Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database

Abstract

Background: Chronic fatigue syndrome (CFS) is relatively common and disabling. Over 8000 patients attend adult services each year, yet little is known about the outcome of patients attending NHS services.Aim: Investigate the outcome of patients with CFS and what factors predict outcome.Design: Longitudinal patient cohort.Methods: We used data from six CFS/ME (myalgic encephalomyelitis) specialist services to measure changes in fatigue (Chalder Fatigue Scale), physical function (SF-36), anxiety and depression (Hospital Anxiety and Depression Scale) and pain (visual analogue pain rating scale) between clinical assessment and 8–20 months of follow-up. We used multivariable linear regression to investigate baseline factors associated with outcomes at follow-up.Results: Baseline data obtained at clinical assessment were available for 1643 patients, of whom 834 (51%) had complete follow-up data. There were improvements in fatigue [mean difference from assessment to outcome: −6.8; 95% confidence interval (CI) −7.4 to −6.2; P < 0.001]; physical function (4.4; 95% CI 3.0–5.8; P < 0.001), anxiety (−0.6; 95% CI −0.9 to −0.3; P < 0.001), depression (−1.6; 95% CI −1.9 to −1.4; P < 0.001) and pain (−5.3; 95% CI −7.0 to −3.6; P < 0.001). Worse fatigue, physical function and pain at clinical assessment predicted a worse outcome for fatigue at follow-up. Older age, increased pain and physical function at assessment were associated with poorer physical function at follow-up.Conclusions: Patients who attend NHS specialist CFS/ME services can expect similar improvements in fatigue, anxiety and depression to participants receiving cognitive behavioural therapy and graded exercise therapy in a recent trial, but are likely to experience less improvement in physical function. Outcomes were predicted by fatigue, disability and pain at assessment.

Letter to the Editor: Response to correspondence concerning ‘Recovery from chronic fatigue syndrome after treatments in the PACE trial’

“…We therefore agree with Cox (2013) and Courtney (2013) that no single threshold measurement is sufficient; this is why we measured several domains of improvement and combined them into a composite measure of recovery (White et al 2013). Shepherd (2013) suggests asking patients whether they recovered as a result of [our italics] receiving a treatment; we did not ask this since it is not possible for individuals to ascribe change to one particular source in exclusion from all others, such as regression to the mean or external factors.…”

“…We agree with Carter (2013) that there is a difference between sustained recovery and temporary remission; this is why we were careful to give a precise definition of recovery and to emphasize that it applied at one particular point only and to the current episode of illness (White et al 2013).…”

“…Recovery after SMC alone, using our composite criteria, was only 7% -the same as that without treatment (Cairns & Hotopf, 2005) -whereas three times as many (22%) recovered after receiving CBT or GET. The PACE trial has shown that both CBT and GET are moderately effective, safe, cost-effective, and are more likely to lead to recovery (White et al 2011(White et al , 2013McCrone et al 2012). These treatments should now be routinely offered to all those who may benefit from them (Crawley et al 2013).…”

La Escala de Ansiedad y Depresión Hospitalaria (HAD) en fibromialgia: Análisis de sensibilidad y especificidad

“…este resultado coincide con lo referido en la literatura acerca de la presencia de estos trastornos en FM (Bennett, 2002;epstein et al, 1999;gonzález, elorza y Failde, 2010; revuelta, segura y paulino, 2010; entre otros. estas pacientes suelen mostrar medias más elevadas en el HaD que las de otros enfermos físicos (Bambauer, locke, aupont (cella, chalder y White, 2011;crawley et al, 2013;ledingham, Doherty y Doherty, 1993;ray, Jefferies y Weir, 1995). la literatura aporta puntuaciones medias en el HaD para FM que oscilan en torno a 9-12 para ansiedad y 8-10 para depresión (rangos: 0-21) (Miró, Diener, Martínez, sánchez y Valenza, 2014;scheafer et al, 2011;Nam, tin, Bain, thorne y ginsburg, 2013;Vallejo et al, 2012).…”

“…esto ha fomentado en ocasiones el debate y la controversia acerca de la utilidad y eficacia del HAD, de sus subescalas y de su uso como escala global de distrés psicológico (Brennan et al, 2010;coyne y Van sonderen, 2012;Mitchell, Meader y symonds, 2010;Norton, cosco, Doyle, Done y sacker, 2012). probablemente, esta variabilidad de puntos de corte del HaD tiene que ver fundamentalmente con dos aspectos: 1) los instrumentos criterio, representatividad de los componentes de depresión y/o ansiedad evaluados (cognitivos y/o afectivos, o incluso comportamentales) y teorías que Víctor cabrera, Maite Martín-aragón, María del carMen terol, rosa núñez y María de los Ángeles Pastor respaldan estos constructos, y 2) la heterogeneidad de las muestras de estudio.…”