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Letter to the Editor: ‘Recovery from chronic fatigue syndrome after treatments given in the PACE trial’: an appropriate threshold for a recovery?

Published online by Cambridge University Press:  19 July 2013

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Abstract

Type
Correspondence
Copyright
Copyright © Cambridge University Press 2013 

The main trial recovery criteria, described by White et al. (Reference White, Goldsmith, Johnson, Chalder and Sharpe2013), allow participants with SF-36 physical function scores of ⩾60 to be classed as recovered if, for example, their ‘main symptom’ is no longer fatigue.

In terms of clinical interpretation, such a threshold is problematic because it is in conflict with how the condition itself is defined. For example, it indicates worse impairment than the PACE Trial entry criteria threshold of ⩽65 (White et al. Reference White, Goldsmith, Johnson, Potts, Walwyn, DeCesare, Baber, Burgess, Clark, Cox, Bavinton, Angus, Murphy, Murphy, O'Dowd, Wilks, McCrone, Chalder and Sharpe2011) and the diagnostic threshold of ⩽70 used by Reeves et al. (Reference Reeves, Wagner, Nisenbaum, Jones, Gurbaxani, Solomon, Papanicolaou, Unger, Vernon and Heim2005) to indicate ‘substantial’ physical impairment.

Further, a score of ⩽65 has been used to indicate severely impaired physical function in similar patient groups (Stulemeijer et al. Reference Stulemeijer, de Jong, Fiselier, Hoogveld and Bleijenberg2004; van't Leven et al. Reference van't Leven, Zielhuis, van der Meer, Verbeek and Bleijenberg2009).

Declaration of Interest

None.

References

Reeves, WC, Wagner, D, Nisenbaum, R, Jones, JF, Gurbaxani, B, Solomon, L, Papanicolaou, DA, Unger, ER, Vernon, SD, Heim, C (2005). Chronic Fatigue Syndrome – a clinically empirical approach to its definition and study. BMC Medicine 3, 19.CrossRefGoogle ScholarPubMed
Stulemeijer, M, de Jong, LWAM, Fiselier, TJW, Hoogveld, SWB, Bleijenberg, G (2004). Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. Britiah Medical Journal 330, 14.CrossRefGoogle ScholarPubMed
van't Leven, M, Zielhuis, GA, van der Meer, JW, Verbeek, AL, Bleijenberg, G (2009). Fatigue and chronic fatigue syndrome-like complaints in the general population. European Journal of Public Health 20, 251257.CrossRefGoogle ScholarPubMed
White, PD, Goldsmith, K, Johnson, AL, Chalder, T, Sharpe, M; PACE Trial Management Group (2013). Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychological Medicine. Published online: 31 January 2013. doi:10.1017/S0033291713000020.Google ScholarPubMed
White, PD, Goldsmith, KA, Johnson, AL, Potts, L, Walwyn, R, DeCesare, JC, Baber, HL, Burgess, M, Clark, LV, Cox, DL, Bavinton, J, Angus, BJ, Murphy, G, Murphy, M, O'Dowd, H, Wilks, D, McCrone, P, Chalder, T, Sharpe, M; PACE Trial Management Group (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 377, 823836.CrossRefGoogle Scholar