Homebound versus bedridden status among those with Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome, by  Karl Conroy, Shaun Bhatia, Mohammed Islam and Leonard A Jason in Healthcare 2021, 9(2), 106 [doi.org/10.3390/healthcare9020106] (This article belongs to the Special Issue ME/CFS – the Severely and Very Severely Affected)


Research abstract:

Persons living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) vary widely in terms of the severity of their illness.

It is estimated that of those living with ME/CFS in the United States, about 385,000 are homebound. There is a need to know more about different degrees of being homebound within this severely affected group. The current study examined an international sample of 2138 study participants with ME/CFS, of whom 549 were severely affected (operationalized as ‘Homebound’).  A subsample of 89 very severely affected participants (operationalized as ‘Homebound-bedridden’) was also examined.

The findings showed a significant association between severely and very severely affected participants within the post-exertional malaise (PEM) symptom domain. The implications of these findings are discussed.

4. Discussion (excerpt)
The findings of the current study indicated that PEM, social functioning, and physical functioning were significant predictors of a participant with ME/CFS being ‘Homebound’ (compared to ‘Not homebound’). Among symptom items in the DSQ-1 PEM domain, “next day soreness or fatigue after non-strenuous, everyday activity” and “physically drained or sick after mild activity” were the strongest predictors of ‘Homebound’ status. These predictive results were consistent with the mean comparisons reported by Pendergrast and colleagues [21].

Moreover, the unique aspect of our study was subdividing the ‘Homebound’ group into two subgroups: ‘Homebound-bedridden’ and ‘Homebound-not bedridden. We found that higher symptom scores in the PEM domain decreased the odds of a participant being ‘Homebound-bedridden’ (versus ‘Homebound-not bedridden’). Among the PEM symptom items, “minimum exercise makes you physically tired” significantly decreased the odds of a participant being ‘Homebound-bedridden’…

Our study found that participants who reported worse symptoms in the PEM domain [25] and less physical and social functioning [32] were at increased odds of being ‘Homebound’ (compared to ‘Not homebound’). Among participants who were classified as ‘Homebound,’ those who reported worse symptoms in the PEM domain were at decreased odds of being ‘Homebound-bedridden’ (compared to ‘Homebound-not bedridden’). We hypothesized that for participants who are ‘Homebound,’ those who are ‘Homeboundbedridden’ may experience less PEM symptomology because they are expending less energy. Based on the proportion of participants who were ‘Homebound’ in our study, we estimate that as many as 385,000 persons with ME/CFS are homebound in the United States. There is a pressing need to find ways of providing services to this under-resourced group.

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