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Outcomes/Effectiveness Research

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Most people who have chronic fatigue syndrome are underemployed or unemployed, and some can be considered disabled

Chronic fatigue syndrome (CFS) causes severe, disabling physical and mental fatigue, which is exacerbated by minimal exertion. CFS is diagnosed by excluding other medical problems that might cause these symptoms because no diagnostic laboratory marker or biopsy specimen has yet been identified for CFS. A recent systematic review of published studies related to CFS disability examined the extent of functional disability associated with the disease and its impact on a person's ability to work.

The review by Susan D. Ross, M.D., F.R.C.P.C., and colleagues at the MetaWorks, Inc., Evidence-based Practice Center found that most patients with CFS are underemployed or unemployed. The studies they reviewed demonstrated that CFS patients suffer from physical and mental impairments, and that some are disabled, according to the Social Security Administration definition. However, the relationship of these impairments to work status was not well demonstrated. Also, no distinctive demographic, clinical, or psychiatric traits were shown to be consistently predictive of the ability of patients with CFS to return to work. Only depression seemed to be associated with unemployment in patients with CFS.

Of the eight studies that compared any physical impairment and employment, the percentage of patients with CFS who were employed ranged from 13 to 49 percent, whereas the percentage of those without CFS who were employed ranged from 71 to 100 percent. Only cognitive behavior therapy, rehabilitation, and exercise therapy were associated with restoring the ability of people with CFS to work, but no specific intervention was proven to be effective in restoring the ability to work. Simple and consistent evaluations of functional capacity in patients with CFS are needed, conclude the researchers. Their work was supported by the Agency for Healthcare Research and Quality (contract 290-97-0016).

See "Disability and chronic fatigue syndrome: A focus on function," by Dr. Ross, Rhonda P. Estok, R.N., B.S.N., C.N.O.R., Diana Frame, M.E.M., and others, in the May 24, 2004, Archives of Internal Medicine 164, pp. 1098-1107.

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