A systematic review describing the prognosis of chronic fatigue syndrome (2005), Cairns, R & Hotopf, M

R. Cairns, M. Hotopf, A systematic review describing the prognosis of chronic fatigue syndrome, Occupational Medicine, Volume 55, Issue 1, January 2005, Pages 20–31, https://doi.org/10.1093/occmed/kqi013

Content only available as PDF:
https://academic.oup.com/occmed/article-pdf/55/1/20/4197149/kqi013.pdf

Abstract

Aim
To perform a systematic review of studies describing the prognosis of chronic fatigue (CF) and chronic fatigue syndrome (CFS) and to identify occupational outcomes from such studies.

Method
A literature search was used to identify all studies describing the clinical follow-up of patients following a diagnosis of CF or CFS. The prognosis is described in terms of the proportion of individuals improved during the period of follow-up. Return to work, other medical illnesses and death as outcomes are also considered, as are variables which may influence prognosis.

Results
Twenty-eight articles met the inclusion criteria and, for the 14 studies of subjects meeting operational criteria for CFS, the median full recovery rate was 5% (range 0–31%) and the median proportion of patients who improved during follow-up was 39.5% (range 8–63%).

Less fatigue severity at baseline, a sense of control over symptoms and not attributing illness to a physical cause were all associated with a good outcome. Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome.

Conclusions
Full recovery from untreated CFS is rare.

The prognosis for an improvement in symptoms is less gloomy. This review looks at the course of CF/CFS without systematic intervention. However, there is increasing evidence for the effectiveness of cognitive behavioural and graded exercise therapies. Medical retirement should be postponed until a trial of such treatment has been given.

 

This one certainly gets mentioned a lot...

While I agree with the conclusion "Full recovery from untreated CFS is rare.", a major limitation is the lack of long-term followup of most studies.

 

See also:
S A M Stevelink, N T Fear, M Hotopf, T Chalder, Factors associated with work status in chronic fatigue syndrome, Occupational Medicine, Volume 69, Issue 6, August 2019, Pages 453–458, https://doi.org/10.1093/occmed/kqz108

https://www.s4me.info/threads/facto...-stevelink-n-t-fear-m-hotopf-t-chalder.10645/

 

Another limitation is that the studies in the review are mostly patients that have been sick in the range of 3-5 years or more, and there are indications people sick for shorter periods have a better prognosis, so this can't be applied to them.

Also it seems like they just straight up took the median of the studies to arrive at the 5% estimate rather than doing a weighted average or any kind of more sophisticated statistical analysis

 

Yes, for example:

Vink M, Vink-Niese A. The draft updated NICE guidance for ME/CFS highlights the unreliability of subjective outcome measures in non-blinded trials. Journal of Health Psychology. January 2021 (Editorial), doi:10.1177/1359105321990810

https://journals.sagepub.com/doi/full/10.1177/1359105321990810

https://www.s4me.info/threads/the-d...nreliability-vink-vink-niese-johp-2021.18862/

Cairns and Hotopf acknowledge some limitations, but certainly not all; above all, it seems to me they acknowledge limitations at some places in their paper but fail to acknowledge them in their conclusions.

Won't be able in the near future to have a more thorough look at this. Not sure if it's worthwhile either, but I think some of their considerations regarding return to work are justified, in part -- especially the chances to return to work after long term sick leave. But then they again squeeze these considerations into their hypothesis.

(That's why, in my dualistic way of thinking, I posted this thread on the psychosocial research subforum.)

 

Tried to find by skimming but haven't : In which way did the authors acknowledge the fact that the patient samples were a mix of CF diagnosis and also different CFS diagnostic criteria?