title: Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution.
abstract: BACKGROUND
  Chronic fatigue syndrome (CFS) is defined by symptoms and disability, has no confirmatory physical signs or characteristic laboratory abnormalities, and the etiology and pathophysiology remain unknown. Difficulties with accurate case ascertainment contribute to this ignorance.
  
  
  METHODS
  Experienced investigators from around the world who are involved in CFS research met for a series of three day workshops in 2000, 2001 and 2002 intended to identify the problems in application of the current CFS case definition. The investigators were divided into focus groups and each group was charged with a topic. The investigators in each focus group relied on their own clinical and scientific knowledge, brainstorming within each group and with all investigators when focus group summaries were presented. Relevant literature was selected and reviewed independent of the workshops. The relevant literature was circulated via list-serves and resolved as being relevant by group consensus. Focus group reports were analyzed and compiled into the recommendations presented here.
  
  
  RESULTS
  Ambiguities in the current CFS research definition that contribute to inconsistent case identification were identified. Recommendations for use of the definition, standardization of classification instruments and study design issues are presented that are intended to improve the precision of case ascertainment. The International CFS Study Group also identified ambiguities associated with exclusionary and comorbid conditions and reviewed the standardized, internationally applicable instruments used to measure symptoms, fatigue intensity and associated disability.
  
  
  CONCLUSIONS
  This paper provides an approach to guide systematic, and hopefully reproducible, application of the current case definition, so that case ascertainment would be more uniform across sites. Ultimately, an operational CFS case definition will need to be based on empirical studies designed to delineate the possibly distinct biological pathways that result in chronic fatigue.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. wcr1@cdc.gov
authors.forename: William C
authors.initials: WC
authors.lastname: Reeves
authors.forename: Andrew
authors.initials: A
authors.lastname: Lloyd
authors.forename: Suzanne D
authors.initials: SD
authors.lastname: Vernon
authors.forename: Nancy
authors.initials: N
authors.lastname: Klimas
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Jason
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
authors.forename: Birgitta
authors.initials: B
authors.lastname: Evengard
authors.forename: Peter D
authors.initials: PD
authors.lastname: White
authors.forename: Rosane
authors.initials: R
authors.lastname: Nisenbaum
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Unger
mesh_terms: D003071:Cognition; D015897:Comorbidity; D004185:Disability Evaluation; D020920:Dyssomnias; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000503:physiopathology; D017144:Focus Groups; D006801:Humans; D015201:Meta-Analysis as Topic; D010146:Pain; D011569:Psychiatric Status Rating Scales; D018434:Sickness Impact Profile; D035501:Uncertainty