Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management – Source: QJM, Jun 9, 2010

[Note: orthostatic symptoms generally involve disregulated control of blood pressure/heart rate on rising to upright position. Common symptoms are dip in blood pressure, dizziness/faint feeling, fast heart rate.]

Objectives: To establish the relationship between the functional impairment experienced by chronic fatigue syndrome (CFS) patients and the symptoms frequently experienced by those with CFS; specifically cognitive impairment, fatigue, and orthostatic symptoms.

Design: Cross sectional questionnaire survey.

Setting: Specialist CFS Clinical Service.

Subjects: Ninety-nine Fukuda diagnosed CFS and 64-matched controls.

Main outcome measures: Symptom and functional assessment tools completed and returned by post included; PROMIS HAQ (Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire), CFQ (Cognitive Failures Questionnaire), FIS (Fatigue Impact Scale) and OGS (Orthostatic Grading Scale) assessment tools.


• CFS patients experience greater functional impairment than controls [mean (95% CI) PROMIS HAQ scores CFS 36 (31-42) vs. controls 6 (2-10); P < 0.0001], especially in the functional domains of activities and reach. • Poorer functional ability impairment is significantly associated with greater cognitive impairment (P = 0.0002, r = 0.4), fatigue (P < 0.0001, r = 0.5) and orthostatic symptoms (P < 0.0001, r = 0.6). • However, only orthostatic symptoms (OGS) independently associated with functional impairment (beta = 0.4, P = 0.01). Conclusion: Treatment of orthostatic symptoms in CFS has the potential to improve functional capacity and so improve quality of life.

[Ed. Note: Dr. David S Bell, in the May 2010 issue of Lyndonville News, remarked that in his 13-year follow-up of 1985 Lyndonville outbreak patients he failed to realize that “when people say whether or not they are better, usually they refer only to that one central symptom that determines whether you can function like a normal person” – the symptom being orthostatic intolerance, or “ability to function in the upright position.”

Source: QJM: An International Journal of Medicine, Jun 9, 2010. PMID: 20534655, by Costigan A, Elliott C, McDonald C, Newton JL.  NIHR Biomedical Research Centre in Ageing-Cardiovascular Theme, Newcastle University, Newcastle, UK. [Email: Julia.Newton@nuth.nhs.uk]

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