A national assessment of the service, support, and housing preferences by persons with chronic fatigue syndrome. Toward a comprehensive rehabilitation program

A Literature Review of GP Knowledge and Understanding of ME/CFS: A Report from the Socioeconomic Working Group of the European Network on ME/CFS (EUROMENE)

Background and Objectives: The socioeconomic working group of the European myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS; Materials and Methods: A MEDLINE search was carried out. The papers identified were reviewed following the synthesis without meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature; Results: Thirty-three papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. It should be noted, though, that these papers were mostly from the United Kingdom. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These findings were consistent with the findings of the qualitative studies that were examined, and have changed little over several decades; Conclusions: Disbelief and lack of knowledge and understanding of ME/CFS among GPs is widespread, and the resultant diagnostic delays constitute a risk factor for severe and prolonged disease. Failure to diagnose ME/CFS renders problematic attempts to determine its prevalence, and hence its economic impact.

Coping and Occupational Participation in Chronic Fatigue Syndrome

Existing studies have shown that individuals with chronic fatigue syndrome demonstrate functional impairment in several domains related to occupational participation. Researchers have not yet explored whether coping styles may be associated with occupational participation in individuals with this condition. The aim of this study was to examine the effects of coping styles on occupational participation among adults with chronic fatigue syndrome. The authors hypothesized that occupational participation would be associated with coping strategies oriented toward information seeking and maintaining activity, and that this relationship would endure despite individual differences in illness severity. The study used a cross-sectional design to describe the associations between coping and occupational participation for 47 individuals diagnosed as having chronic fatigue syndrome. Findings from linear regression analysis revealed that the coping style of maintaining activity was positively associated with occupational participation, whereas illness accommodation was negatively associated. Implications of the findings for continued research and clinical practice in occupational therapy are discussed.

Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study

Background

Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability.

Objective

While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested.

Methods

This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened.

Results

The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon.

Conclusions

This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRTCTN): 22975026; http://www.isrctn.com/ISRCTN22975026 (Archived by WebCite at http://www.webcitation.org/6gBK00CUX)

The use of mixed methods in studying a chronic illness

This article explores mixed methods approaches with an illness called Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). Qualitative and Quantitative data were used to investigate the epidemiology of this illness, as well as explore attributions based on the name of the illness, and finally treatment approaches. In each of the domains within the ME and CFS research reviewed, our analyses were richer and our findings ultimately more impactful when we integrated qualitative and quantitative research methods. The use of a multiphase mixed methods research program provided our team unique vantage points for better understanding social and community issues involving this controversial chronic illness. Further, this approach allowed us to implement the insights gained through an advocacy lens to change policy, recommend and evaluate treatments, and amplify voices within the patient population. In this way, we believe that the practice of methodological pluralism is especially applicable and effective to the study of chronic illness, and believe other investigators will benefit from the use of these approaches with similar disenfranchised and unfairly treated populations.

An approach to persons with chronic fatigue syndrome based on the model of human occupation: part one, impact on occupational performance and participation

Chronic fatigue syndrome (CFS) is a prevalent and disabling condition that involves six or more months of unexplained fatigue severe enough to interfere with previous levels of occupational, educational, and/or social performance. The fatigue is accompanied by at least four of eight additional physical and cognitive symptoms (Fukuda et al., 1994). This paper conceptualizes the multiple factors that affect occupational adaptation in persons with CFS. The Model of Human Occupation (MOHO) if used as a framework for understanding the synergistic and evolving relationships between motivation, roles, habits, performance capacities, and the environment as they influence individuals with CFS. Examples from the literature, autobiographical accounts, and from practice experience are used to illustrate the experience and impact of CFS on everyday life.

Energy Conservation/Envelope Theory Interventions to Help Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

OBJECTIVES

Treatment approaches for patients with Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS) have been controversial. This paper provides the theoretical and conceptual background for the Energy Envelope Theory to assist patients with ME/CFS and reviews evidence of its treatment efficacy.

METHODS

Over a 15-year period, efforts were directed to develop a non-pharmacologic intervention that endeavored to help patients with ME/CFS self-monitor and self-regulate energy expenditures and learn to pace activities and stay within their energy envelope.

CONCLUSIONS

Studies show that the energy envelope approach, which involves rehabilitation methods, helps patients with ME/CFS pace activities and manage symptoms and can significantly improve their quality of life.

Provision of social support to individuals with chronic fatigue syndrome

The present study evaluated a buddy program designed to provide support for individuals with chronic fatigue syndrome (CFS). The intervention involved weekly visits by a student paraprofessional, who helped out with tasks that needed to be done in an effort to reduce some of the taxing demands and responsibilities that participants regularly encountered. This model of rehabilitation focused on avoiding overexertion in persons with CFS, aiming to avoid setbacks and relapses while increasing their tolerance for activity. Participants with CFS were randomly assigned to either a 4-month buddy intervention or a control condition. Posttest results showed that individuals who received a student buddy intervention had significantly greater reductions in fatigue severity and increases in vitality than individuals in the control condition. There were no significant changes between groups for physical functioning and stress. Buddy interventions that help patients with CFS reduce overexertion and possibly remain within their energy envelopes can be thought of as representing a different paradigm than nonpharmacologic interventions that focus only on increasing levels of activity through graded exercise.

The expressed needs of people with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review

BACKGROUND

We aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) METHODS: We carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process.

RESULTS

Thirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation.

CONCLUSIONS

Although the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs.

Differential effects of faith-based coping on physical and mental fatigue in middle-aged and older cardiac patients

PURPOSE

This analysis investigated the effect of faith-based coping used by cardiac patients undergoing surgery on physical and mental fatigue, symptoms which have significant prognostic implications for mortality. Particularly, we explored whether this faith effect is independent or explained by positive mediators.

METHODS

Two weeks preoperatively, 481 patients (male, 58%; mean age = 62 years) were recruited for three sequential interviews. Among them, 426 completed the second interview, and 335 completed the post-operative follow-up. Cross-clamp and bypass time were obtained from patients' charts. Plasma interlukin-6 (IL-6) was used as a correlate of age-associated diseases and frailty.

RESULTS

Hierarchical multiple regression analyses showed that pre-operative positive religious coping styles and optimism contributed to reduced physical fatigue, controlling for post-operatively confirmed prayer coping and such covariates as severe injury. Depression and lower-back problems contributed to mental fatigue. No potential mediators explained these effects.

CONCLUSION

Faith-based coping and optimism are independent predictors of physical fatigue.

Identifying office resource needs of Canadian physicians to help prevent, assess and treat patients with substance use and pathological gambling disorders

A study was conducted to determine whether there is a need for office-based resources to assist physicians in the prevention, assessment and/or management of patients, self and peers with substance use (excluding alcohol and tobacco) or pathological gambling disorders. The needs assessment was undertaken in three parts. Survey information was collected from 54 respondents including Executive Directors of the Canadian Medical Association's national affiliates and provincial/territorial Divisions, Deputy Ministers of Health, Registrars of provincial/territorial licensing bodies and Deans or Associate Deans of Continuing Medical Education programs in universities. Key informant interviews were conducted with 22 "experts" in the field of substance use and/or pathological gambling disorders. Focus groups were held in Vancouver, Toronto, Ottawa, Montreal and Halifax with 34 physicians who are interested in and whose caseload included patients with substance use and/or gambling disorders. Results suggest that current resources for both substance use and pathological gambling disorders are inadequate for physicians because there are gaps in the types activities and resources available, existing resources have not been effectively diffused or disseminated to physicians and training is needed to complement these resources to encourage proper implementation.

The development of the Chronic Fatigue Syndrome Attitudes Test. A psychometric analysis

Chronic Fatigue Syndrome (CFS) is characterized by debilitating symptoms including persistent or relapsing fatigue. As a result of CFS, some individuals experience significant stigma that is attached to this illness. Many medical professionals are skeptical of the validity of the illness, and employers often fail to appreciate the seriousness of the symptoms. Although negative attitudes greatly affect the lives of individuals with CFS, there is presently no measurement of attitudes toward this illness and people who have CFS. The purpose of the present studies was to create a scale that measures attitudes toward individuals with CFS--the Chronic Fatigue Attitudes Test (CAT)--and to assess the scale's reliability and validity. The 13-item scale was created using several constructs outlined in the literature regarding negative attitudes toward people with CFS, disabilities, and AIDS. Theoretical implications of the findings and the utility of the CAT are discussed.

Social, community, and preventive interventions

Psychology can and should be at the forefront of participation in social, community, and preventive interventions. This chapter focuses on selective topics under two general areas: violence as a public health problem and health promotion/competence promotion across the life span. Under violence prevention, discussion of violence against women, youth violence, and child maltreatment are the focal points. Under health and competence promotion, attention is paid to the prevention of substance abuse and HIV/AIDS. We highlight a few significant theoretical and empirical contributions, especially from the field of community/prevention psychology. The chapter includes a brief overview of diversity issues, which are integral to a comprehensive discussion of these prevention efforts. We argue that the field should extend its role in social action while emphasizing the critical importance of rigorous research as a component of future interventions.