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Prognosis in Chronic Fatigue Syndrome (CFS): a prospective study on the natural course

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OBJECTIVE–To determine spontaneous improvement after a follow up
interval of 18 months in patients with chronic fatigue
syndrome and to identify factors that predict improvement.

METHODS–A longitudinal study was used. Of 298 initially
assessed self referred patients fulfilling criteria for
chronic fatigue syndrome, 246 patients completed self report
questionnaires at follow up (response rate 83%). A
multidimensional assessment method was used, measuring
behavioural, emotional, cognitive, and social functioning.
Comparison data from 53 healthy subjects matched for age, sex,
and educational level were available.

RESULTS–Three per cent
of patients reported complete recovery and 17% reported
improvement. At follow up, there were considerable problems at
work and consumption of medication was high. Subjective
improvement was confirmed by dimensional change: at follow up
recovered patients had similar scores to healthy subjects and
improved patients showed significant improvement on four out
of seven outcome measures and had higher scores than healthy
subjects in all dimensions. Sociodemographic variables or
treatment by specialists and alternative practitioners did not
predict improvement. Predictors of improvement were:
subjective sense of control over symptoms, less fatigue,
shorter duration of complaints, and a relative absence of
physical attributions.

CONCLUSION–The improvement rate in
patients with a relatively long duration of complaints is
small. Psychological factors are related to improvement,
especially cognitive factors.

MCM: Follwup at 18 months of 298 pts yielded 83% response
rate.3% of pts reported complete recovery, 17% reported
improvement. Predictors of improvement were: subjective
sense of control over symptoms, less fatigue, shorter duration
of complaints, and a relative absence of physical
attributions.

Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW,
Bleijenberg G

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