Cherry, B. J., Weiss, J., Barakat, B. K., Rutledge, D. N.,&  Jones, C. J. (2009). Physical performance as a predictor of attention and processing speed in fibromyalgia. Archives of Physical Medicine & Rehabilitation, 90, 2066-2073. doi: 10.1016/j.apmr.2009.07.011Opens in new window


To explore the associations between physical (both self-report and objective measures) and cognitive function for persons with fibromyalgia (FM). DESIGN: Correlational study. SETTING: An exercise testing laboratory in southern California. PARTICIPANTS: Community-residing and functionally independent (not wheelchair-bound) adults meeting the American College of Rheumatology 1990 criteria for FM (N=51) with a mean age of 54 years and no history of stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite Physical Function Scale, Fibromyalgia Impact Questionnaire, adapted Trail Making Test parts A (TMT-A) and B (TMT-B), Digit Symbol Substitution Test, a composite index of TMT-A, TMT-B, and Digit Symbol Substitution Test combined, and physical performance assessments. RESULTS: Hierarchical regression analyses indicated that better objective physical performance predicted increased cognitive function for TMT-A and the composite cognitive score after controlling for age and symptom burden. That is, as the physical performance level decreased, cognitive performance levels decreased. CONCLUSIONS: Findings suggest that research is needed to determine whether patterns of physical activity participation, through their effects on physical fitness and performance, can enhance cognitive performance in persons with FM. Physiologic changes in specific brain regions in FM (eg, hippocampus, neural pain regions) suggest that further research is also warranted in determining specific relationships between biomarkers and cognitive performance in persons with FM.


Rutledge, D.N., Mouttapa, M., & Wood, P.B. (2009). Symptom clusters in fibromyalgia: Potential utility in patient assessment and treatment evaluation. Nursing Research, 58, 359-367. doi: 10.1097/NNR.0b013e3181b499d2Opens in new window


Recent evidence points to the likelihood of heterogeneity in the presentation and, perhaps, etiology of fibromyalgia (FM). A clearer understanding of the symptomatology and consideration of potential FM subtypes could add insights regarding this condition. OBJECTIVE: The aim of this study was to determine whether clusters could be identified among 20 symptoms that participants in a prior online study identified and to elucidate the underlying structure of resultant clusters. METHODS: Factor analysis was used on data from a study sponsored by the National Fibromyalgia Association in which 2,569 persons with FM responded to an online survey during a 3-day period in 2005. RESULTS: In this well-educated, primarily Caucasian sample, morning stiffness, fatigue, and not feeling rested in the morning were the symptoms with the highest severity scores. A series of exploratory factor analyses and subsequent confirmatory factor analysis with Cronbach's alpha testing led to a five-factor model with the following domains containing 17 symptoms: Somatic, Distress, Fibromyalgia Core, Dyscognition, and Sleep Problems. DISCUSSION: The findings support the heterogeneity of the FM experience and the presence of symptom clusters within the greater spectrum of symptoms comprising the FM syndrome. These observations suggest the possibility of tailoring interventions based upon individual patient symptomatology. Further work is needed to develop symptom inventories that can be used in clinical trials as outcome metrics and by healthcare providers to describe clinical burden and effect of treatments.



Jones, C. J., Rutledge, D. N., Jones, K. D., Matallana, L., & Rooks, D. (2008). Self-assessed physical function levels of women with fibromyalgia. Women’s Health Issues, 18, 406-412. doi: 10.1016/j.whi.2008.04.005Opens in new window


We sought to determine the self-reported physical function level of women with fibromyalgia (FM). METHODS: We performed a secondary analysis using data from an Internet-based survey posted on the National Fibromyalgia Association website. Data used for this study included women (n = 1,735) aged 31-78 years who reported being diagnosed with FM. RESULTS: More than 25% of women reported having difficulty taking care of personal needs and bathing, and >60% reported difficulty doing light household tasks, going up/down 1 flight of stairs, walking (1/2) mile, and lifting or carrying 10 lbs. More than 90% of women reported having difficulty doing heavy household tasks, lifting or carrying 25 lbs, and doing strenuous activities. Women with lower functional ability reported higher levels of fatigue, pain, spasticity, depression, restless legs, balance problems, dizziness, fear of falling, and bladder problems. CONCLUSIONS: The average woman in this sample reported having less functional ability related to activities of daily living and instrumental activities of daily living than the average community-dwelling woman in her 80s. Several symptoms/conditions were found to be associated with functional limitation in women with FM. Targeting these-singly or in clusters-may potentially be important in terms of future interventions.



Rutledge, D.N., & Jones, C.J. (2007). Effects of topical essential oil on exercise volume during a 12-week exercise program for women with fibromyalgia: A feasibility study. Journal of Alternative and Complementary Medicine, 13, 1099-1106. doi: 10.1089/acm.2007.0551.Opens in new window


We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. DESIGN: This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. Settings: Settings included community sites in southern California. SUBJECTS: The study included 20 women randomized to 024 oil, 23 to sham oil. INTERVENTIONS: Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. OUTCOME MEASURES: Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). RESULTS: The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. CONCLUSIONS: Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.


Rutledge, D. N., Jones, C. J., & Jones, K. (2007) Predicting physical function in persons with fibromyalgia. Journal of Nursing Scholarship, 39, 319-324. PMID:18021131Opens in new window


The purpose of this study was to investigate predictors of high physical function in people with fibromyalgia (FM). DESIGN: Cross-sectional descriptive, correlational study of 2,580 persons with FM who responded to an online survey during fall 2005. METHODS: The survey indicated self-reported physical activity levels, functional abilities, symptoms, health care costs, employment status, work productivity, self management strategies. It had adequate validity and reliability. A significant binary logistic regression model of predictors of physical function (individual factors, symptoms, self management strategies) was validated using backwards logistic regression. FINDINGS: Significant explanatory variables of high physical function were: men, greater education, younger age, lower intensity fatigue, spasticity, and balance problems, not using prescription pain medications, using aerobic or strength training exercise, and not using relaxation methods. CONCLUSIONS: People with FM suffer from multiple symptoms and use many modalities to control symptoms to remain functional. Given knowledge of predictors of physical function in FM, health care providers might be able to develop strategies to promote better functioning. Prospective trials are needed to track the natural course of study variables, measuring their effect on function, and to test effects of interventions to maximize function.


Bennett, R. M., Jones, C. J., Turk, D. C., Russell, I. J., & Matallana, L. (2007). An internet based survey of 2,596 fibromyalgia people with fibromyalgia. BMC Musculoskeletal Disorders, 8, 27. doi:10.1186/1471-2474-8-27.Opens in new window  


This study explored the feasibility of using an Internet survey of people with fibromyalgia (FM), with a view to providing information on demographics, sources of information, symptoms, functionality, perceived aggravating factors, perceived triggering events, health care utilization, management strategies, and medication use. METHODS: A survey questionnaire was developed by the National Fibromyalgia Association (NFA) in conjunction with a task force of "experts in the field". The questionnaire underwent several rounds of testing to improve its face validity, content validity, clarity and readability before it was mounted on the internet. The questionnaire consisted of 121 items and is available online at the website of the National Fibromyalgia Association. RESULTS: The questionnaire was completed by 2,569 people. Most were from the United States, with at least one respondent from each of the 50 states. Respondents were predominantly middle-aged Caucasian females, most of whom had FM symptoms for > or = 4 years. The most common problems were morning stiffness, fatigue, nonrestorative sleep, pain, concentration, and memory. Aggravating factors included: emotional distress, weather changes, insomnia, and strenuous activity. Respondents rated the most effective management modalities as rest, heat, pain medications, antidepressants, and hypnotics. The most commonly used medications were: acetaminophen, ibuprofen, naproxen, cyclobenzaprine, amitriptyline, and aspirin. The medications perceived to be the most effective were: hydrocodone preparations, aprazolam, oxycodone preparations, zolpidem, cyclobenzaprine, and clonazepam. CONCLUSION: This survey provides a snap-shot of FM at the end of 2005, as reported by a self-selected population of people. This descriptive data has a heuristic function, in that it identifies several issues for further research, such as the prescribing habits of FM health care providers, the role of emotional precipitants, the impact of obesity, the significance of low back pain and the nature of FM related stiffness.