From Quality of Life Research, 11 October 2014 [Epub ahead of print].
Assessment of recovery status in chronic fatigue syndrome using normative data.
P.O. Box 6483, East Perth, WA, 6892, Australia.
Adamowicz et al. have reviewed criteria previously employed to define recovery in chronic fatigue syndrome (CFS).
They suggested such criteria have generally lacked stringency and consistency between studies and recommended future research should require “normalization of symptoms and functioning”.
Options regarding how “normalization of symptoms and functioning” might be operationalized for CFS cohorts are explored.
A diagnosis of CFS excludes many chronic disabling illnesses present in the general population, and CFS cohorts can almost exclusively consist of people of working age; therefore, it is suggested that thresholds for recovery should not be based on population samples which include a significant proportion of sick, disabled or elderly individuals.
It is highlighted how a widely used measure in CFS research, the SF-36 physical function subscale, is not normally distributed. This is discussed in relation to how recovery was defined for a large intervention trial, the PACE trial, using a method that assumes a normal distribution.
Summary data on population samples are also given, and alternative methods to assess recovery are proposed.
The “normalization of symptoms and function” holds promise as a means of defining recovery from CFS at the current time.
However, care is required regarding how such requirements are operationalized, otherwise recovery rates may be overstated, and perpetuate the confusion and controversy noted by Adamowicz et al.
From Clinical Rheumatology, 14 October 2014.[Epub ahead of print].
What is in a name? Comparing diagnostic criteria for chronic fatigue syndrome with or without fibromyalgia.
Meeus M(1), Ickmans K, Struyf F, Kos D, Lambrecht L, Willekens B, Cras P, Nijs J.
1) Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, firstname.lastname@example.org.
The current study had two objectives. (1) to compare objective and self-report measures in patients with chronic fatigue syndrome (CFS) according to the 1994 Center for Disease Control (CDC) criteria, patients with multiple sclerosis (MS), and healthy controls, and (2) to contrast CFS patients who only fulfil CDC criteria to those who also fulfil the criteria for myalgic encephalomyelitis (ME), the 2003 Canadian criteria for ME/CFS, or the comorbid diagnosis of fibromyalgia (FM).
One hundred six participants (48 CFS patients diagnosed following the 1994 CDC criteria, 19 MS patients, and 39 healthy controls) completed questionnaires assessing symptom severity, quality of life, daily functioning, and psychological factors. Objective measures consisted of activity monitoring, evaluation of maximal voluntary contraction and muscle recovery, and cognitive performance. CFS patients were screened whether they also fulfilled ME criteria, the Canadian criteria, and the diagnosis of FM.
CFS patients scored higher on symptom severity, lower on quality of life, and higher on depression and kinesiophobia and worse on MVC, muscle recovery, and cognitive performance compared to the MS patients and the healthy subjects. Daily activity levels were also lower compared to healthy subjects. Only one difference was found between those fulfilling the ME criteria and those who did not regarding the degree of kinesiophobia (lower in ME), while comorbidity for FM significantly increased the symptom burden.
CFS patients report more severe symptoms and are more disabled compared to MS patients and healthy controls.
Based on the present study, fulfillment of the ME or Canadian criteria did not seem to give a clinically different picture, whereas a diagnosis of comorbid FM selected symptomatically worse and more disabled patients.
From Health Care for Women International, 14 October 2014. [Epub ahead of print].
Severity Scales for Use in Primary Health Care to Assess Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.
Hardcastle SL(1), Brenu EW, Johnston S, Staines D, Marshall-Gradisnik S.
1) National Centre for Neuroimmunology and Emerging Diseases, Griffith Health Centre, School of Medical Science, Griffith University, Gold Coast, Queensland, Australia.
Abstract Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a physical and cognitive disabling illness, characterised by severe fatigue and a range of physiological symptoms that primarily affects
women. The immense variation in clinical presentation suggests differences in severity based on symptomology, physical and cognitive functional capacities.
In this review paper, we examined a number of severity scales used in assessing severity of patients with CFS/ME and the clinical aspects of CFS/ME severity subgroups. The use of severity scales may be important in CFS/ME as it permits the establishment of subgroups which may improve accuracy in both clinical and research settings.