alex3619
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A review was just published in BMJ Open:
http://bmjopen.bmj.com/content/4/2/e003973.full.pdf html
It contains this wonderful gem:
This in the conclusion:
http://bmjopen.bmj.com/content/4/2/e003973.full.pdf html
Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review
Kjetil Gundro Brurberg,Marita Sporstøl Fønhus,Lillebeth Larun,Signe Flottorp,Kirsti Malterud
ABSTRACT
Objective:To identify case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and explore how the validity of case definitions can be evaluated in the absence of a reference standard.
Design:Systematic review.
Setting:International.
Participants:A literature search, updated as of November 2013, led to the identification of 20 case
definitions and inclusion of 38 validation studies.
Primary and secondary outcome measure: Validation studies were assessed for risk of bias and categorised according to three validation models:
(1) independent application of several case definitions on the same population,
(2) sequential application of different case definitions on patients diagnosed with CFS/ME with one set of diagnostic criteria or
(3) comparison of prevalence estimates from different case definitions applied on different populations.
Results:A total of 38 studies contributed data of sufficient quality and consistency for evaluation of validity, with CDC-1994/Fukuda as the most frequently applied case definition. No study rigorously assessed the reproducibility or feasibility of case definitions. Validation studies were small with methodological weaknesses and inconsistent results. No empirical data indicated that any case definition specifically identified patients with a neuroimmunological condition.
Conclusions:Classification of patients according to severity and symptom patterns, aiming to predict prognosis or effectiveness of therapy, seems useful. Development of further case definitions of CFS/ME should be given a low priority. Consistency in research can be achieved by applying diagnostic criteria that have been subjected to systematic evaluation
It contains this wonderful gem:
It is likely that all CFS/ME case definitions capture conditions with different or multifactorial pathogenesis and varying prognosis. The futile dichotomy of ‘organic’ versus ‘psychic’disorder should be abandoned. Most medical disorders have a complex aetiology. Psychological treatments are often helpful also for clear-cut somatic disorders. Unfortunately, patient groups and researchers with vested interests in the belief that ME is a distinct somatic disease seem unwilling to leave the position that ME is an organic disease only. This position has damaged the research and practice for patients suffering from CFS/ME
This in the conclusion:
Our review provided no evidence that any of the case definitions identify patients with specific or ‘organic only’ disease aetiology. Priority should be given to further development and testing of promising treatment options for patients with CFS/ME.
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