Quality of life, distrust in health care system and adherence to medical recommendations in patients with fibromyalgia: a latent profile analysis

Kamel Gana, Marie Cuvelier, Michèle Koleck


Introduction: Fibromyalgia is a very heterogeneous disorder. This heterogeneity is one of the reasons why researchers have tried to analyze different patient profiles and their relationship with quality of life. The aim of the present study was to identify: (1) latent profiles based on the Revised Fibromyalgia Impact Questionnaire’s scores, and (2) possible differences between them in quality of life, distrust in healthcare system, and adherence to medical recommendations.

Methods: 707 FM patients (aged 18-85 years, 95% women) completed the Revised Fibromyalgia Impact Questionnaire, the 12-Item Short Form Health Survey, the Patient Adherence Scale, and the Health Care System Distrust Scale. Data were analyzed using latent profile analysis.

Results: Three profiles were identified: (1) Low fibromyalgia impact profile (2) Moderate fibromyalgia impact profile, and (3) High fibromyalgia impact profile. Significant differences between these profiles were found in quality of life, adherence to medical recommendations, and distrust in healthcare system. Poor-sleep quality emerged as a significant high important symptom in the three profiles.

Conclusion: The greater the fibromyalgia impact, the lower the quality of life, and the adherence to medical recommendations and the greater the mistrust in the healthcare system. Self-perceived sleep quality in fibromyalgia patients should require special attention from clinicians.


Fibromyalgia; Latent profile; Quality of life; Adherence; Distrust.

Full Text:



Ahnquist, J., Wamala, S. P., & Lindström, M. (2010). What has trust in the health-care system got to do with psychological distress? Analyses from the National Swedish Survey of Public Health. International Journal for Quality in Health Care, 22 (4), 250–258. https://doi.org/10.1093/intqhc/mzq024

Albajes, K., & Moix, J. (2021). Psychological Interventions in Fibromyalgia: An Updated Systematic Review. Mediterranean Journal of Clinical Psychology, 9(1).https://doi.org/10.6092/2282-1619/mjcp-2759

Armstrong, K., Rose, A., Peters, N., Long, J. A., McMurphy, S., & Shea, J. A. (2006). Distrust of the health care system and self-reported health in the United States. Journal of general internal medicine, 21(4), 292–297. https://doi.org/10.1111/j.1525-1497.2006.00396.x

Angarita, O. N., Pérez, A. A., Feliu, S. A., Andrés, R. L., Borràs, X., Suso, R. C., Slim, M., Herrera, M. P., Fernández, V. R., Blanco, M. E., & Luciano, J. V. (2020). Patients with fibromyalgia reporting severe pain but low impact of the syndrome: Clinical and pain‐related cognitive features. Pain Practice, 20 (3), 255–261. https://doi.org/10.1111/papr.12847

Arnold, L. M., Bennett, R. M., Crofford, L. J., Dean, L. E., Clauw, D. J., Goldenberg, D. L., Fitzcharles, M.-A., Paiva, E. S., Staud, R., Sarzi-Puttini, P., Buskila, D., & Macfarlane, G. J. (2019). AAPT diagnostic criteria for fibromyalgia. The Journal of Pain, 20 (6), 611–628. https://doi.org/10.1016/j.jpain.2018.10.008

Bazzichi, L., Giacomelli, C., Consensi, A., Giorgi, V., Batticciotto, A., Di Franco, M., & Sarzi-Puttini, P. (2020). One year in review 2020: fibromyalgia. Clinical and experimental rheumatology, 38 Suppl 123(1), 3–8.

Benkert, R., Cuevas, A., Thompson, H. S., Dove-Meadows, E., & Knuckles, D. (2019). Ubiquitous yet unclear: A systematic review of medical mistrust. Behavioral Medicine, 45(2), 86-101. https://doi.org/10.1080/08964289.2019.1588220

Boulton, T. (2019). Nothing and everything: Fibromyalgia as a diagnosis of exclusion and inclusion. Qualitative Health Research, 29(6), 809–819. https://doi.org/10.1177/1049732318804509

Braun, A., Evdokimov, D., Frank, J., Pauli, P., Üçeyler, N., & Sommer, C. (2020). Clusteringfibromyalgia patients: A combination of psychosocial and somatic factors leads to resilient coping in a subgroup of fibromyalgia patients. PLoS ONE, 15(12). https://doi.org/doi:10.1371/journal.pone.0243806

Briones-Vozmediano, E., Vives-Cases, C., Ronda-Pérez, E., & Gil-González, D. (2013). Patients' and professionals' views on managing fibromyalgia. Pain research & management, 18(1), 19–24. https://doi.org/10.1155/2013/742510

Campos, R. P., Vázquez, I., & Vilhena, E. (2020). Clinical, psychological and quality of life differences in fibromyalgia patients from secondary and tertiary healthcare. European Journal of Pain. https://doi.org/10.1002/ejp.1694

Choy, E. (2015). The role of sleep in pain and fibromyalgia. Nature Reviews Rheumatology 11(9), 513–520. https://doi-org/10.1038/nrrheum.2015.56

Conversano, C., Ciacchini, R., Tropeano, A., Orrù, G., & Gemignani, A. (2019). Psychological and physical interdependence between fibromyalgia syndrome and menopause: A review of the literature. Mediterranean Journal of Clinical Psychology, 7(3), 1-19. https://doi.org/10.6092/2282-1619/2019.7.2279

Cooper, S., & Gilbert, L. (2017). An exploratory study of the experience of fibromyalgia diagnosis in South Africa. Health, 21(3), 337–353. https://doi.org/10.1177/1363459316677623

Diaz-Piedra, C., Di Stasi, L. L., Baldwin, C. M., Buela-Casal, G., & Catena, A. (2015). Sleep disturbances of adult women suffering from fibromyalgia: A systematic review of observational studies. Sleep Medicine Reviews, 21, 86–99. https://doi.org/10.1016/j.smrv.2014.09.001

Dobkin, P. L., Sita, A., & Sewitch, M.J. (2006). Predictors of adherence to treatment in women with fibromyalgia. The Clinical Journal of Pain, 22 (3), 286-294. https://doi.org/10.1097/01.ajp.0000173016.87612.4b

Fitzcharles, M.-A., Ste-Marie, P. A., Goldenberg, D. L., Pereira, J. X., Abbey, S., Choinière, M., Ko, G., Moulin, D. E., Panopalis, P., Proulx, J., & Shir, Y. (2013). 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: Executive summary. Pain Research & Management, 18 (3), 119–126. https://doi.org/10.1155/2013/918216

Galvez-Sánchez, C. M., & Reyes Del Paso, G. A. (2020). Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives. Journal of clinical medicine, 9 (4), 1219. https://doi.org/10.3390/jcm9041219

Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., Bullinger, M., Kaasa, S., Leplege, A., Prieto, L., & Sullivan, M. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. Journal of clinical epidemiology, 51(11), 1171–1178. https://doi.org/10.1016/s0895-356(98)00109-7

Hagell, P., Westergren, A., & Årestedt, K. (2017). Beware of the origin of numbers: Standard scoring of the SF-12 and SF-36 summary measures distorts measurement and score interpretations. Research in Nursing & Health, 40(4), 378–386. https://doi.org/10.1002/nur.21806

Hamilton, N. A. (2015). Sleep and fibromyalgia: It is time to think big. Sleep Medicine, 16(8), 908–909. https://doi.org/10.1016/j.sleep.2015.05.001

Häuser, W., & Fitzcharles, M. A. (2018). Facts and myths pertaining to fibromyalgia. Dialogues in Clinical Neuroscience, 20(1), 53–62. https://doi.org/10.31887/DCNS.2018.20.1/whauser.

Homma, M., Ishikawa, H., & Kiuchi, T. (2018). Illness perceptions and negative responses from medical professionals in patients with fibromyalgia: Association with patient satisfaction and number of hospital visits. Patient education and counseling, 101(3), 532-540. https://doi.org/10.1016/j.pec.2017.08.014

Homma, M., Ishikawa, H. & Kiuchi, T. (2016). Association of physicians’ illness perception of fibromyalgia with frustration and resistance to accepting patients: a cross-sectional study. Clinical Rheumatology, 35, 1019-1027. https://doi.org/10.1007/s10067-014-2752-6

Lee, J.-W., Lee, K.-E., Park, D.-J., Kim, S.-H., Nah, S.-S., Lee, J. H., Kim, S.-K., Lee, Y.-A., Hong, S.-J., Kim, H.-S., Lee, H.-S., Kim, H. A., Joung, C.-I., Kim, S.-H., & Lee, S.-S. (2017). Determinants of quality of life in patients with fibromyalgia: A structural equation modeling approach. PLOS ONE, 12(2), e0171186. https://doi.org/10.1371/journal.pone.0171186

Lobo, C. P., Pfalzgraf, A. R., Giannetti, V., & Kanyongo, G. (2014). Impact of invalidation and trust in physicians on health outcomes in fibromyalgia patients. The primary care companion for CNS disorders, 16(5), 10.4088/PCC.14m01664. https://doi.org/10.4088/PCC.14m01664

Luciano, J. V., Forero, C. G., Cerdà-Lafont, M., Peñarrubia-María, M. T., Fernández-Vergel, R., Cuesta-Vargas, et al. (2016). Functional status, quality of life, and costs associated with fibromyalgia subgroups: A latent profile analysis. The Clinical Journal of Pain, 32(10), 829–840. https://doi.org/10.1097/AJP.0000000000000336

McNeish, D., An, J., & Hancock, G. R. (2018). The Thorny Relation Between Measurement Quality and Fit Index Cutoffs in Latent Variable Models. Journal of Personality Assessment, 100(1), 43–52. https://doi.org/10.1080/00223891.2017.1281286

Mohseni, M., & Lindstrom, M. (2007). Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study. Social Science & Medicine, 64(7), 1373–1383. https://doi.org/10.1016/j.socscimed.2006.11.023

Musa, D., Schulz, R., Harris, R., Silverman, M., & Thomas, S. B. (2009). Trust in the health care system and the use of preventive health services by older Black and White adults. American Journal of Public Health, 99(7), 1293–1299. https://doi.org/10.2105/AJPH.2007.123927

Muthén, L.K., & Muthén, B.O. (2010). Mplus user’s guide, 6th ed. Los Angeles, CA: Muthén & Muthén.

Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling, 14(4), 535–569. http://dx.doi.org/10.1080/10705510701575396

Oliveira Junior, J-O., & Ramos, J-V-C. (2019). Adherence to fibromyalgia treatment: challenges and impact on the quality of life. Brazilian Journal of Pain, 2(1), 81-87. https://doi.org/10.5935/2595-0118.20190015

Ozawa, S., & Sripad, P. (2013). How do you measure trust in the health system? A systematic review of the literature. Social Science & Medicine, 91, 10–14. https://doi.org/10.1016/j.socscimed.2013.05.005

Pérez-Aranda, A., Andrés-Rodríguez, L., Feliu-Soler, A., Núñez, C., Stephan-Otto, C., Pastor-Mira, M. A., López-Roig, et al. (2019). Clustering a large Spanish sample of patients with fibromyalgia using the Fibromyalgia Impact Questionnaire-Revised: differences in clinical outcomes, economic costs, inflammatory markers, and gray matter volumes. Pain, 160(4), 908–921. https://doi.org/10.1097/j.pain.0000000000001468

Pérez-Aranda, A., Feliu-Soler, A., Mist, S. D., Jones, K. D., López-Del-Hoyo, Y., Oliván-Arévalo, R., Kratz, A., Williams, D. A., & Luciano, J. V. (2020). Subgrouping a Large U.S. Sample of Patients with Fibromyalgia Using the Fibromyalgia Impact Questionnaire-Revised. International journal of environmental research and public health, 18 (1), 247. https://doi.org/10.3390/ijerph18010247

Raspe, H., & Croft, P. (1995). Fibromyalgia. Bailliere's Clinical Rheumatology, 9, 599–614. https://doi.org/10.1016/s0950-3579(05)80261-4

Rose, A., Peters, N., Shea, J. A., & Armstrong, K. (2004). Development and testing of the health care system distrust scale. Journal of General Internal Medicine, 19(1), 57–63. https://doi.org/10.1111/j.1525-1497.2004.21146.x

Rowe, C. A., Sirois, F. M., Toussaint, L., Kohls, N., Nöfer, E., Offenbächer, M., & Hirsch, J. K. (2019). Health beliefs, attitudes, and health-related quality of life in persons with fibromyalgia: Mediating role of treatment adherence. Psychology, Health & Medicine, 24(8), 962–977. https://doi.org/10.1080/13548506.2019.1576913

Salaffi, F., Mozzani, F., Draghessi, A., Atzeni, F., Catellani, R., Ciapetti, A., Di Carlo, M., & Sarzi-Puttini, P. (2016). Identifying the symptom and functional domains in patients with fibromyalgia: results of a cross-sectional Internet-based survey in Italy. Journal of Pain Research, 9, 279–286. https://doi.org/10.2147/JPR.S100829

Stewart, J. A., Mailler-Burch, S., Müller, D., Studer, M., von Känel, R., Grosse Holtforth, M., Schwegler, K., & Egloff, N. (2019). Rethinking the criteria for fibromyalgia in 2019: the ABC indicators. Journal of pain research, 12, 2115–2124. https://doi.org/10.2147/JPR.S205299

Tein, J. Y., Coxe, S., & Cham, H. (2013). Statistical power to detect the correct number of classes in latent profile analysis. Structural Equation Modeling, 20(4), 640–657. https://doi.org/10.1080/10705511.2013.824781

Terol Cantero, M. C., Buunk, A. P., Cabrera, V., Bernabé, M., & Martin-Aragón Gelabert, M. (2020). Profiles of women with fibromyalgia and social comparison processes. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00440

Undeland, M., & Malterud, K. (2007). The fibromyalgia diagnosis: hardly helpful for the patients? A qualitative focus group study. Scandinavian journal of primary health care, 25, 250–255. https://doi.org/10.1080/02813430701706568

Vita, R., Caputo, A., Quattropani, M. C., Watt, T., Feldt-Rasmussen, U., Puleio, P., ... & Martino, G. (2020). Quality of Life in Patients with Hyperthyroidism: Where do we stand? Mediterranean Journal of Clinical Psychology, 8(2). https://doi.org/10.6092/2282-1619/mjcp-2521

Wang, S.-M., Han, C., Lee, S.-J., Patkar, A. A., Masand, P. S., & Pae, C.-U. (2015). Fibromyalgia diagnosis: A review of the past, present and future. Expert Review of Neurotherapeutics, 15(6), 667–679. https://doi.org/10.1586/14737175.2015.1046841

Ware, J., Jr, Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233. https://doi.org/10.1097/00005650-199603000-00003

White, M. K., Maher, S. M., Rizio, A. A., & Bjorner, J. B. (2018). A meta-analytic review of measurement equivalence study findings of the SF-36® and SF-12® Health Surveys across electronic modes compared to paper administration. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 27(7), 1757–1767. https://doi.org/10.1007/s11136-018-1851-2

Wright, K.B. (2005). Researching Internet-Based Populations: Advantages and Disadvantages of Online Survey Research, Online Questionnaire Authoring Software Packages, and Web Survey Services, Journal of Computer-Mediated Communication, 10 (3), JCMC1034, https://doi.org/10.1111/j.1083-6101.2005.tb00259.x

Wu, Y.-L., Chang, L.-Y., Lee, H.-C., Fang, S.-C., & Tsai, P.-S. (2017). Sleep disturbances in fibromyalgia: A meta-analysis of case-control studies. Journal of Psychosomatic Research, 96, 89–97. https://doi.org/10.1016/j.jpsychores.2017.03.011

DOI: https://doi.org/10.13129/2282-1619/mjcp-2953


  • There are currently no refbacks.