Measurements of recovery and predictors of outcome in an untreated Chronic Fatigue Syndrome Sample, by Marie Thomas, Andrew Smith in Journal of Health and Medical Sciences Vol 2, #2, pp 167-178 [Published online: April 22, 2019] doi:10.31014/aior.1994.02.02.33
The current study examined a large cohort of untreated Chronic Fatigue Syndrome patients at initial assessment and at specific time points over a three-year period. Methods used in previous studies to assess patient health, were validated and used to assess recovery and improvement.
Possible predictors of outcome would then be identified by assessing improvements in health status at specific follow-up points. The illness was also assessed in terms of recovery and improvement by using health related and psychosocial measures together with the aetiology of the illness. These were further used to investigate possible mechanisms influencing or predicting recovery or improvement.
Two-hundred and twenty-six patients completed wide ranging questionnaires at initial
assessment and again six and eighteen months and three years later. A current state of health score was used to measure recovery over time and analyses conducted to investigate the relationship between this and other health related measures. Regression analyses were conducted to assess predictors of improvement and recovery.
Spontaneous recovery rates in the untreated patient at three-year follow-up were low (6%). The data suggested, however, that illness length, symptom severity and health status have an important role in recovery. Although there was no evidence to suggest an association between illness onset type and subsequent recovery or psychopathology scores at initial assessment and recovery, regression analyses did indicate that levels of anxiety, cognitive difficulties and social support at initial assessment predict a positive outcome. The state of health measure was validated as a method of accurately assessed the health status of patients and was used as an indicator of improvement and recovery within this group.
Spontaneous recovery in the patient group was associated with several factors measured at initial assessment. However, further studies are necessary to more fully identify the factors which affect recovery or improvement and to investigate the exact nature of the mechanisms involved. The present study shows that spontaneous recovery of CFS
patients is rare. Treatment or management is essential, and the efficacy of different approaches must be assessed.
2.3.1 Measurement of Recovery
Health status and severity were measured by a ‘current state of health measure’ (Smith et al., 1996). This 5-item scale categorised the patient’s health as follows: (1) worse than at any stage of the illness; (2) bad; (3) bad with some recovery; (4) recovering with occasional relapses and (5) almost completely recovered. In order to test the validity of this measure to accurately describe health status at any given time, patients were categorised into two groups at baseline: those who were in poor health (scoring ‘worse than any stage’, ‘bad’ and ‘bad with some recovery’) and those who thought they were recovering (scoring ‘recovering with occasional relapse’ and ‘almost completely recovered’). These baseline data were then compared to measures known to be associated with the illness, including: (a) positive and negative mood (Zevon & Tellegen, 1982); (b) depression (Beck et al., 1961; Radloff, 1997); (c) anxiety (Spielberger et al., 1971); (d) fatigue related symptoms (Ray et al., 1993); (e) physical symptoms (Cohen & Hoberman, 1983; Smith et al., 1996); (f) cognitive failures (Broadbent et al., 1982) and, (g) stress (Cohen et al., 1983).
Overall, the current longitudinal study has provided data indicating that prognosis for the untreated CFS patient is poor. Associations between the state of health measure and other physical and mental health variables have been verified using a large group of patients. The validation of a simple 5-item measure by other standardised measures leads us to believe that this score can be used to accurately rate patient illness severity. We have also shown that this measure can predict and assess recovery. Positive outcome measures are indicated in cases where illness length is short and when the number and severity of symptoms are low. We have confirmed the widely held belief among healthcare professionals that offering care to this patient group before the illness is allowed to become entrenched is of major importance if therapy is to be successful. The measures described here can now be used to evaluate the efficacy of treatments in future studies. Further research is necessary, however, to identify the, as yet, unidentified factors which can accurately predict positive outcome in this illness.