Abstract
The current study examined a large cohort of untreated Chronic Fatigue Syndrome patients at initial assessment and at specific time points over a three-year period. Methods used in previous studies to assess patient health, were validated and used to assess recovery and improvement. Possible predictors of outcome would then be identified by assessing improvements in health status at specific follow-up points. The illness was also assessed in terms of recovery and improvement by using health related and psychosocial measures together with the aetiology of the illness. These were further used to investigate possible mechanisms influencing or predicting recovery or improvement. Two-hundred and twenty-six patients completed wide ranging questionnaires at initial assessment and again six and eighteen months and three years later. A current state of health score was used to measure recovery over time and analyses conducted to investigate the relationship between this and other health related measures. Regression analyses were conducted to assess predictors of improvement and recovery. Spontaneous recovery rates in the untreated patient at three-year follow-up were low (6%). The data suggested, however, that illness length, symptom severity and health status have an important role in recovery. Although there was no evidence to suggest an association between illness onset type and subsequent recovery or psychopathology scores at initial assessment and recovery, regression analyses did indicate that levels of anxiety, cognitive difficulties and social support at initial assessment predict a positive outcome. The state of health measure was validated as a method of accurately assessed the health status of patients and was used as an indicator of improvement and recovery within this group. Spontaneous recovery in the patient group was associated with several factors measured at initial assessment. However, further studies are necessary to more fully identify the factors which affect recovery or improvement and to investigate the exact nature of the mechanisms involved. The present study shows that spontaneous recovery of CFS patients is rare. Treatment or management is essential, and the efficacy of different approaches must be assessed.
Highlights
The fatigue experienced in Chronic Fatigue Syndrome (CFS) is of sufficient severity to cause substantial functional impairment but is accompanied by four or more co-existing symptoms including those of a cognitive or neuropsychiatric nature (Centre for Disease Control (CDC) criteria; Fukuda et al, 1994)
In order to test the validity of this measure to accurately describe health status at any given time, patients were categorised into two groups at baseline: those who were in poor health and those who thought they were recovering
307 CFS patients were recruited to the research panel
Summary
The fatigue experienced in Chronic Fatigue Syndrome (CFS) is of sufficient severity to cause substantial functional impairment but is accompanied by four or more co-existing symptoms including those of a cognitive or neuropsychiatric nature (Centre for Disease Control (CDC) criteria; Fukuda et al, 1994). The incidence of CFS in the general population, the review concluded, is relatively low. Price et al (1992) reported findings from a community-based survey suggesting that 7.4 per 100,000 of the population (0.0074%) fulfilled the CDC criteria for CFS. Ranjith’s review of the literature agreed that, the symptom of fatigue is common, cases of medically unexplained fatigue that fulfil the CDC criteria are somewhat rare (Ranjith, 2005). The relatively low incidence of CFS should not, detract from the severe effect the illness has on the individual sufferer’s quality of life. In the light of this, continued research into the causes of and potential therapies for CFS are vital to alleviate this financial burden (Reynolds, Vernon, Bouchery & Reeves, 2004)
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