276.589.6specificity68.4259.876.2+lr2.652.33.0lr0.240.10.4lr : likelihood ratio ) .
first total score was correlated with 
 subscores of the acr 2013altcr , namely pli ( r=0.619 , p<0.001 ) and siqr scores ( r=0.408 , 
 p<0.001 ) .
similarly , the first and hads were significantly correlated ( r=0.424 , 
 p<0.001 ) ( table 2table 2.the coefficient of determinations between first total score and acr 2013 
 subscores ( pli and siqr score ) and hads scores.plisiqrhadsfirst total score0.383 * 0.166 * 0.18*pli0.196 * 0.131*siqr0.194*data expressed as squared spearman s rho correlation coefficients .
first : 
 fibromyalgia rapid screening tool ; hads : hospital anxiety and depression scale ; pli : 
 pain location inventory ; siqr : symptom impact questionnaire , * p<0.001 statistically 
 significant ) .
first : 
 fibromyalgia rapid screening tool ; hads : hospital anxiety and depression scale ; pli : 
 pain location inventory ; siqr : symptom impact questionnaire , * p<0.001 statistically 
 significant logistic regression analysis was carried out to find the confounding effect of the hads on 
 the first to discriminate the patients with fms .
the model was able to discriminate patients 
 with fibromyalgia and without fibromyalgia ( 2 log likelihood=274.82 ; =95.29 , 
 d.f=2 ; p < 0.001 ; nagelkerke r= 0.4 ) .
the first global score explained 30% of 
 the proportion of uncertainty ; each point increase in first global score meant 10 times 
 greater odds of experiencing fms .
in this study , we showed that the turkish version of the first is a reliable 
 patient - completed instrument for identifying patients with fms .
the acr 2013altcr was used 
 for comparison , and the first was similar to the acr criteria in terms of defining patients 
 with fms .
the first demonstrated high correlation with acr 2013altcr subscores and hads 
 scores . in our study , we examined the consistency of the first over time .
we used the acr 2013altcr because these criteria were equally efficient with somewhat 
 better specificity , and a smaller number was needed to diagnose than in the 2011modcr8 .
the acr 2013altcr were also marginally more 
 efficient in differentiating common chronic pain disorders from fms8 .
torres et al.10 used acr 1990 criteria , and perrot et al.9 stated that they diagnosed patients on the basis of acr 
 criteria , referring to the article by wolfe et al . , who used the symptom intensity scale , 
 which is a combination of pain counts in 19 nonarticular regions with a visual analogue 
 scale for fatigue12 .
torres et al . reported the sensitivity of the first as 90.5% and its specificity as 85.7% . 

the turkish version demonstrated similar sensitivity and specificity . in this study by 
 torres et al .
positive likelihood ratio was calculated as 1.99 and negative likelihood ratio 
 as 0.2 for cut - off point of 5 which is the established score for the original version of 
 first . in our study
positive and negative likelihood ratio values were 2.65 and 0.24 
 respectively , with fairly narrow confidence intervals .
our study group was similar to torres 
 et al.10 ; the majority of the patients in 
 the study by torres were female , as in our study group . in the original study of the first 
 by perrot et al.9 ,
first total score was 
 not significantly correlated with the beck depression inventory , hads - depression , and 
 hads - anxiety scores . in our study
, we were able to demonstrate that first scores are 
 correlated with hads scores ; however , despite the correlation of first with hads scores , the 
 first was still able to discriminate between patients with and without fms .
different from previous studies , we included patients with various chronic pain problems at 
 a tertiary care level .
fitzcharles et al . argued that , if patients in a study have an 
 established diagnosis of fms , they may express symptom severity at the extreme end of the 
 spectrum , thus increasing construct validity13 .
similar to our study , bennett et al.8 included a wide range of common pain disorders as the dominating 
 principle of their study and claimed to simulate everyday clinical practice .
both rehabilitation specialists and physical therapists are dealing with various pain 
 conditions . among these disorders
fms is a prevalent condition and can be encountered 
 secondarily as in case of rheumatologic disorders .
first includes 6 items with either yes or 
 no answer , thus enables easy and quick scoring .
it can be used as an adjunct to physical 
 examination or evaluation of patients undergoing physical therapy .
. patients were recruited from tertiary care hospitals however study 
 population is not limited to patients referred from primary care clinics .
an important consideration for the first is ease of use and scoring in the settings 
 involved with chronic pain patients .
it can be completed in less than 3 minutes and seems to be acceptable and relevant for the 
 patients10 . since it is a single page 
 and evaluation requires simple addition , use of the first may be advantageous in a busy 
 clinical setting such as surgical units .
it was demonstrated that patients with fms were more likely to have surgical 
 interventions including back or neck surgery14 .
surgeons and interventionalists may also benefit from using an 
 easy - to - administer patient - completed screening tool to avoid unnecessary procedures .
 [ purpose ] an easy - to - use , psychometrically validated screening tool for fibromyalgia is 
 needed . 
 this study aims to evaluate the reliability and validity of the turkish version of 
 the fibromyalgia rapid screening tool by correlating it with 2013 american college of 
 rheumatology alternative diagnostic criteria and the hospital anxiety and depression 
 scale . 
 [ subjects and methods ] subjects were 269 physical medicine and rehabilitation 
 clinic outpatients . 
 patients completed a questionnaire including the fibromyalgia rapid 
 screening tool ( twice ) , 2013 american college of rheumatology alternative diagnostic 
 criteria , and the hospital anxiety and depression scale . 
 scale reliability was examined by 
 test - retest . 
 the 2013 american college of rheumatology alternative diagnostic criteria was 
 used for comparison to determine criterion validity . 
 the sensitivity , specificity , and 
 positive and negative likelihood ratios were calculated according to 2013 american college 
 of rheumatology alternative diagnostic criteria . 
 logistic regression analysis was 
 conducted to find the confounding effect of the hospital anxiety and depression scale on 
 fibromyalgia rapid screening tool to distinguish patients with fibromyalgia syndrome . 
 
 [ results ] the fibromyalgia rapid screening tool was similar to the 2013 american college 
 of rheumatology alternative diagnostic criteria in defining patients with fibromyalgia 
 syndrome . 
 fibromyalgia rapid screening tool score was correlated with 2013 american 
 college of rheumatology alternative diagnostic criteria subscores . 
 each point increase in 
 fibromyalgia rapid screening tool global score meant 10 times greater odds of experiencing 
 fibromyalgia syndrome . 
 [ conclusion ] the turkish version of the fibromyalgia rapid 
 screening tool is reliable for identifying patients with fibromyalgia . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
Conflict of interest