From BMJ Open, 26 November 2014.
Longitudinal follow-up of employment status in patients with chronic fatigue syndrome after mononucleosis
Morten Nyland(1), Halvor Naess(1,2), Jon Steinar Birkeland(2), Harald Nyland(1)
1) Institute of Clinical Medicine, University of Bergen, Bergen, Norway
2) Department of Neurology, Haukeland University Hospital, Bergen, Norway
To examine the effect of early clinical and demographic factors on occupational outcome, return to work or awarded permanent disability pension in young patients with chronic fatigue syndrome (CFS).
Longitudinal cohort study.
A written self-management programme including a description of active coping strategies for daily life was provided.
Patients with CFS after mononucleosis were evaluated at Department of Neurology, Haukeland University Hospital during 1996–2006 (contact 1). In 2009 self-report questionnaires were sent to all patients (contact 2).
PRIMARY AND SECONDARY OTCOME MEASURES
Primary measure was employment status at contact 2. Secondary measures included clinical symptoms, and Fatigue Severity Scale (FSS) scores on both contacts, and Work and Social Adjustment Scale (WSAS) at contact 2.
Of 111 patients at contact 1, 92 (83%) patients returned the questionnaire at contact 2. Mean disease duration at contact 1 was 4.7 years and at contact 2 11.4 years. At contact 1, 9 (10%) were part-time or full-time employed. At contact 2, 49 (55%) were part-time or full-time employed. Logical regression analysis showed that FSS≥5 at contact 2 was associated with depression, arthralgia and long disease duration (all at contact 1).
About half of younger patients with CFS with long-term incapacity for work experienced marked improvement including full-time or part-time employment showing better outcomes than expected. Risk factors for transition to permanent disability were depression, arthralgia and disease duration.
STRENGTHS AND LIMITATIONS OF THIS STUDY
Two strengths of the study are very long prospective follow-up period and focus on employment.
A limitation is that patients were recruited from a tertiary centre.
Long-term prognosis for young patients with chronic fatigue syndrome after mononucleosis is favourable for a large subgroup.
More than half of the patients with long-term incapacity for work are re-employed after mean disease duration of 11.4 years.
Factors associated with poor long-term prognosis include depression, arthralgia and disease duration.
From the American Journal of Neuroprotection and Neuroregeneration, 1 October 2014.
Chronic Fatigue Syndrome/Fibromyalgia: Past and Present
Chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FM) were first described in the 1800s. The present estimated prevalence of CFS and FM is estimated to be ~3% to ~15% in western countries. However, diagnosis of CFS and FM continue to mystify physicians due to presentation of broad symptomology. As a result, much controversy remains regarding treatment(s) for CFS/FM sufferers. The article presents information on the potential effective diagnosis and treatments options available to physicians and therapists.