Variability in symptoms complicates utility of case definitions

McManimen, Stephanie; Jason, Leonard A.; Williams, Yolonda

doi:10.1080/21641846.2015.1041336

Cited by 14 publications

(13 citation statements)

References 22 publications

(32 reference statements)

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“…A recent review of 53 studies that used the Fukuda criteria for diagnosing CFS found that these three critical symptoms were detected among the groups identified as having CFS at variable rates: post-exertional malaise ranged from 25-100%, neurocognitive deficits from 16-100%, and unrefreshing sleep from 16-100% [20]. It is possible that those patients with CFS identified by the Fukuda criteria do not consistently report these core symptoms.…”

Section: Identification Of Core Features Of the Illnessmentioning

confidence: 99%

The implications of using a broad versus narrow set of criteria in research

Jason¹,

Gleason²,

Fox³

2017

J Med Therap

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The Fukuda et al. criteria is the most widely used clinical case definition for diagnosing patients with chronic fatigue syndrome (CFS). Despite the frequency with which the Fukuda criteria are applied, the list of symptoms outlined in this case definition were not well enough specified to be easily applied to research settings. In 2005, Reeves et al. laid out a set of standards for operationalizing the Fukuda definition, specifying scales and cutoff scores for measuring the symptom criteria. This operationalization, often known as the empirical criteria, has been shown to identify an unexpectedly large number of patients, seemingly widening the net of inclusion for CFS diagnostic criteria. However, in a recent study in 2016 by Unger and colleagues it has been suggested that the 2005 Reeves et al. 2005 operationalization of the Fukuda criteria does not over-identify the number of patients with CFS as had been previously reported. This article reviews prior studies which provide context for these findings and offers a possible explanation for the discrepancies. Clearly, determining what case definition to use and how to operationalize it remains an important activity for scientists in this field, as it will influence work in multiple domains, including etiology, pathophysiology, epidemiology and treatment. We review these new findings, putting them in context and trying to highlight some of the reasons for the dramatic shifts in CFS prevalence rates across various studies.Most notably, the Center for Disease Control (CDC) estimates of CFS prevalence rates have increased dramatically over the years. In 2003, Reyes et al. published a prevalence study using the traditional approach to diagnosing CFS via Fukuda and found a prevalence rate of .24% in Wichita, Kansas [5].1 This rate was somewhat comparable to a previous population prevalence study in Chicago, which found a rate of .42% [6], again using the traditional approach to the Fukuda criteria. However, in a subsequent CDC population based study in Georgia, using the 2005 Reeves et al. empirical criteria, Reeves and colleagues concluded that the CFS prevalence rate had risen to 2.54% [4], which represents a 10-fold increase compared to the earlier CDC estimates. One explanation for the 10-fold increase is that cases of CFS did indeed increase over time, though this seems unlikely. When Jason and colleagues [7] conducted a follow-up to their original communitybased prevalence study [6] using the same traditional approach to diagnosing with the Fukuda criteria, they found that 10 years later CFS prevalence rates had remained relatively stable [7]. In light of this, other explanations for the increase in CDC prevalence rates need to be explored.

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Section: Identification Of Core Features Of the Illnessmentioning

confidence: 99%

The implications of using a broad versus narrow set of criteria in research

Jason¹,

Gleason²,

Fox³

2017

J Med Therap

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“…Various names and case definitions have been used to describe constellations of these symptoms, including myalgic encephalomyelitis (ME; Carruthers et al., ; Ramsay, ), ME/CFS (Carruthers et al., ), CFS (Fukuda et al., ; Sharpe et al., ), and systemic exertion intolerance disease (SEID; Institute of Medicine, ). Unfortunately, these case definitions select different groups of individuals (e.g., Brown, Jason, Evans, & Flores, ; Jason, Brown, Evans, Sunnquist, & Newton, ; Johnston et al., ), and the same case definitions are applied inconsistently across research settings (McManimen, Jason, & Williams, ). Perhaps due to heterogeneity in the diagnostic process, neither biological markers nor curative treatments have yet been discovered.…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, these case definitions select different groups of individuals (e.g., Brown, Jason, Evans, & Flores, 2013; Jason, Brown, Evans, Sunnquist, & Newton, 2013; The Vercoulen et al (1998) cognitive behavioral model of CFS. Darker boxes represent what this study refers to as the "behavioral pathway" Johnston et al, 2014), and the same case definitions are applied inconsistently across research settings (McManimen, Jason, & Williams, 2015). Perhaps due to heterogeneity in the diagnostic process, neither biological markers nor curative treatments have yet been discovered.…”

Section: Introductionmentioning

confidence: 99%

A reexamination of the cognitive behavioral model of chronic fatigue syndrome

Sunnquist

Jason

2018

J Clin Psychol

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“…McManimen et al [2] reviewed 53 articles that used the Fukuda et al [1] definition and found the following reported ranges of rates of key symptoms: post-exertional malaise: 25–100%; neurocognitive deficits: 16–100%; and unrefreshing sleep: 16–100%. It is at least possible that this variability was due to lack of the requirement for key symptoms.…”

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confidence: 99%

Clinical criteria versus a possible research case definition in chronic fatigue syndrome/myalgic encephalomyelitis

Jason

McManimen

Sunnquist

et al. 2017

Fatigue: Biomedicine, Health & Behavior

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Background The Institute of Medicine (IOM) recently developed clinical criteria for what had been known as chronic fatigue syndrome (CFS). Given the broad nature of the clinical IOM criteria, there is a need for a research definition that would select a more homogenous and impaired group of patients than the IOM clinical criteria. At the present time, it is unclear what will serve as the research definition. Purpose The current study focused on a research definition which selected homebound individuals who met the four IOM criteria, excluding medical and psychiatric co-morbidities. Methods Our research criteria were compared to those participants meeting the IOM criteria. Those not meeting either of these criteria sets were placed in a separate group defined by 6 or more months of fatigue. Data analyzed were from the DePaul Symptom Questionnaire and the SF-36. Due to unequal sample sizes and variances, Welch’s F tests and Games-Howell post hoc tests were conducted. Results Using a large database of over 1,000 patients from several countries, we found that those meeting a more restrictive research definition were even more impaired and more symptomatic than those meeting criteria for the other two groups. Conclusion Deciding on a particular research case definition would allow researchers to select more comparable patient samples across settings, and this would represent one of the most significant methodologic advances for this field of study.

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Variability in symptoms complicates utility of case definitions

Cited by 14 publications

References 22 publications

The implications of using a broad versus narrow set of criteria in research

The implications of using a broad versus narrow set of criteria in research

A reexamination of the cognitive behavioral model of chronic fatigue syndrome

Clinical criteria versus a possible research case definition in chronic fatigue syndrome/myalgic encephalomyelitis

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