Exploring Biopsychosocial Stress Markers in Women With Fibromyalgia.

BACKGROUND: Identification of fibromyalgia has been a challenge for healthcare professionals due to the lack of a clinical biomarker. A well-supported integrative hypothesis holds that this condition is a chronic pain problem partly caused by long-term dysregulation of stress response. Therefore, stress assessment from a biopsychosocial perspective may be a useful approach to recognizing fibromyalgia. PURPOSE: A cross-sectional case-control study was conducted to explore stress markers from a multidimensional perspective, including heart rate variability (as a biomarker of stress) as well as psychological distress and social stress. METHODS: Forty-seven women with fibromyalgia were recruited from support groups and another 47 were recruited as matched pain-free controls. Comparison and discriminant function analyses were performed. RESULTS: The data support the goodness of biopsychosocial stress markers in women with fibromyalgia, resulting in the identification of between 70% and 74.5% of fibromyalgia cases (sensitivity) and 85%-87% pain-free controls (specificity), with medium-high levels of fit (λ = 0.58 and λ = 0.59; p < .00). Women with fibromyalgia were characterized by high levels of psychological distress, social stress (disorder levels), and autonomic dysregulation. Although distress and social stress had a greater weight in discriminant functions, dysregulation in terms of low parasympathetic activity and high sympathetic activity at rest was also relevant. CONCLUSIONS: A biopsychosocial approach to stress with an objective biomarker such as heart rate variability may be a useful tool to identify and manage FM.

Is Thought Management a Resource for Functioning in Women with Fibromyalgia Irrespective of Pain Levels?

OBJECTIVE: This study aimed to examine the relationship between cognitive factors (cognitive fusion and catastrophizing) and functional limitation experienced by patients with fibromyalgia across different levels of pain severity (i.e., moderation). METHODS: The sample comprised 226 women with fibromyalgia. Their mean age was 56.91 years (standard deviation = 8.94; range = 30 to 78 years). RESULTS: Pain severity, cognitive fusion, and all components of catastrophizing (i.e., rumination, magnification, and helplessness) contributed to greater fibromyalgia impact on functioning in the multivariate analyses (all P < 0.001). A moderation effect was also found in the relationship between cognitive fusion and fibromyalgia impact on functioning (B = -0.12, t = -2.42, P = 0.016, 95% confidence interval: -0.22 to -0.02) and between magnification and fibromyalgia impact (B = -0.37, t = -2.21, P = 0.028, 95% confidence interval: -0.69 to -0.04). This moderation was not observed for rumination and helplessness. CONCLUSIONS: The results suggest that in interventions to improve functioning in people with fibromyalgia, some maladaptive forms of thought management (i.e., cognitive fusion and magnification) preferably should be challenged at milder levels of pain severity. According to our findings, cognitive fusion and magnification might have less room to impact functioning at higher levels of pain severity; therefore, rumination and helplessness, which had comparable associations with functioning irrespective of pain levels, would be preferable targets in psychological interventions in patients with fibromyalgia experiencing more severe pain levels.

Why do some people with severe chronic pain adhere to walking prescriptions whilst others won't? A cross-sectional study exploring clinical and psychosocial predictors in women with fibromyalgia.

Fibromyalgia (FM) is a highly disabling condition characterized by widespread chronic pain. Physical exercise, such as walking, has been recommended as the treatment of choice for FM. However, adherence to physical exercise tends to be poor. Pain is one of the main inhibitors to adhere to walking in FM patients. The main objective of this study has been to determine whether there is a clinical and psychosocial profile to help predict individual differences in adherence to walking in a sample of patients with FM with severe pain levels. In this cross-sectional study, the sample was composed of 172 women with FM and severe pain levels (> 7 in an 11-point numerical scale). Women were classified into two groups: (1) those who walked regularly and (2) patients who rarely or never walked. Group differences regarding clinical outcomes (e.g., FM impact, anxiety, depression, cognitive fusion, catastrophizing, affect, and personality), sociodemographic variables, and medical history were analyzed. Patients who walked despite pain significantly reported less impact of FM, anxiety, depression, catastrophizing, cognitive fusion, negative affect, openness to experience, agreeableness, and conscientiousness. The unique predictors of group membership (walking versus no walking) in a binary regression were FM impact and negative affect. The results show that adherence to exercise might be influenced and predicted by the clinical profile of the patient, which suggests that personalized motivational interventions should be addressed to this at-risk subgroup.

Assessing Self-Efficacy for Physical Activity and Walking Exercise in Women with Fibromyalgia.

BACKGROUND: Exercise and physical activity are an evidence-based practice for chronic pain. Health professionals need instruments to assess self-efficacy for this practice taking into account the specific barriers of patients with these health problems. PURPOSE: To develop and test the psychometric properties of a new self-efficacy scale for physical activity and walking exercise in patients with fibromyalgia. DESIGN: A cross-sectional and prospective study was conducted in a Spanish Fibromyalgia Unit. Two hundred and eleven new patients signed the informed consent and participated in the study. All of them were women, referred to by either Primary or Specialized Health Care. In addition to the new scale, they filled out several self-reported and validated instruments to collect the data present in this study. RESULTS: Exploratory factor analysis showed a three-factor model (GFI = .99; RMSR = .06) that explained 74.2% of the total variance. They assessed how confident patients felt about walking quickly in both 30- and 60-minute sessions, (Factor I: 10 items; α = .97), to perform daily physical activities (Factor II: 10 items; α = .93) and to undertake moderate physical activity (Factor III: 5 items; α = .95). The total score of the scale and the three-factor scores showed good criterion validity and adequate validity based on the relationships with other constructs. CONCLUSIONS: The scale showed adequate psychometric properties and can be a useful tool to help health professionals monitor patients' self-efficacy perception and customize both physical activity and walking exercise intervention goals and their implementation.

Promoting unsupervised walking in women with fibromyalgia: a randomized controlled trial.

The objective of this study is to test the efficacy of a group motivational plus implementation intentions intervention in promoting adherence to an unsupervised walking program recommended for fibromyalgia, compared to an implementation intentions condition and to an active control condition. A triple-blind, randomized, longitudinal study with measures at baseline, short (seven weeks post-intervention), mid (12 weeks) and long-term (36 weeks) is performed. Data are analyzed using multilevel longitudinal growth curve two-level modelling. Participants are 157 women with fibromyalgia. In the short-term, adherence to the minimum and to the standard walking program (primary outcome measures) is explained by time (both p <.001), motivational plus implementation intentions intervention (both p <.001) and by their interaction (both p <.001). Regarding the secondary outcomes, only physical function is explained by time (p <.001), motivational plus implementation intentions intervention (p <.05) and by their interaction (p <.05). Motivational plus implementation intentions intervention achieve the promotion of walking as an exercise in the short-term; furthermore, physical function of the women in this condition is better than in the other two intervention groups, which is a relevant outcome from a rehabilitation point of view. However, more studies are needed to maintain the exercise at mid and long-term.

Are Pacing Patterns Really Based on Value Goals? Exploring the Contextual Role of Pain Acceptance and Pain Catastrophizing in Women with Fibromyalgia.

Pain catastrophizing and pain acceptance have been associated with functioning in fibromyalgia. In relation to activity patterns, pacing has been defined as a helpful pattern to regulate activities in the context of value-based goals, but results regarding whether it is adaptive or not are controversial. This study analyzes the moderating role of pain acceptance between pain catastrophizing and pacing in 231 women with fibromyalgia. Moderation analyses were conducted with model 1 from the PROCESS Macro version 3.4. The results showed a clear moderating effect of pain acceptance. At low levels of pain acceptance, catastrophizing and pacing patterns maintained significant and positive associations. However, at high levels of pain acceptance, pacing was independent of catastrophizing. Far from considering pacing patterns as functional or dysfunctional per se, our results suggest that women with low pain acceptance carry out pacing influenced by catastrophizing independently of their goal pursuit, while patients who accept their pain may use pacing as a regulatory mechanism according to their goals.

Predicting walking as exercise in women with fibromyalgia from the perspective of the theory of planned behavior.

Based on the theory of planned behavior, this study examined factors related to the intention to adhere to an unsupervised walking program and the intention-behavior gap in relation to walking adherence in women with fibromyalgia. We also accounted for specific variables: fear of movement, pain intensity, distress and disability. TPB constructs, walking behavior and the above-mentioned variables were assessed in 274 women aged 18 to 70 years old (mean 51.8, range 25.5-69.1 years) at baseline and seven weeks later (n = 219) during 2012. Intention to adhere to a walking program showed medium scores at baseline and was associated with attitude and perceived behavioral control (PBC). Self-reported walking adherence at Time 2 was only predicted by perceived behavioral control. The intention-behavior gap was present in 33% of participants. Logistic regression analysis showed PBC associated with being a successful intender. Women with fibromyalgia were motivated to walk; however, they did not act on their intentions, and PBC appeared as the main explanation. Women who perceived high control in comparison to those who perceived low control, increased their likelihood of adhering to a walking program about three-fold. Women with fibromyalgia should increase their perceived control through different strategies.

Validation of the Spanish version of the Oxford Cognitive Screen (S-OCS): psychometric properties of a short cognitive stroke-specific screening tool.

OBJECTIVE:: The aim of this study is to examine the psychometric properties of the Spanish version of the Oxford Cognitive Screen in a subacute stroke population. PARTICIPANTS AND SETTING:: Fifty-seven subacute stroke outpatients and 54 healthy individuals were recruited in Alicante province, Spain. MAIN MEASURE:: The Oxford Cognitive Screen. OTHER MEASURES:: The Montreal Cognitive Assessment, the Barcelona test, and the Barthel Index. DESIGN:: A validation study was conducted to analyze the inter-rater, intra-rater, test-retest, and internal consistency of the Spanish version of the Oxford Cognitive Screen. Concurrent validity was assessed using the Montreal Cognitive Assessment and the Barcelona test, and divergent validity using the Barthel index. Discriminant indices such as the sensitivity, specificity, predictive values, and optimal cut-offs were also estimated. RESULTS:: The subtests of the Spanish version of the Oxford Cognitive Screen showed excellent estimates for the inter-reliability (intraclass correlation coefficient (ICC) = 0.790 to 1.000; rs = 0.693 to 1.000), and acceptable-good for intra-reliability (ICC = 0.181 to 0.990) and test-retest reliability ( rs = 0.173 to 0.971). Internal consistency was also excellent (standardized Cronbach's α = 0.907). Spearman correlations for the concurrent validity were low-strong ( rs = -0.193 to 0.95) and low-moderate ( rs = -0.091 to 0.443) for divergent validity. The optimal cut-offs estimated for the subtests of the Spanish version of the Oxford Cognitive Screen showed good-high specificity (66.7%-100%) and positive predictive value (67.9%-100%), and low-good sensitivity (14.8%-83.3%) and moderate-good negative predictive value (53.5%-76.6%). Discriminant power as measured by the area under the curve indicated acceptable-good values (0.397 to 0.894). CONCLUSION:: Our findings support that the Spanish version of the Oxford Cognitive Screen is a reliable and valid tool for screening cognitive impairments in subacute stroke patients.

To walk or not to walk: insights from a qualitative description study with women suffering from fibromyalgia.

Walking improves health outcomes in fibromyalgia; however, there is low adherence to this practice. The aim of this research was to explore the beliefs of women suffering from fibromyalgia toward walking, and the meaning that they attribute to the behavior of walking as part of their fibromyalgia treatment. This study is a qualitative description research. Forty-six (46) women suffering from fibromyalgia and associated with local fibromyalgia associations located in four different Spanish cities (Elche, Alicante, Madrid, and Talavera de la Reina) participated in focus group discussions in the summer 2012. Thematic content analysis was performed in transcribed verbatim from interviews. Participants perceived several inhibitors for walking even when they had positive beliefs toward its therapeutic value. Whereas participants believed that walking can generate improvement in their disease and their health in general, they did not feel able to actually do so given their many physical impediments. Furthermore, participants struggled with social isolation and stigma, which was lessened through the conscious support of family. Advice from family doctors was also a very important facilitator to participants. In a health care delivery context that favors person-centered care, and in order to foster adherence to walking-based fibromyalgia treatments, it is recommended that therapeutic walking programs be tailored to each woman' individual circumstances, and developed in close collaboration with them to help them increase control over their health and their condition.

Prevalence and predictors of unsupervised walking and physical activity in a community population of women with fibromyalgia.

Physical exercise is recognized as a component of the evidence-based guidelines for treatment of fibromyalgia. Walking is a low-moderate intensity exercise easily adaptable to a fibromyalgia patient's situation. The present study aims to estimate the prevalence of unsupervised walking for exercise in women with fibromyalgia, to describe their level of physical activity and to identify their predictors among socio-demographic, symptom perception and medical advice to walk. A cross-sectional survey with 920 women (all members of fibromyalgia associations) completed the International Physical Activity Questionnaire-Short Form and self-reported scales to assess symptom perception, walking, medical advice to walk and physical comorbidity. The prevalence of reported walking regularly as physical exercise was 30.8 % and it was predicted by medical advice (odds ratio, OR 1.876), age (OR 1.021) and fatigue intensity (OR 0.912). The prevalence of physical activity was 16 % for high-intensity activity, 40 % for moderate activity and 44 % for low activity. Predictors of low versus moderate and high physical activity were pain intensity (OR 1.171) and fatigue impact perception (OR 1.076). Evidence shows a low percentage of women with fibromyalgia walking regularly for physical exercise. Most reported low or moderate physical activity. The results indicate the importance of doctors' advice in promoting walking. Symptom perception and socio-demographic characteristics were weak predictors. Further work is required to examine other determinants of these low levels.

Family physicians' professional identity formation: a study protocol to explore impression management processes in institutional academic contexts.

BACKGROUND: Despite significant differences in terms of medical training and health care context, the phenomenon of medical students' declining interest in family medicine has been well documented in North America and in many other developed countries as well. As part of a research program on family physicians' professional identity formation initiated in 2007, the purpose of the present investigation is to examine in-depth how family physicians construct their professional image in academic contexts; in other words, this study will allow us to identify and understand the processes whereby family physicians with an academic appointment seek to control the ideas others form about them as a professional group, i.e. impression management. METHODS/DESIGN: The methodology consists of a multiple case study embedded in the perspective of institutional theory. Four international cases from Canada, France, Ireland and Spain will be conducted; the "case" is the medical school. Four levels of analysis will be considered: individual family physicians, interpersonal relationships, family physician professional group, and organization (medical school). Individual interviews and focus groups with academic family physicians will constitute the main technique for data generation, which will be complemented with a variety of documentary sources. Discourse techniques, more particularly rhetorical analysis, will be used to analyze the data gathered. Within- and cross-case analysis will then be performed. DISCUSSION: This empirical study is strongly grounded in theory and will contribute to the scant body of literature on family physicians' professional identity formation processes in medical schools. Findings will potentially have important implications for the practice of family medicine, medical education and health and educational policies.

Effects of Walking as Physical Exercise on Functional Limitation through Pain in Patients with Fibromyalgia-How Does Catastrophic Thinking Contribute?

Background: Aerobic exercise has a beneficial impact on physical and mental health. However, patients with fibromyalgia do not always report perceiving these improvements. Objective: The aim of this study was to examine whether catastrophic thinking moderated the effects of perceived pain severity once an active and regular lifestyle had been established on functional limitation in chronic pain patients, in particular in fibromyalgia patients. Methods: The sample consisted of a total of 491 women with fibromyalgia diagnosed according to the criteria of the American College of Rheumatology. Participants completed an ad-hoc item about lifestyle related to walking pattern, the Brief Pain Inventory, the Pain Catastrophization Scale, and the Fibromyalgia Impact Questionnaire-Revised. To examine the relationship between the variables, a moderate mediation analysis was performed through the macro PROCESS (model 14). Results: The relationship between the performance of the recommended walking pattern and functional limitation was mediated by the severity of pain (B = −5.19, SE = 1.59, t = −3.25, 95% CI = [−4.06, −0.28], p < 0.001). Furthermore, it was found that the mediating effect of pain severity was moderated by catastrophic thinking (Index = −0.014, SE = 0.007, 95% CI [0.002, 0.030]). Conclusions: The positive effect of walking on functionality through the reduction of pain levels is favored when patients present low catastrophizing, which affects the relevance of including interventions focused on the reduction of catastrophizing in the prescription of physical exercise in patients with fibromyalgia as the treatment of choice.

Assessing Walking Programs in Fibromyalgia: A Concordance Study between Measures.

This study analyzes the degree of agreement between three self-report measures (Walking Behavior, WALK questionnaire and logbooks) assessing adherence to walking programs through reporting their components (minutes, rests, times a week, consecutive weeks) and their concordance with a standard self-report of physical activity (IPAQ-S questionnaire) and an objective, namely number of steps (pedometer), in 275 women with fibromyalgia. Regularized partial correlation networks were selected as the analytic framework. Three network models based on two different times of assessment, namely T1 and T2, including 6 weeks between both, were used. WALK and the logbook were connected with Walking Behavior and also with the IPAQ-S. The logbook was associated with the pedometers (Z-score > 1 in absolute value). When the behavior was assessed specifically and in a detailed manner, participants' results for the different self-report measures were in agreement. Specific self-report methods provide detailed information that is consistent with validated self-report measures (IPAQ-S) and objective measures (pedometers). The self-report measures that assess the behavioral components of physical activity are useful when studying the implementation of walking as physical exercise.

Predicting Abusive Behaviours in Spanish Adolescents' Relationships: Insights from the Reasoned Action Approach.

(1) Background: Partner violence prevention programmes do not produce the expected behavioural changes. Accordingly, experts suggest applying evidence-based behavioural models to identify the determinants of abusive behaviours. In this research, we applied the reasoned action approach (RAA) to predict the performance (boys) and acceptance (girls) of abusive behaviours in adolescents. (2) Method: We designed a questionnaire based on the RAA and performed a cross-sectional study. We analysed the predictive capacity of the RAA constructs on intentions with the sample of single adolescents (n = 1112). We replicated the analysis only with those who were in a relationship (n = 587) and in addition analysed the predictive capacity of intention on future behaviour (3 months later). (3) Results: The hierarchical regression analysis performed with the sample of single adolescents showed that the model explained 56% and 47% of the variance of boys' intentions to perform the controlling and devaluing behaviours, respectively; and 62% and 33% of girls' intention to accept them. With those in a relationship, the model explained 60% and 53% of the variance of boys' intentions to perform the controlling and devaluating behaviour, respectively, and 70% and 38% of girls' intention to accept them. Intention exerted direct effects on boys' performance of controlling and devaluing behaviours (31% and 34% of explained variance, respectively) and on girls' acceptance (30% and 7%, respectively). (4) Conclusions: The RAA seems useful to identify the motivational determinants of abusive behaviours, regardless of adolescents´ relationship status, and for their prediction. Perceived social norms emerge as a relevant predictor on which to intervene to produce behavioural changes with both sexes.

Pain-Related Worrying and Goal Preferences Determine Walking Persistence in Women with Fibromyalgia.

Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = -2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0-1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = -3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.

The Role of Acceptance in Eating Behaviors-Spanish Validation of Food Craving Acceptance and Action Questionnaire (FAAQ-S).

Background: The Food Craving Acceptance and Action Questionnaire (FAAQ) was developed to measure food craving acceptance, but has not yet been adapted to Spanish. The aim of this study was to validate the FAAQ to the Spanish population and to analyze its psychometric properties. Method: Two studies were conducted. In the first study, the sample consisted of 224 undergraduate students who participated in the comprehension of the Spanish version and the Confirmatory Factor Analysis (CFA). The second sample consisted of 378 participants from a community sample who completed the refined version of the FAAQ and similar and dissimilar measures. Results: Study (1) The CFA was conducted, showing an inadequate fit of the model (CFI = 0.74, RMSEA = 0.18). Therefore, FAAQ was refined and it was administered to the community sample. Study (2) After an exploratory factor analysis, two factors were obtained as in the original FAAQ, Acceptance (30.92% variance explained) and Willingness (36.05%). The internal consistency was adequate for both subscales (ω = 0.88 and ω = 0.87, respectively). Correlation between the factors was r = 0.07, which provides evidence that Acceptance and Willingness are different constructs. Correlations of Acceptance with similar variables (r between -0.30 and -0.52) were stronger than the dissimilar measures (r between -0.26 and 0.24). This did not occur for the Willingness subscale, since correlations were low in all cases (r between -0.22 and 0.25). Conclusions: Spanish version of the FAAQ showed evidence of its reliability and validity, and may be a measure to provide a better understanding of how acceptance of thoughts and emotions concerning food and willingness impact eating management behaviors.

Positive and Negative Emotional Eating Are Not the Same-The Spanish Version of the Positive-Negative Emotional Eating Scale (PNEES).

The literature points to the importance of distinguishing between positive and negative emotional eating in relation to overeating and binge eating. The aim of this study was to evaluate the Spanish version of the Positive-Negative Emotional Eating Scale (PNEES) in a Spanish community sample. The sample consisted of 628 participants. The mean age was 27.5 (SD = 12.7) and 70.1% of them were women. The participants completed the PNEES, and measures of anxiety and depression (HADS), and eating disorder-related scales (TFEQ-R18, BULIT-R, and EAT-26) that were selected to examine convergent validity. A confirmatory factor analysis was conducted, replicating the original two-factor solution, consisting of Negative Emotional Eating (PNEES-N) and Positive Emotional Eating (PNEES-P). The results showed an acceptable fit of the model (CFI = 0.986; TLI = 0.984, RMSEA = 0.055). Internal consistency ranged from ω = 0.92 to ω = 0.96 for both subscales and the total score. PNEES-P correlations with other variables were lower with respect to the PNEES-N, showing that they are different constructs. A mediation analysis was conducted, in which PNEES-P significantly predicted binge eating and PNEES-N was a partially mediator variable. The results showed that the adaptation process was successful.

Contextualizing goal preferences in fear-avoidance models. Looking at fatigue as a disabling symptom in fibromyalgia patients.

The fear-avoidance model provides an explanation for the development of chronic pain, including the role of perception (i.e. pain catastrophism) as an explanatory variable. Recent research has shown that the relationship between pain catastrophism and avoidance is influenced in turn by different psychological and contextual variables, highlighting the affective-motivational ones. From this perspective, the Goal Pursuit Questionnaire (GPQ) was developed to measure the preference for hedonic goals (mood-management or pain-avoidance goals) over achievement goals in musculoskeletal pain patients. Recently, the Spanish version of the GPQ in fibromyalgia patients has been validated. Our aim has been to adapt the Spanish version of GPQ from pain to fatigue symptoms and to validate this new questionnaire (GPQ-F) in fibromyalgia. Despite the recognition of fibromyalgia as a complex disorder and the need for a differential study of its symptoms, fatigue, despite its high prevalence and limiting nature, remains the forgotten symptom. We conducted a cross-sectional study with 231 women with fibromyalgia. Previously, we adapted the Spanish GPQ for fatigue symptoms with three sub-studies (group structured interview, self-administration questionnaire and thinking-aloud; n = 15-27 patients). We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Exploratory factor analysis showed two factors: 'Fatigue-avoidance goal' and 'Mood-management goal' (39.3% and 13.9% of explained variance, respectively). The activity avoidance pattern fully mediated the relation between both catastrophizing and fatigue-avoidance goals with fatigue. The study shows initial findings about the usefulness of the GPQ-F as a tool to analyze goal preferences related to fatigue in fibromyalgia. The results supported the mediational role of activity avoidance patterns in the relationship between preference for fatigue-avoidance goals and fatigue.

Is Perfectionism Always Dysfunctional? Looking into Its Interaction with Activity Patterns in Women with Fibromyalgia.

The intrinsically adaptive or maladaptive nature of certain activity patterns in fibromyalgia (FM) has been put into question. The role of contextual factors related to their influence on functional limitation is required. Perfectionism complicates the ability to cope of these patients. The aim of the study has been to analyze the moderating role of perfectionism between activity patterns and functional limitation. The sample were 228 women with FM. Moderation analyses were conducted with the PROCESS Macro. Activity avoidance and excessive persistence were associated with poorer functionality, regardless of perfectionism. Pain avoidance and task persistence were more strongly associated with FM impact in women with high or moderate levels of perfectionism. In a clinical setting adapting the recommendations given to patients according to their level of perfectionism would be justified. Pain avoidance might be inadvisable at high levels of perfectionism, and task persistence is recommendable especially when perfectionism is high.