title: Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database.
abstract: BACKGROUND
  Chronic fatigue syndrome (CFS) is relatively common and disabling. Over 8000 patients attend adult services each year, yet little is known about the outcome of patients attending NHS services.
  
  
  OBJECTIVE
  Investigate the outcome of patients with CFS and what factors predict outcome.
  
  
  METHODS
  Longitudinal patient cohort.
  
  
  METHODS
  We used data from six CFS/ME (myalgic encephalomyelitis) specialist services to measure changes in fatigue (Chalder Fatigue Scale), physical function (SF-36), anxiety and depression (Hospital Anxiety and Depression Scale) and pain (visual analogue pain rating scale) between clinical assessment and 8-20 months of follow-up. We used multivariable linear regression to investigate baseline factors associated with outcomes at follow-up.
  
  
  RESULTS
  Baseline data obtained at clinical assessment were available for 1643 patients, of whom 834 (51%) had complete follow-up data. There were improvements in fatigue [mean difference from assessment to outcome: -6.8; 95% confidence interval (CI) -7.4 to -6.2; P < 0.001]; physical function (4.4; 95% CI 3.0-5.8; P < 0.001), anxiety (-0.6; 95% CI -0.9 to -0.3; P < 0.001), depression (-1.6; 95% CI -1.9 to -1.4; P < 0.001) and pain (-5.3; 95% CI -7.0 to -3.6; P < 0.001). Worse fatigue, physical function and pain at clinical assessment predicted a worse outcome for fatigue at follow-up. Older age, increased pain and physical function at assessment were associated with poorer physical function at follow-up.
  
  
  CONCLUSIONS
  Patients who attend NHS specialist CFS/ME services can expect similar improvements in fatigue, anxiety and depression to participants receiving cognitive behavioural therapy and graded exercise therapy in a recent trial, but are likely to experience less improvement in physical function. Outcomes were predicted by fatigue, disability and pain at assessment.
authors.affiliation: Centre for Child & Adolescent Health, School of Social & Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. esther.crawley@bristol.ac.uk
authors.forename: E
authors.initials: E
authors.lastname: Crawley
authors.forename: S M
authors.initials: SM
authors.lastname: Collin
authors.forename: P D
authors.initials: PD
authors.lastname: White
authors.forename: K
authors.initials: K
authors.lastname: Rimes
authors.forename: J A C
authors.initials: JA
authors.lastname: Sterne
authors.forename: M T
authors.initials: MT
authors.lastname: May
mesh_terms: D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000209:etiology; D016208:Databases, Factual; D003863:Depression / Q000209:etiology; D015673:Fatigue Syndrome, Chronic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome
references.citation: Popul Health Metr. 2007 Jun 08;5:5
references.pmid: 17559660
references.citation: Lancet. 2011 Mar 5;377(9768):823-36
references.pmid: 21334061
references.citation: BMC Health Serv Res. 2011 Sep 15;11:217
references.pmid: 21923897
references.citation: Spine J. 2007 Sep-Oct;7(5):541-6
references.pmid: 17448732
references.citation: Int J Epidemiol. 2002 Feb;31(1):163-5
references.pmid: 11914314
references.citation: Am J Psychiatry. 2003 Apr;160(4):785-7
references.pmid: 12668371
references.citation: Psychosom Med. 2004 May-Jun;66(3):330-5
references.pmid: 15184691
references.citation: Aust N Z J Psychiatry. 2009 Jan;43(1):25-35
references.pmid: 19085525
references.citation: Ann Epidemiol. 2000 Oct 1;10(7):458
references.pmid: 11018368
references.citation: Psychol Med. 2005 Sep;35(9):1317-26
references.pmid: 16168154
references.citation: Behav Res Ther. 2012 Jun;50(6):393-6
references.pmid: 22504122
references.citation: Arch Intern Med. 2003 Jul 14;163(13):1530-6
references.pmid: 12860574
references.citation: Behav Res Ther. 2007 Jun;45(6):1085-94
references.pmid: 17074300
references.citation: Ann Intern Med. 1994 Dec 15;121(12):953-9
references.pmid: 7978722
references.citation: BMC Health Serv Res. 2003 Dec 31;3(1):25
references.pmid: 14702202
references.citation: Br J Psychiatry. 2002 Sep;181:248-52
references.pmid: 12204931
references.citation: Ann Intern Med. 1995 Jul 15;123(2):81-8
references.pmid: 7778839
references.citation: Am J Public Health. 1997 Sep;87(9):1449-55
references.pmid: 9314795
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: J R Soc Med. 2006 Oct;99(10):506-20
references.pmid: 17021301
references.citation: Gen Hosp Psychiatry. 2001 Sep-Oct;23(5):254-60
references.pmid: 11600166
references.citation: J Neurol Neurosurg Psychiatry. 1994 May;57(5):617-21
references.pmid: 8201336
references.citation: BMJ Open. 2012 Aug 16;2(4):
references.pmid: 22899647
references.citation: Health Qual Life Outcomes. 2003 Aug 01;1:29
references.pmid: 12914662
references.citation: J Psychosom Res. 2009 Jan;66(1):31-5
references.pmid: 19073290
references.citation: J Psychosom Res. 1993;37(2):147-53
references.pmid: 8463991