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Cited by 31Fibromyalgia and Chronic Fatigue Syndrome ResearchMusculoskeletal pain and rehabilitationMedical Practices and Rehabilitation

Which aspects of health differ between working and nonworking women with fibromyalgia? A cross-sectional study of work status and health

Open access
Palstam, Annie, Bjersing, Jan L, Mannerkorpi, Kaisa·2012·BMC Public Health
DOI 10.1186/1471-2458-12-1076PMC PMC3541061
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Abstract

BACKGROUND: Women with fibromyalgia (FM) describe great difficulties in managing work. Reported work ability in women with FM varies from 34 to 77 percent in studies from different countries. Many factors are suggested to affect the ability to work in women with FM, including pain, fatigue, impaired physical capacity and activity limitations. However, it is difficult to define to which extent symptom severity can be compatible with work. The aim of this study was to investigate which aspects of health differ between working women with FM and nonworking women with FM. METHODS: A cross-sectional study of 129 women of working age with FM which included clinical assessment, structured interviews, questionnaires and performance-based tests. The women were categorized as working or nonworking. Aspects of health are presented according to the International Classification of Functioning, Disability and Health (ICF). RESULTS: Working women with FM presented better health than nonworking women with FM in ratings of body function (FIQ pain p < 0.001, FIQ fatigue p = 0.006, FIQ stiffness p = 0.009, HADS-Depression p = 0.007). Ratings of overall health status were also significantly better in working women with FM than in nonworking women with FM (FIQ total, eight-item p = 0.001 and SF-36 PCS p < 0.001). No significant differences were found between working- and nonworking women in tests of physical capacity. FIQ pain was an independent explanatory factor for work in stepwise multiple logistic regression analysis (OR 0.95, CI 0.93- 0.98), p < 0.001. CONCLUSION: Working women with FM reported better health than nonworking women with FM in terms of pain, fatigue, stiffness, depression, disease specific health status and physical aspects of quality of life, which represent body functions and overall health status. However, they were equally impaired in tests of physical capacity. Moderate pain levels were compatible with work, while severe pain appeared to compromise work. Fatigue was better tolerated, as women scoring severe levels of fatigue worked.

AI snapshot

Written from the paper’s full text.

TL;DR

In this cross-sectional study of 129 women with fibromyalgia, working women reported better health than nonworking women in pain, fatigue, stiffness, depression, disease-specific health status, and physical quality of life, but physical capacity tests did not differ. FIQ pain was the only independent explanatory factor for work (OR 0.95, 95% CI 0.93–0.98).

Key findings

  • Working women (n = 53) had better ratings than nonworking women (n = 76) for FIQ pain (p < 0.001), FIQ fatigue (p = 0.006), FIQ stiffness (p = 0.009), HADS-Depression (p = 0.007), FIQ total eight-item (p = 0.001), and SF-36 PCS (p < 0.001).
  • No significant differences were found in performance-based physical capacity tests: 6MWT (p = 0.087), Grippit right hand (p = 0.284), and Grippit left hand (p = 0.343).
  • FIQ pain was the only statistically significant independent explanatory factor for work in stepwise multiple logistic regression (OR 0.95, CI 0.93–0.98, p < 0.001; AUC 0.75, CI 0.66–0.83).
  • Pain localizations were fewer in working women (mean 12.5, SD 3.3) than nonworking women (mean 14.0, SD 3.2; p = 0.009); 29% of working women and 52% of nonworking women scored above the HADS-D cutoff for possible depression.

Methods

  • Cross-sectional study of 129 women of working age with fibromyalgia recruited from three primary health-care centres in West Sweden; categorized as working (25–100%, n = 53) or nonworking (0%, n = 76).
  • Data included clinical assessment, structured interviews, questionnaires, and performance-based tests; health aspects were presented according to the International Classification of Functioning, Disability and Health (ICF).
  • Between-group differences used Mann-Whitney U, Mantel-Haenszel, and Fisher’s exact tests with p ≤ 0.010 considered significant; variables with significant differences were entered into stepwise multiple logistic regression.

Limitations

  • Stated: the cross-sectional design does not allow analyses of cause and effect, and specific work demands were not reported and need further investigation.
  • Evident: all participants were women recruited from primary care in West Sweden, which limits generalizability; work status included part-time work and disability benefits, and no men were studied.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-2458-12-1076

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    FIQ pain was an independent explanatory factor for work in stepwise multiple logistic regression analysis (OR 0.95, CI 0.93-0.98, p < 0.001).

    “FIQ pain was an independent explanatory factor for work in stepwise multiple logistic regression analysis (OR 0.95, CI 0.93- 0.98), p < 0.001.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no significant difference in anxiety (HADS-A) between working and nonworking women with fibromyalgia.

    “There was no significant difference in anxiety (HADS-A) between WW and NWW.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The number of pain localizations was fewer in working women than nonworking women with fibromyalgia (p = 0.009).

    “The number of pain localizations was fewer in WW than in NWW (p = 0.009)”
    Quote in the paperSubstantial claim
  • Findingown data

    No significant differences were found between working and nonworking women with fibromyalgia in activity limitations in daily life (FIQ physical function).

    “No significant differences were found between WW and NWW in leisure time physical activity (LTPAI) or activity limitations in daily life (FIQ physical function).”
    Quote in the paperNot a substantial claim
  • Findingown data

    No significant differences were found between working and nonworking women with fibromyalgia in performance-based tests of physical capacity (6MWT, Grippit).

    “No significant differences were found between working- and nonworking women in tests of physical capacity.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 16
  • May combine two claims. 4

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Working women with fibromyalgia have previously been reported to experience less pain, less fatigue and better functional status than nonworking women with fibromyalgia.

    “Working women with FM have previously been reported to experience less pain, less fatigue and better functional status than nonworking women with FM [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Reisine S, Fifield J, Walsh SJ, Feinn R: Do employment and family work affect the health status of women with fibromyalgia?. J Rheumatol. 2003, 30 (9): 2045-2053.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Work is an important factor for health status in women in general.

    “work is an important factor for health status in women in general [43,44]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [43] Krantz G, Ostergren PO: Common symptoms in middle aged women: their relation to employment status, psychosocial work conditions and social support in a Swedish setting. J Epidemiol Community Health. 2000, 54 (3): 192-199. 10.1136/jech.54.3.192. source

      Not checked in the free run.

    • cites [44] Dew MA, Bromet EJ, Penkower L: Mental health effects of job loss in women. Psychol Med. 1992, 22 (3): 751-764. 10.1017/S0033291700038198. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Clinical assessments of tender points by manual palpation and muscle tenderness with the Somedic Algometer were conducted by trained examiners to verify diagnosis according to the American College of Rheumatology criteria for fibromyalgia.

    “Clinical assessments of tender points by manual palpation [1] and muscle tenderness with the Somedic Algometer (Somedic Production AB, Sollentuna, Sweden) [15] were conducted by trained examiners to verify diagnosis according to the American College of Rheumatology criteria for FM [1].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, et al: The american college of rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990, 33: 160-172. 10.1002/art.1780330203. source

      Not checked in the free run.

    • cites [15] Kosek E, Ekholm J, Hansson P: Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain. 1996, 68: 375-383. 10.1016/S0304-3959(96)03188-0. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Self-rated disability and unmarried status have been associated with work disability in fibromyalgia.

    “as well as self rated disability and unmarried status [10,11].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Wolfe F, Anderson J, Harkness D, Bennett RM, Caro XJ, Goldenberg DL, Russell IJ, Yunus MB: Work and disability status of persons with fibromyalgia. J Rheumatol. 1997, 24 (6): 1171-1178.

      Not checked in the free run.

    • cites [11] Sallinen M, Kukkurainen ML, Peltokallio L, Mikkelsson M: Women’s narratives on experiences of work ability and functioning in fibromyalgia. Musculoskeletal Care. 2010, 8 (1): 18-26. 10.1002/msc.162. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The theory of the healthy worker effect suggests that healthier individuals are more likely to remain in the workforce.

    “The theory of the healthy worker effect suggests that healthier individuals are more likely to remain in the workforce [42].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Li C-Y, Sung E-C: A review of the healthy worker effect in occupational epidemiology. Occup Med. 1999, 49 (4): 225-229. 10.1093/occmed/49.4.225. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The specific demands in work were not reported in the study.

    “Also, the specific demands in work were not reported in the study and need further investigation.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The main strength of the present study is the integration of physical, social and psychological assessments including subjective ratings as well as clinical assessments and performance-based tests of physical capacity.

    “The main strength of the present study is the integration of physical, social and psychological assessments including subjective ratings as well as clinical assessments and performance-based tests of physical capacity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A limitation of this study is the cross-sectional design, which does not allow analyses of cause and effect.

    “A limitation of this study is the cross sectional design which does not allow analyses of cause and effect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The between-group analyses comprised 33 statistical analyses, with 11 significant values at significance level 0.01, and the upper level of number of false significances was 0.2, indicating 0-1 of the significances found might be false.

    “The between-group analyses comprised a total of 33 statistical analyses, with 11 significant values at significance level 0.01, and the upper level of number of false significances was 0.2, which indicates that 0–1 of the significances found might be false.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Impaired health status assessed by SF-36 has earlier been associated with work disability in rheumatoid arthritis, systemic lupus erythematosus and musculoskeletal pain.

    “Impaired health status assessed by SF-36 has earlier been associated with work disability in rheumatoid arthritis (RA) [35], systemic lupus erythematosus (SLE) [40] and musculoskeletal pain [41].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [35] Ödegård S, Finset A, Kvien TK, Mowinckel P, Uhlig T: Work disability in rheumatoid arthritis is predicted by physical and psychological health status: a 7-year study from the Oslo RA register. Scand J Rheumatol. 2005, 34: 441-447. 10.1080/03009740510018633. source

      Not checked in the free run.

    • cites [40] Baker K, Pope J, Fortin P, Silverman E, Peschken C: Work disability in systemic lupus erythematosus is prevalent and associated with socio-demographic and disease related factors. Lupus. 2009, 18: 1281-1288. 10.1177/0961203309345784. source

      Not checked in the free run.

    • cites [41] Atroshi I, Andersson IH, Gummesson C, Leden I, Odenbring S, Ornstein E: Primary care patients with musculoskeletal pain. Scand J Rheumatol. 2002, 31: 239-244. 10.1080/030097402320318440. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Activity limitations in fibromyalgia have an impact on work ability.

    “Activity limitations in FM have an impact on work ability [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] White KP, Speechley M, Harth M, Ostbye T: Comparing self-reported function and work disability in 100 community cases of fibromyalgia syndrome versus controls in London, Ontario: The London fibromyalgia epidemiology study. Arthritis Rheum. 1999, 42 (1): 76-83. 10.1002/1529-0131(199901)42:1<76::AID-ANR10>3.0.CO;2-G. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Severe pain and fatigue combined with a demanding life situation and ageing have been associated with work disability in fibromyalgia.

    “Severe pain and fatigue combined with a demanding life situation and ageing have been associated with work disability in FM”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Wolfe F, Anderson J, Harkness D, Bennett RM, Caro XJ, Goldenberg DL, Russell IJ, Yunus MB: Work and disability status of persons with fibromyalgia. J Rheumatol. 1997, 24 (6): 1171-1178.

      Not checked in the free run.

    • cites [11] Sallinen M, Kukkurainen ML, Peltokallio L, Mikkelsson M: Women’s narratives on experiences of work ability and functioning in fibromyalgia. Musculoskeletal Care. 2010, 8 (1): 18-26. 10.1002/msc.162. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was approved by the ethics committee at the Sahlgrenska Academy, University of Gothenburg, and written and oral informed consent was obtained from all participants.

    “The study was approved by the ethics committee at the Sahlgrenska Academy, University of Gothenburg. Written and oral informed consent was obtained from all participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Depression symptoms have a negative impact on work ability in fibromyalgia.

    “This supports the results of an earlier study on work disability in FM reporting the negative impact of depression symptoms on work ability [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Kurtze N, Gundersen KT, Svebak S: The impact of perceived physical dysfunction, health-related habits, and affective symptoms on employment status among fibromyalgia support group members. J Muscoskel Pain. 2001, 9 (2): 39-53. 10.1300/J094v09n02_04. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pain has previously been found to be a critical factor for work in rheumatic diseases.

    “Pain has previously been found to be a critical factor for work in rheumatic diseases [10,35].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Wolfe F, Anderson J, Harkness D, Bennett RM, Caro XJ, Goldenberg DL, Russell IJ, Yunus MB: Work and disability status of persons with fibromyalgia. J Rheumatol. 1997, 24 (6): 1171-1178.

      Not checked in the free run.

    • cites [35] Ödegård S, Finset A, Kvien TK, Mowinckel P, Uhlig T: Work disability in rheumatoid arthritis is predicted by physical and psychological health status: a 7-year study from the Oslo RA register. Scand J Rheumatol. 2005, 34: 441-447. 10.1080/03009740510018633. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The FIQ total score predicts work disability in fibromyalgia.

    “This supports the results from an earlier study on work disability in FM where the FIQ total score was found to predict work disability [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] White KP, Speechley M, Harth M, Ostbye T: Comparing self-reported function and work disability in 100 community cases of fibromyalgia syndrome versus controls in London, Ontario: The London fibromyalgia epidemiology study. Arthritis Rheum. 1999, 42 (1): 76-83. 10.1002/1529-0131(199901)42:1<76::AID-ANR10>3.0.CO;2-G. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Fatigue has previously been found to be an important factor for work disability in rheumatic diseases.

    “Fatigue has previously been found to be an important factor for work disability in rheumatic diseases [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Ödegård S, Finset A, Kvien TK, Mowinckel P, Uhlig T: Work disability in rheumatoid arthritis is predicted by physical and psychological health status: a 7-year study from the Oslo RA register. Scand J Rheumatol. 2005, 34: 441-447. 10.1080/03009740510018633. source

      Not checked in the free run.

17 of 17

  • The paper relies on this without support.

    It is difficult to define to what extent symptom severity can be compatible with work.

    “However, it is difficult to define to which extent symptom severity can be compatible with work.”

  • The paper relies on this without support.

    Assessments of physical, social and psychological health components combining subjective ratings with performance-based tests would advance understanding in this area.

    “Assessments of physical, social and psychological health components combining subjective ratings with performance-based tests would advance our understanding in this area.”
2 of 2

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Related

Authors
Palstam, A., Bjersing, J. L., & Mannerkorpi, K.
Affiliations
  • University of Gothenburg (SE)
  • Sahlgrenska University Hospital (SE)
Corresponding author
Palstam, Annie
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2012-12
Volume
12
Issue
1
Pages
1076-1076
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/1471-2458-12-1076
PMC
PMC3541061
OpenAlex
W2096486732
Semantic Scholar
361fab53438cd20a7afeea3b1fc4d33534ac7438
Cited by
31
References
52
Citations by year
2026: 3 · 2025: 4 · 2024: 4 · 2023: 2 · 2021: 1 · 2020: 3 · 2019: 3 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 1
FWCI
1.36
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Diva portal (Dalarna University Library) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
fibromyalgia, employment status, employment, women, pain, fatigue, stiffness, depression, physical capacity, health status, quality of life, physiological function, International Classification of Functioning, Disability and Health
MeSH terms
Adult, Cross-Sectional Studies, Employment, Female, Fibromyalgia, Health Status, Health Status Indicators, Humans, Interviews as Topic, Middle Aged, Surveys and Questionnaires, Regression Analysis, Task Performance and Analysis, Women, Women, Working, International Classification of Functioning, Disability and Health

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