Patient Activation, Disease Burden, and Quality of Life in Women With Fibromyalgia

Patient activation (understood as the individual's knowledge, skills, and confidence in managing their health) is increasingly recognized in chronic illness care. However, to date, its role in fibromyalgia has not been systematically examined using validated quantitative measures.

To examine the associations between patient activation, perceived disease burden, and health-related quality of life (HRQoL) in women with fibromyalgia.

A cross-sectional study among 123 Israeli women with self-reported fibromyalgia. Participants completed the Patient Activation Measure (PAM-13), the Revised Fibromyalgia Impact Questionnaire (FIQR), and the Short Form-12 (SF-12), yielding physical (PCS-12) and mental (MCS-12) HRQoL scores. Associations were examined using Pearson correlations and multivariate linear regression analyses, adjusting for sociodemographic factors. Bootstrap mediation analysis (10,000 samples) assessed whether FIQR statistically accounted for the association between PAM and MCS-12.

Higher PAM scores were significantly associated with lower FIQR and higher MCS-12 scores, but not with PCS-12 (p < .001). In multivariable analyses, PAM remained independently associated with both FIQR (β = -0.29, p = .005) and MCS-12 (β = 0.17, p = .001). Mediation analysis indicated that FIQR partially accounted for the association between PAM and MCS-12 (indirect effect = 0.078, 95% CI [0.016, 0.150]), while the direct effect remained statistically significant.

Higher patient activation in women with fibromyalgia was associated with lower perceived disease burden and better mental HRQoL, but not with physical HRQoL. Perceived disease burden may partially account for the association between PAM and MCS-12.

These findings suggest the potential value of activation-informed interventions in improving mental well-being in fibromyalgia patients.