Investigating fatigue of less than 6 months’ duration. Guidelines for family physicians – Chronic Fatigue Syndrome and fibromyalgia related research

OBJECTIVE: To develop an evidence-based systematic approach to

assessment of adult patients who present to family physicians

complaining of fatigue of less than 6 months’ duration. The

guidelines present investigative options, making explicit what

should be considered in all cases and what should be

considered only in specific situations. They aim to provide

physicians with an approach that, to the extent possible, is

based on evidence so that time and cost are minimized and

detection and management of the cause of the fatigue are


QUALITY OF EVIDENCE: MEDLINE was searched from 1966

to 1997 using the key words family practice and fatigue.

Articles about chronic fatigue syndrome were excluded.

Articles with level 3 evidence were found, but no randomized

trials, cohort studies, or case-control studies were found.

Articles looking specifically at the epidemiology,

demographics, investigations, and diagnoses of patients with

fatigue were chosen. Articles based on studies at referral and

specialty centres were given less weight than those based on

studies in family physicians’ offices.


to these guidelines will decrease the cost of investigating

the symptom of fatigue and optimize diagnosis and management.

This needs to be proved in practice, however, and with

research that produces level 1 and 2 evidence.


Adults presenting with fatigue of less than 6 months’ duration

should be assessed for psychosocial causes and should have a

focused history and physical examination to determine whether

further investigations should be done. The guidelines outline

investigations to be considered. The elderly require special

consideration. These guidelines have group validation, but

they need to be tested by more physicians in various locations

and types of practices.

Godwin M, Delva D, Miller K, Molson J, Hobbs N, MacDonald S, MacLeod

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