title: Chronic fatigue syndrome - an update.
abstract: BACKGROUND
  Chronic fatigue syndrome is a widespread condition with a huge impact not only on a patient's life, but also on society as evidenced by substantial losses of productivity, informal costs, and medical expenses. The high prevalence rates (0.2-6.4%) and the low employment rates (27-41%) are responsible for the enormous burden imposed on society, with loss of productivity representing the highest cost. The objective of this review is to systematically review the recent literature on chronic fatigue syndrome/myalgic encephalomyelitis.
  
  
  METHODS
  The published literature between 1 January 1990 and 1 April 2015 was searched using the MEDLINE, Cochrane Library, and Web of Sciences databases. The reference lists of the selected articles were screened for other relevant articles.
  
  
  CONCLUSIONS
  Despite extensive research, none of the proposed etiological factors have shown strong, reproducible scientific evidence. Over the years, the biopsychosocial model integrating many of the proposed hypotheses has been gaining popularity over the biomedical model, where the focus is on one physical cause. Since the etiological mechanism underlying chronic fatigue syndrome is currently unknown, disease-specific treatments do not exist. Various treatments have been investigated but only cognitive behavior therapy (CBT) and graded exercise therapy (GET) have shown moderate effectiveness.
authors.affiliation: a Department of Physical and Rehabilitation Medicine , University Hospital Ghent , De Pintelaan 185, Gent 9000 , Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Rimbaut
authors.affiliation: a Department of Physical and Rehabilitation Medicine , University Hospital Ghent , De Pintelaan 185, Gent 9000 , Belgium.
authors.forename: Céline
authors.initials: C
authors.lastname: Van Gutte
authors.affiliation: a Department of Physical and Rehabilitation Medicine , University Hospital Ghent , De Pintelaan 185, Gent 9000 , Belgium.
authors.forename: Lina
authors.initials: L
authors.lastname: Van Brabander
authors.affiliation: a Department of Physical and Rehabilitation Medicine , University Hospital Ghent , De Pintelaan 185, Gent 9000 , Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Vanden Bossche
keywords: Chronic fatigue syndrome; Cost of care; Evidence based medicine; Exercise/activity; Physiotherapy; Systematic review