Classification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Types of Fatigue

Jason, Leonard A.; Boulton, Aaron J.; Porter, Nicole; Jessen, Tricia; Njoku, Mary Gloria C.; Friedberg, Fred

doi:10.1080/08964280903521370

Cited by 31 publications

(23 citation statements)

References 27 publications

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“…There were significant differences between the CFS and control samples for all variables, including: age, gender, race, Hispanic origin, marital status, educational attainment, and work status. Socio-demographic information can be found in Jason, Jessen, et al (2009) and Jason et al (in press).…”

Section: Resultsmentioning

confidence: 99%

Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity

Jason¹,

Evans²,

Brown³

et al. 2011

DSQ

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Few studies have explored issues of sensitivity and specificity for using the fatigue construct to identify patients meeting chronic fatigue syndrome (CFS) criteria. In this article, we examine the sensitivity and specificity of several fatigue scales that have attempted to define severe fatigue within CFS. Using Receiver Operating Characteristic (ROC) curve analysis, we found most scales and sub-scales had either significant specificity and/or sensitivity problems. However, the postexertional subscale of the ME/CFS Fatigue Types Questionnaire (Jason, Jessen, et al., 2009) was the most promising in terms of specificity and sensitivity. Among the more traditional fatigue scales, Krupp, LaRocca, Muir-Nash, and Steinberg's (1989) Fatigue Severity Scale had the best ability to differentiate CFS from healthy controls. Selecting questions, scales and cut off points to measure fatigue must be done with extreme care in order to successfully identify CFS cases. Keywordschronic fatigue syndrome; fatigue; fatigue scales; sensitivity and specificity There have been relatively few studies assessing the sensitivity and specificity of fatigue scales which are frequently used to identify individuals with chronic fatigue syndrome (CFS) and differentiate them from healthy controls. The present investigation consists of two distinct studies, both of which employ samples of individuals with CFS and controls, and to assess the effectiveness of several well known fatigue instruments in discriminating between these two groups by utilizing Receiver Operating Characteristic (ROC) curve analyses. The Fukuda et al. (1994) CFS case definition is the currently accepted case definition internationally, although there is no available "gold standard" to assess fatigue severity. This case definition requires an individual to experience six or more months of persisting or recurring chronic fatigue and the co-occurrence of four of eight additional core symptoms. However, these Fukuda et al. requirements have been criticized as lacking operational definitions and guidelines for accurate identification of CFS cases (Jason, King, et al., 1999;Reeves et al., 2003). For example, these criteria do not specify how to assess fatigue severity or the presence of persisting or recurring fatigue for a period of 6 or more months. Partially in response to these problems with operationalizing the Fukuda et al. definition, the Centers for Disease Control and Prevention (CDC) developed an empiric case definition for CFS that involves assessment of symptoms, disability, and fatigue with standardized instruments and specific cutoff points .Correspondence concerning this article should be addressed to Leonard A. Jason, Ph.D., Director, Center for Community Research, 990 W. Fullerton Ave., Suite 3100, Chicago, Il. 60614. telephone: 773-325-2018; fax: 773-325-4923 et al., 2007), rates that are about ten times higher than prior CDC prevalence estimates (Reyes et al., 2003) and estimates of other investigators . It is plausible that this inflated CFS prevalence...

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Section: Resultsmentioning

confidence: 99%

Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity

Jason¹,

Evans²,

Brown³

et al. 2011

DSQ

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“…Some individuals experience PEM immediately after mental or physical exertion, but others develop PEM hours after the initial activity of cause. In a study conducted by Jason, Boulton et al (2010), a sample of participants with CFS was broken into clusters using a five-cluster solution based on a composite score of the onset, frequency, and severity of fatigue. Significant group differences were found for each fatigue dimension (post-exertional, wired, brain fog, energy, and flu-like) on the MFTQ.…”

Section: Discussionmentioning

confidence: 99%

“…These descriptors highlight that PEM goes beyond general fatigue and may include pain, mood disturbances, and malaise among other symptoms. To better assess PEM, these five items have been included in the DePaul Symptom Questionnaire (DSQ) (Jason, Evans, et al, 2010), so individuals who may be eschewing exercise or excessive activity in order to avoid eliciting PEM would still be recognized under criteria to establish ME, ME/CFS, and CFS. Hence, there would be less of a focus on common fatigue, but more of an emphasis on the usage of reliable items that would reflect the actual debilitating nature of PEM for these individuals.…”

Section: Discussionmentioning

confidence: 99%

Problems in Defining Post-Exertional Malaise

Jason

Evans

et al. 2015

Journal of Prevention & Intervention in the Community

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Post-Exertional Malaise (PEM) is a cardinal symptom of the illnesses referred to as Myalgic Encephalomyelitis (ME), Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS), and chronic fatigue syndrome (CFS). PEM is reported to occur in many of these patients, and with several criteria (e.g., ME and ME/CFS), this symptom is mandatory (Carruthers et al., 2003, 2011). In the present study, 32 participants diagnosed with CFS (Fukuda et al., 1994) were examined on their responses to self-report items that were developed to capture the characteristics and patterns of PEM. As shown in the results, the slight differences in wording for various items may affect whether one is determined to have PEM according to currently used self-report criteria to assess CFS. Better understanding of how this symptom is assessed might help improve the diagnostic reliability and validity of ME, ME/CFS, and CFS.

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“…It is also possible that different causative molecular insults result in different subsequent clinical presentations and this could contribute towards heterogeneity in the disorder. Patient subtyping to manage this heterogeneity has been previously discussed in the field [20,23] and is lent credence by reproduced patterns of differential disease-associated gene expression [24][25][26], gene expression profiles concurrent with comorbid POTS [27], distinct DNA methylation profiles associated with quality of life scores and PEM [28], severity and frequency of physical or mental fatigue [29], or irritable bowel syndrome (IBS) comorbidity [30] which can be concurrent with specific changes to patient metabolism [31]. As timely, objective and accurate diagnosis remains the most clear challenge facing the field, patient subtyping may be an important component of new diagnostic techniques and has seen early investigation with stratification-based severity scores [32] or cytokine co-expression patterns [33].In summation, ME/CFS etiology has been difficult to pin down due to the combination of a diagnostic quagmire and the disorder's heterogeneous symptom presentation across multiple body systems.…”

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confidence: 99%

Pathological Mechanisms Underlying Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Missailidis¹,

Annesley²,

Fisher³

2019

Preprint

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The underlying molecular basis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is not well understood. Characterized by chronic, unexplained fatigue, a disabling payback following exertion ("post-exertional malaise") and variably presenting, multi-system symptoms, ME/CFS is a complex disease which demands a concerted biomedical investigation from disparate fields of expertise. ME/CFS research and patient treatment have been challenged by the lack of diagnostic biomarkers and finding these is a prominent direction of current work. Despite these challenges, modern research demonstrates a tangible biomedical basis for the disorder across many body systems. This evidence is mostly comprised of disturbances to immunological and inflammatory pathways, autonomic and neurological dysfunction, abnormalities in muscle and mitochondrial function, shifts in metabolism, and gut physiology or gut microbiota disturbances. It is possible that these threads are together entangled as parts of an underlying molecular pathology reflecting a farreaching homeostatic shift. Due to the variability of non-overlapping symptom presentation or precipitating events such as infection or other bodily stresses, the initiation of body-wide pathological cascades with similar outcomes stemming from different causes may be implicated in the condition. Patient stratification to account for this heterogeneity is therefore one important consideration during exploration of potential diagnostic developments.compounded by medical guidelines in some developed countries which are out of date regarding ME/CFS clinical practice and require urgent, overdue revision.Case definitions such as the commonly termed Oxford [1] or Fukuda [2] criteria are most often utilized throughout the UK and USA respectively, yet may fail to discriminate between generalized chronic fatigue and ME/CFS which specifically also involves PEM, which aids in characterizing this disorder as a discrete clinical entity. Also in usage are the Canadian Consensus Criteria [3] and International Consensus Criteria [4] which mandate PEM for a diagnosis of ME/CFS and therefore may be considered more specific definitions. While the presence of PEM is an optional component of the Fukuda criteria, PEM is, unfortunately, not required for research participation by all studies using this or other less strict definitions. Consequently, the discovery of a reliable diagnostic biomarker is perhaps the most common recurring theme in modern ME/CFS research. Despite myriad relevant study outcomes [5][6][7][8][9][10][11][12][13][14][15][16], no such discovery has yet been widely validated or implemented as a suitable diagnostic biomarker of ME/CFS. Not only does ME/CFS affect multiple body systems and organs, but it does so with different and time-varying levels of severity and different patterns of comorbidities in different individuals, thereby producing a highly heterogeneous patient population [7,[17][18][19][20][21][22][23]. This complexity represents a major challenge to the task of incrim...

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Classification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Types of Fatigue

Cited by 31 publications

References 27 publications

Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity

Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity

Problems in Defining Post-Exertional Malaise

Pathological Mechanisms Underlying Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

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