Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups, 1996, Komaroff et al

[EndME]

Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups

purpose
To measure the functional status and well-being of patients with chronic fatigue syndrome (CFS), and compare them with those of a general population group and six disease comparison groups.

patients and methods
The subjects of the study were patients with CFS (n = 223) from a CFS clinic, a population-based control sample (n = 2,474), and disease comparison groups with hypertension (n = 2,089), congestive heart failure (n = 216), type II diabetes mellitus (n = 163), acute myocardial infarction (n = 107), multiple sclerosis (n = 25), and depression (n = 502). We measured functional status and wellbeing using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), which is a self-administered questionnaire in which lower scores are indicative of greater impairment. results: Patients with CFS had far lower mean scores than the general population control subjects on all eight SF-36 scales. They also scored significantly lower than patients in all the disease comparison groups other than depression on virtually all the scales. When compared with patients with depression, they scored significantly lower on all the scales except for scales measuring mental health and role disability due to emotional problems, on which they scored significantly higher. The two SF-36 scales reflecting mental health were not correlated with any of the symptoms of CFS except for irritability and depression.

conclusion
Patients with CFS had marked impairment, in comparison with the general population and disease comparison groups. Moreover, the degree and pattern of impairment was different from that seen in patients with depression.

https://www.sciencedirect.com/science/article/abs/pii/S000293439600174X

 

[EndME]

Note: I have added this paper as it's currently being looked at as part of the response to the paper by Walitt et al (see https://www.s4me.info/threads/use-o...s-2024-walitt-et-al.37463/page-30#post-524230).

 

[EndME]

Cohort recruitment

CFS patient were recruited from the CFS Cooperative Research Center at Brigham and Women’s Hospital and Harvard Medical School and met the 1988 CDC criteria. Patients had undergone a standard medical examination.

The other groups were recruited from various settings (the general population were chosen from a larger sample of US households and completed the survey via mail or phone, the MS group was taken from the Brigham and Women’s Hospital whilst the remaining disease comparison groups were taken from the larger MOS survey).

SF-36 results

Several of the SF-36 scales are designed to reflect impairment due to physical causes, and other scales are designed to reflect impairment due to psychological causes.

SF-36 survey including two follow-ups for the ME/CFS patient group. One at 13 months (which was completed by 80% of ME/CFS patients) and one at 28 months (which was completed by 52% of ME/CFS patients).

Patients with CFS had markedly lower scores than general population control subjects on every scale (P <O.OOOOl for all scales, Table II and Figure). When the scores of CFS were compared with the scores of the general population group, by determining the percentile at which the mean CFS score would have occurred in the general population, the percentiles ranged from the 7th to the 29th percentile (median, 14.5%). The differences were particularly large for the role- physical score and the vitality score.

Patients with CFS also scored significantly lower on nearly every scale than the five disease compari- son groups other than depression: hypertension (P <O.OOOOl), type II diabetes (P <O.OOOOl), AM1 (P ~0.00002), congestive heart failure (P <O.OOOOl,ex- cept for physical functioning and role-emotional), and MS (P <O.OOl on five of the eight scales; Table II).

Compared with patients with depression, patients with CFS had lower scores on all scales except the mental health and role-emotional scales (Table 11, P <O.OOOOfol r all comparisons). Thus, the profile of impairment was quite different for patients with CFS than for patients with depression: patients with CFS had far greater impairment in overall health (general health perceptions and vitality scales), and more work/homemaking impairment due to physical health problems (role-physical), but less mental health impairment.

The SF-36 scales for physical functioning and role limitations due to physical health problems had modest but highly significant correlations with :several of the CDC minor criteria symptoms (Table IV j, particularly fevers, postexertional malaise, cognitive and sleep disturbance, but had no correlation with patients’ self-perception of mood disorders (irritability or depression).

Finally the SF-36 scores were also relatively stable over time. There was a small improvement in the vitality scale, whilst the physical functioning scale declined slightly from the second to third administration (but not statistically significant).

To summarise:

In particular, most patients describe themselves as substantially impaired. Many cannot perform all of their primary responsibilities, at home or at work. Some are completely disabled.

The patients with CFS were younger and better educated than the healthy control and disease comparison group populations. Since both younger age and greater education are independently associated with higher functional status using multivariate analysis (B. Gandek and J. E. Ware, Jr., unpublished data), the lower functional status in the patients with CFS is even more striking.