title: Measuring substantial reductions in functioning in patients with chronic fatigue syndrome.
abstract: OBJECTIVE
  All the major current case definitions for chronic fatigue syndrome (CFS) specify substantial reductions in previous levels of occupational, educational, social, or personal activities to meet criteria. Difficulties have been encountered in operationalizing 'substantial reductions.' For example, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) has been used to determine whether individuals met the CFS disability criterion. However, previous methods of using the SF-36 have been prone to including people without substantial reductions in key areas of physical functioning when diagnosing CFS. This study sought to empirically identify the most appropriate SF-36 subscales for measuring substantial reductions in patients with CFS.
  
  
  METHODS
  The SF-36 was administered to two samples of patients with CFS: one recruited from tertiary care and the other a community-based sample; as well as a non-fatigued control group. Receiver operating characteristics were used to determine the optimal cutoff scores for identifying patients with CFS.
  
  
  RESULTS
  The SF-36 Role-Emotional subscale had the worst sensitivity and specificity, whereas the Vitality, Role-Physical, and Social Functioning subscales had the best sensitivity and specificity.
  
  
  CONCLUSIONS
  Based on the evidence from this study, the potential criteria for defining substantial reductions in functioning and diagnosing CFS is provided.
authors.affiliation: Center for Community Research, DePaul University, Chicago, IL 60614, USA. ljason@depaul.edu
authors.forename: Leonard
authors.initials: L
authors.lastname: Jason
authors.forename: Molly
authors.initials: M
authors.lastname: Brown
authors.forename: Meredyth
authors.initials: M
authors.lastname: Evans
authors.forename: Valerie
authors.initials: V
authors.lastname: Anderson
authors.forename: Athena
authors.initials: A
authors.lastname: Lerch
authors.forename: Abigail
authors.initials: A
authors.lastname: Brown
authors.forename: Jessica
authors.initials: J
authors.lastname: Hunnell
authors.forename: Nicole
authors.initials: N
authors.lastname: Porter
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D018450:Disease Progression; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010808:Physical Examination; D018570:Risk Assessment; D012720:Severity of Illness Index; D018434:Sickness Impact Profile