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Grant support

This work was funded by the Health Research Fund (Fondo de Investigacion en Salud), grant number PI17/00858 from the Instituto de Salud Carlos III (Spain). Lopez-Roig, S. and Pastor-Mira, M.A. contribution were supported by a research grant from MINECO (PSI2016-79566-C2-1-R).

Analysis of institutional authors

Velasco-Furlong, LAuthorGutierrez-Hermoso, LAuthorPenacoba-Puente, CCorresponding Author
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Article

The 4 U's Rule of Fibromyalgia: A Proposed Model for Fatigue in a Sample of Women with Fibromyalgia: A Qualitative Study

Publicated to:International Journal Of Environmental Research And Public Health. 17 (17): 1-23 - 2020-09-01 17(17), DOI: 10.3390/ijerph17176224

Authors: Velasco-Furlong, Lilian; Gutierrez-Hermoso, Lorena; Mateos-Pintado, Beatriz; Garvi-de Castro, Daniel; Blanco-Rico, Sheila; Sanroman-Canelada, Lucia; Lopez-Roig, Sofia; Angeles Pastor-Mira, Maria; Penacoba-Puente, Cecilia

Affiliations

Univ Miguel Hernandez, Dept Behav Sci & Hlth, Avinguda Univ Elx S-N, Elche 03202, Spain - Author
Univ Rey Juan Carlos, Dept Psychol, Ave Atenas S-N, Alcorcon 28922, Spain - Author

Abstract

Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the Goal Pursuit Questionnaire (GPQ) that may occur in the daily lives of women with fibromyalgia, according to an ABC (Antecedents-Behaviors-Consequences) model. This study followed a qualitative descriptive research method and a deductive-inductive hybrid approach based on a phenomenological paradigm. Twenty-six women with fibromyalgia participated in focus group discussions between February and March of 2018. Thematic content analysis was carried out from transcribed verbatim interviews. We identified nine major themes that emerged from the participants' conversations: self-imposed duties, muscle fatigue, overwhelming feeling of tiredness, difficulty thinking, difficulty concentrating, negative emotions, lifestyle changes, affected everyday activities, and lack of motivation for daily activities and social interactions. We conclude that the ABC model allowed certain elements to emerge regarding the fatigue experience, highlighting its importance as a symptom in fibromyalgia. This additional analysis of the ABC model showed that fatigue can be described through the 4 U's Rule, which is integrated by these four adjectives: (1) Unpredictable, (2) Uncontrollable, (3) Unseen, and (4) Unintelligible. Identifying these characteristics can contribute to a better understanding of fibromyalgia in addition to better treatment for these patients.

Keywords
AdultAgedArticleClinical articleComplicationContent analysisCriteriaDaily life activityEmotionEmotionsExperienceFatigueFemaleFibromyalgiaFibromyalgia syndromeFocus groupsGoal pursuit questionnaireHumanHuman relationHumansHybrid approachInformation processingInterpersonal relationsInterviewLifestyleLifestyle modificationMental healthMiddle agedMotivationMuscleMuscle fatigueNarrative analysisNarrativesPainPopulationPrevalenceQualitative analysisQualitative researchQuality of lifeQuestionnaireQuestionnaire surveySocial supportThought disorderWomens health

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal International Journal Of Environmental Research And Public Health due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position 42/176, thus managing to position itself as a Q1 (Primer Cuartil), in the category Public, Environmental & Occupational Health.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 4.82, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-12, the following number of citations:

  • WoS: 12
  • Scopus: 13
  • Europe PMC: 7
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-12:

  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 44 (PlumX).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Velasco Furlong, Lilian) and Last Author (Peñacoba Puente, María Cecilia).

the author responsible for correspondence tasks has been Peñacoba Puente, María Cecilia.