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BMC Health Services Research
Published in: BMC Health Services Research 1/2003

Open Access 01-12-2003 | Research article

Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution

Authors: William C Reeves, Andrew Lloyd, Suzanne D Vernon, Nancy Klimas, Leonard A Jason, Gijs Bleijenberg, Birgitta Evengard, Peter D White, Rosane Nisenbaum, Elizabeth R Unger, the International Chronic Fatigue Syndrome Study Group

Published in: BMC Health Services Research | Issue 1/2003

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Abstract

Background

Chronic fatigue syndrome (CFS) is defined by symptoms and disability, has no confirmatory physical signs or characteristic laboratory abnormalities, and the etiology and pathophysiology remain unknown. Difficulties with accurate case ascertainment contribute to this ignorance.

Methods

Experienced investigators from around the world who are involved in CFS research met for a series of three day workshops in 2000, 2001 and 2002 intended to identify the problems in application of the current CFS case definition. The investigators were divided into focus groups and each group was charged with a topic. The investigators in each focus group relied on their own clinical and scientific knowledge, brainstorming within each group and with all investigators when focus group summaries were presented. Relevant literature was selected and reviewed independent of the workshops. The relevant literature was circulated via list-serves and resolved as being relevant by group consensus. Focus group reports were analyzed and compiled into the recommendations presented here.

Results

Ambiguities in the current CFS research definition that contribute to inconsistent case identification were identified. Recommendations for use of the definition, standardization of classification instruments and study design issues are presented that are intended to improve the precision of case ascertainment. The International CFS Study Group also identified ambiguities associated with exclusionary and comorbid conditions and reviewed the standardized, internationally applicable instruments used to measure symptoms, fatigue intensity and associated disability.

Conclusion

This paper provides an approach to guide systematic, and hopefully reproducible, application of the current case definition, so that case ascertainment would be more uniform across sites. Ultimately, an operational CFS case definition will need to be based on empirical studies designed to delineate the possibly distinct biological pathways that result in chronic fatigue.
Literature
1.
Wessely S: The History of Chronic Fatigue Syndrome. In Chronic Fatigue Syndrome. Edited by: Strauss SE. 1994, New York: Marcel Dekker, Inc, 3-44.
2.
Holmes GP, Kaplan JE, Gantz NM, Komaroff AL, Schonberger LB, Straus SE, et al: Chronic fatigue syndrome: a working case definition. Ann Intern Med. 1988, 108: 387-389.CrossRefPubMed
3.
Lloyd AR, Hickie I, Boughton CR, Spencer O, Wakefield D: Prevalence of chronic fatigue syndrome in an Australian population. Med J Aust. 1990, Suppl 153: 522-528.
4.
Sharpe MC, Archard LC, Banatvala JE, Borysiewicz LK, Clare AW, David A, et al: A report-chronic fatigue syndrome guidelines for research. J R Soc Med. 1991, 84: 118-121.PubMedPubMedCentral
5.
Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A: The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Int Med. 1994, 121: 953-959.CrossRefPubMed
6.
Wilson A, Hickie I, Hadzi-Pavlovic D, Wakefield D, Parker G, Straus SE, et al: What is chronic fatigue syndrome? Heterogeneity within an international multicentre study. Aust N Z J Psych. 2001, 35: 520-527. 10.1046/j.1440-1614.2001.00888.x.CrossRef
7.
Taylor RR, Friedberg F, Jason LA: A Clinician's Guide to Controversial Illnesses: Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical Sensitivities. 2001, Sarasota, Fla.: Professional Resource Press
8.
Andrews G, Peters L: The psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol. 1998, 33: 80-88. 10.1007/s001270050026.CrossRefPubMed
9.
Taylor RR, Jason LA: Comparing the DIS with the SCID: Chronic fatigue syndrome and psychiatric comorbidity. Psychology and Health: The International Review of Health Psychology. 1998, 13: 1087-1104.CrossRef
10.
Bultmann U, de Vries M, Beurskens AJ, Bleijenberg G, Vercoulen JH, Kant IJ: Measurement of prolonged fatigue in the working population: determination of a cut-off point for the Checklist Individual Strength. J Occup Health Psychol. 2000, 5: 411-416. 10.1037//1076-8998.5.4.411.CrossRefPubMed
11.
Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, van der Wilt GJ, Spinhoven P, van der Meer JW: Cognitive behaviour therapy for chronic fatigue syndrome: A multicentre randomised controlled trial. Lancet. 2001, 357: 841-847. 10.1016/S0140-6736(00)04198-2.CrossRefPubMed
12.
Servaes P, Prins J, Verhagen S, Bleijenberg G: Fatigue after breast cancer and in chronic fatigue syndrome: similarities and differences. J Psychsom Res. 2002, 52: 453-459. 10.1016/S0022-3999(02)00300-8.CrossRef
13.
Bultmann U, Kant I, Kasl SV, Beurskens AJ, van den Brand PA: Fatigue and psychological distress in the working population, psychometrics, prevalence, and correlates. J Psychosom Res. 2002, 52: 445-452. 10.1016/S0022-3999(01)00228-8.CrossRefPubMed
14.
Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, et al: Development of a fatigue scale. J Psychosom Res. 1993, 37: 147-153. 10.1016/0022-3999(93)90081-P.CrossRefPubMed
15.
Jason LA, Richman JA, Rademaker AW, Jordan KM, Plioplys AV, Taylor RR, et al: A community-based study of chronic fatigue syndrome. Arch Intern Med. 1999, 159: 2129-2137. 10.1001/archinte.159.18.2129.CrossRefPubMed
16.
Krupp LB, La Rocca NG, Muir-Nash J, Steinberg AD: The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989, 46: 1121-1123.CrossRefPubMed
17.
Ware JE, Sherbourne CD: The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992, 30: 473-83.CrossRefPubMed
18.
Powell P, Bentall RP, Nye FJ, Edwards RH: Randomized controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome. BMJ. 2001, 322: 387-390. 10.1136/bmj.322.7283.387.CrossRefPubMedPubMedCentral
19.
Deale A, Chalder T, Marks I, Wessely S: Cognitive behaviour therapy for chronic fatigue syndrome: a randomized controlled trial. Am J Psych. 1997, 154: 408-414.CrossRef
20.
Bergner M, Bobbit RA, Carter WB, Gilson BS: The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981, 19: 787-805.CrossRefPubMed
21.
Gerber LH, Furst G: Validation of the NIH activity record. A quantitative measure of life activities. Arthritis Care Res. 1992, 5: 81-86.CrossRefPubMed
22.
Jason LA, King CP, Frankenberry EL, Jordan KM, Tryon WW, Rademaker F, Huang CF: Chronic fatigue syndrome: Assessing symptoms and activity level. J Clin Psych. 1999, 55: 411-424. 10.1002/(SICI)1097-4679(199904)55:4<411::AID-JCLP6>3.0.CO;2-N.CrossRef
23.
Vercoulen JH, Bazelmans E, Swanink CM, Fennis JF, Galama JM, Jongen PJ, et al: Physical activity in chronic fatigue syndrome and its role in fatigue. J Psychiatric Res. 1997, 31: 661-673. 10.1016/S0022-3956(97)00039-3.CrossRef
24.
van der Werf SP, Prins JB, Vercoulen JH, van der Meer JW, Bleijenberg G: Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. J Psychosom Res. 2000, 49: 373-379. 10.1016/S0022-3999(00)00197-5.CrossRefPubMed
25.
Tryon WW, Williams R: Fully proportional actigraphy: A new instrument. Behavior Research Methods, Instruments, Computers. 1996, 28: 392-403.CrossRef
26.
Koschera A, Hickie I, Hadzi-Pavlovic D, Wilson A, Lloyd A: Prolonged fatigue, anxiety and depression: exploring relationships in a primary care sample. Aust N Z J Psych. 1999, 33: 545-552. 10.1046/j.1440-1614.1999.00593.x.CrossRef
27.
Hickie IB, Davenport TA, Hadzi-Pavlovic D, Koschera A, Naismith SL, Scott EM, et al: Development of a simple screening tool for common mental disorders in general practice. Med J Aust. 2001, 175 (Suppl): S10-17.PubMed
28.
Bennett BK, Hickie IB, Vollmer-Conna US, Quigley B, Brennan CM, Wakefield D, et al: The relationship between fatigue, psychological and immunological variables in acute infectious illness. Aust N Z J Psych. 1998, 32: 180-186.CrossRef
29.
Moldofsky H: The contribution of sleep medicine to the assessment of the tired patient. Can J Psychiatry. 2000, 45: 798-802.PubMed
30.
Moldofsky H, Cesta A, Cesta C, Unger ER, Nisenbaum R., Reeves WC: Sleep disorders in a population-based study of chronic fatiguing illnesses with Sleep Assessment Questionnaire©. Sleep. 2000, Suppl 23: A67.
31.
Mansfield RW, Cesta A, Sammut C, Moldofsky H: The sensitivity and specificity of the Sleep Assessment Questionnaire© in the identification of patients with insomnia, restless legs syndrome/periodic limb movement disorder, and narcolepsy/idiopathic hypersomnia. Sleep. 2000, 23 (Suppl): A381.
32.
Cesta A, Moldofsky H, Sammut C: The sensitivity and specificity of the Sleep Assessment Questionnaire© (SAQ©) as a measure of non-restorative sleep. Sleep. 1999, 22 (Suppl): 14.
33.
Hoddes E, Zarcone V, Smythe H, Phillips R, Dement WC: Quantification of sleepiness: a new approach. Psychophysiology. 1973, 10: 431-436.CrossRefPubMed
34.
Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcone VP, et al: The Sleep Disorders Questionnaire. I: Creation and multivariate structure of SDQ. Sleep. 1994, 17: 160-167.PubMed
35.
Sahakian BJ, Owen AM: Computerized assessment in neuropsychiatry using CANTAB: discussion paper. J R Soc Med. 1992, 85: 399-402.PubMedPubMedCentral
36.
Fray PJ, Robbins TW, Sahakian BJ: Neuropsychiatric applications of CANTAB. Int J Geriat Psychiat. 1996, 11: 329-336. 10.1002/(SICI)1099-1166(199604)11:4<329::AID-GPS453>3.3.CO;2-Y.CrossRef
37.
Robbins TW, James M, Owen AM, Sahakian BJ, McInnes L, Rabbitt P: Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia. 1994, 5: 266-281.PubMed
38.
Beats BC, Sahakian BJ, Levy R: Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed. Psychol Med. 1996, 26: 591-603.CrossRefPubMed
39.
Purcell R, Maruff P, Kyrios M, Pantelis C: Neuropsychological function in young patients with unipolar major depression. Psychol Med. 1997, 27: 1277-1285. 10.1017/S0033291797005448.CrossRefPubMed
40.
Sweeney JA, Kmiec JA, Kupfer DJ: Neuropsychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biol Psychiatry. 2000, 48: 674-684. 10.1016/S0006-3223(00)00910-0.CrossRefPubMed
41.
Pantelis C, Barnes TR, Nelson HE, Tanner S, Weatherley L, Owen AM, et al: Frontal-striatal cognitive deficits in patients with chronic schizophrenia. Brain. 1997, 120: 1823-1843. 10.1093/brain/120.10.1823.CrossRefPubMed
42.
Swainson R, Hodges JR, Galton CJ, Semple J, Michael A, Dunn BD, et al: Early detection and differential diagnosis of Alzheimer's disease and depression with neuropsychological tasks. Dement Geriatr Cogn Disord. 2001, 12: 265-280. 10.1159/000051269.CrossRefPubMed
43.
Joyce E, Blumenthal S, Wessely S: Memory, attention, and executive function in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 1996, 60: 495-503.CrossRefPubMedPubMedCentral
44.
Vollmer-Conna U, Wakefield D, Lloyd A, Hickie I, Lemon J, Bird KD, et al: Cognitive deficits in patients suffering from chronic fatigue syndrome, acute infective illness, or depression. Br J Psychiatry. 1997, 171: 377-381.CrossRefPubMed
45.
Melzack R: The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975, 1: 277-299. 10.1016/0304-3959(75)90044-5.CrossRefPubMed
46.
Jason LA, Kin CP, Taylor RR, Kennedy C: Defining chronic fatigue syndrome: Methodological challenges. J Chron Fatigue Syndr. 2000, 7: 17-32.CrossRef
47.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 1994, American Psychiatric Association. Washington, DC, Fourth
48.
Friedberg F, Jason JA: Understanding Chronic Fatigue Syndrome: An Empirical Guide to Assessment and Treatment. 1998, Washington, D.C.: American Psychological AssociationCrossRef
49.
Joyce E, Blumenthal S, Wessely S: Memory, attention, and executive function in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 1996, 60: 495-503.CrossRefPubMedPubMedCentral
50.
DeLuca J, Johnson SK, Ellis SP, Natelson BH: Cognitive functioning is impaired in patients with chronic fatigue syndrome devoid of psychiatric disease. J Neurol Neurosurgery Psychiatry. 1997, 62: 151-155.CrossRef
51.
Michiels V, Cluydts R: Neuropsychological functioning in chronic fatigue syndrome: a review. Acta Psychiatr Scand. 2001, 103: 84-93. 10.1034/j.1600-0447.2001.00017.x.CrossRefPubMed
Metadata
Title
Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution
Authors
William C Reeves
Andrew Lloyd
Suzanne D Vernon
Nancy Klimas
Leonard A Jason
Gijs Bleijenberg
Birgitta Evengard
Peter D White
Rosane Nisenbaum
Elizabeth R Unger
the International Chronic Fatigue Syndrome Study Group
Publication date
01-12-2003
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2003
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-3-25

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