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Functional status in patients with Chronic Fatigue Syndrome (CFS), other fatiguing illnesses, & healthy individuals

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By Buchwald D, Pearlman T, Umali J, Schmaling K, Katon W • www.ProHealth.com • October 6, 1996


BACKGROUND: Chronic fatigue syndrome (CFS) is a condition that may
be associated with substantial disability. The Medical
Outcomes Study Short-Form General Health Survey (SF-36) is an
instrument that has been widely used in outpatient populations
to determine functional status. Our objectives were to
describe the usefulness of the SF-36 in CFS patients and to
determine if subscale scores could distinguish patients with
CFS from subjects with unexplained chronic fatigue (CF),
major depression (MD), or acute infectious mononucleosis
(AIM), and from healthy control subjects (HC). An additional
goal was to ascertain if subscale scores correlated with the
signs and symptoms of CFS or the presence of psychiatric
disorders and fibromyalgia.

DESIGN: Prospectively collected
case series.

SETTING: Patients with CFS and CF were seen in a
university-based referral clinic and had undergone a complete
medical and psychiatric evaluation. Other study subjects were
recruited from the community to participate in research
studies.

PARTICIPANTS: The study included 185 patients with
CFS, 246 with CF, 111 with AIM, and 25 with MD. There were 99
HC subjects.

MEASURES: The SF-36 and a structured psychiatric
interview were used. The SF-36 contains 8 subscales:
physical, emotional, social, and role functioning, body pain,
mental health, vitality, and general health- and a structured
psychiatric interview.

RESULTS: Performance characteristics
(internal reliability coefficients, convergent validity) of
the SF-36 were excellent. A strikingly consistent pattern was
found for the physical functioning, role functioning, social
functioning, general health, and body pain subscales, with the
lowest scores in CFS patients, intermediate scores in AIM
patients, and the highest scores in the HC subjects. The CFS
patients had significantly lower scores than patients with CF
alone on the physical functioning (P < or = 0.01), role
functioning (P < or = 0.01), and body pain (P < or = 0.001)
subscales. The emotional functioning and mental health scores
were worst among those with MD. The presence of fibromyalgia,
being unemployed, and increasing fatigue severity all were
associated with additional functional limitations across
multiple functional domains, with increasing fatigue
appearing to have the greatest effect.

CONCLUSIONS: The SF-36
is useful in assessing functional status in patients with
fatiguing illnesses. Patients with CFS and CF have marked
impairment of their functional status. The severity and
pattern of impairment as documented by the SF-36
distinguishes patients with CFS and CF from those with MD and
AIM, and from HC, but does not discriminate between CF and
CFS.

MCM: Used Medical Outcomes General Health Survey (SF-36) in
185 pts w CFS, 246 w CF, 111 with acute infectious
mononucleosis (AIM), and 25 w major depression (MD). Pts w
CFS "appear strikingly disabled, particularly in the domains
of role functioning, social functioning, and vitality." "The
severity and pattern of impairment as documented by the SF-36
distinguishes pts w CFS and CF from those w MD and AIM, and
from HC [healthy controls[, but does not discriminate between
CF and CFS."




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