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Assessing current functioning as a measure of significant reduction in activity level (on ME & CFS)

Dolphin

Senior Member
Messages
17,567
http://www.tandfonline.com/doi/abs/10.1080/21641846.2016.1206176?journalCode=rftg20

Assessing current functioning as a measure of significant reduction in activity level
DOI: 10.1080/21641846.2016.1206176
Taylor Thorpea, Stephanie McManimena, Kristen Gleasona, Jamie Stoothoffa, Julia L. Newtonb, Elin Bolle Strandc & Leonard A. Jasona*


  • Received: 9 May 2016
  • Accepted: 22 Jun 2016
  • Published online: 19 Jul 2016



ABSTRACT

Background
:

Myalgic encephalomyelitis and chronic fatigue syndrome have case definitions with varying criteria, but almost all criteria require an individual to have a substantial reduction in activity level.

Unfortunately, a consensus has not been reached regarding what constitutes substantial reductions.

One measure that has been used to measure substantial reduction is the Medical Outcomes Study Short-Form-36 Health Survey (SF-36). [1]

Purpose:

The current study examined the relationship between the SF-36, a measure of current functioning, and a self-report measure of the percent reduction in hours spent on activities.

Results:

Findings indicated that select subscales of the SF-36 accurately measure significant reductions in functioning.

Further, this measure significantly differentiates patients from controls.

Conclusion:

Determining what constitutes a significant reduction in activity is difficult because it is subjective to the individual.

However, certain subscales of the SF-36 could provide a uniform way to accurately measure and define substantial reductions in functioning.

KEYWORDS
 

Dolphin

Senior Member
Messages
17,567
Thorpe et al. 2016.png
 

Invisible Woman

Senior Member
Messages
1,267
I didn't see it reflected here but a reduction in time spent is not the only thing:

I might have reduced the amount of time I spend on say paperwork or housework but, as I am also functioning less effectively, I achieve less during the time I spend. So If I've cut the time spent by, lets say, 75 % I may only achieve 10% or 5% compared to previous functioning levels, rather than 25%

Also what I do do may well be riddled with errors (and often is!).
 

Tom Kindlon

Senior Member
Messages
1,734
My latest PubMed Commons e-letter criticising the CDC's so-called empiric criteria (Reeves et al. 2005)

http://www.ncbi.nlm.nih.gov/pubmed/16356178#cm16356178_16657

Another study raises serious questions about the use of the role emotional subscale of the SF-36 in the diagnosis of CFS

A CDC group (Reeves et al (2005)) proposed a way to operationalise chronic fatigue syndrome (CFS) criteria including subscales of the SF-36[1,2]: "We defined substantial reduction in occupational, educational, social, or recreational activities as scores lower than the 25th percentile of published US population [] on the physical function (≤ 70), or role physical (≤ 50), or social function (≤ 75), or role emotional (≤ 66.7) subscales of the SF-36." This method has been used in numerous subsequent CDC CFS studies but not by external groups, apart from Leonard Jason and colleagues who have examined the effect of this operationalisation of the criteria.

A newly published study looked at using the SF 36 subscales to define reduced activity in CFS (and ME)[3]. Six of the 8 subscales (Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality and Social Functioning) correlated with the sum of current hours of activity. Two subscales did not correlate (Role-Emotional and Mental Health).

The same 6 subscales correlated with percentage reduction in the total hours of activity. Again, two subscales did not correlate (Role-Emotional and Mental Health).

Also, a "ROC analysis was used to assess which of the SF-36 subscales best discriminated between patients with ME and CFS and healthy controls. The ROC analysis used a plot of sensitivity versus 1-specificity for scores on the SF-36. The area under the curve (AUC) assessed the degree to which each subscale was able to discriminate between patients and controls. The closer the AUC is to 1, the better discriminatory power that SF-36 subscale has." The same 6 subscales (Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality and Social Functioning) had AUCs of 0.89 or better. By comparison, the Mental Health Functioning subscale had a AUC of 0.59. The AUC for the Role Emotional subscale was even worse at 0.47.

Each of these results demonstrates that the Role Emotional subscale is not suitable to be used to operationalise criteria for CFS.

References:

[1] Reeves WC, Wagner D, Risenbaum R, et al. Chronic fatigue syndrome – a clinically empirical approach to its definition and study. BMC Med. 2005;3(19):1–9.

[2] Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): conceptual framework and item selection. Med Care. 1992;30:473–483

[3] Thorpe T, McManimen S, Gleason K, Stoothoff J, Newton J, Strand EB, Jason LA (2016). Assessing current functioning as a measure of significant reduction in activity level. Fatigue: Biomedicine, Health & Behavior. Published online: 19 Jul 2016 doi: 10.1080/21641846.2016.1206176
 

taniaaust1

Senior Member
Messages
13,054
Location
Sth Australia
I didn't see it reflected here but a reduction in time spent is not the only thing:

I might have reduced the amount of time I spend on say paperwork or housework but, as I am also functioning less effectively, I achieve less during the time I spend. So If I've cut the time spent by, lets say, 75 % I may only achieve 10% or 5% compared to previous functioning levels, rather than 25%

Also what I do do may well be riddled with errors (and often is!).

Same here, I tend to think it can take me 10 times longer (depending on whatever Im doing) to do what I did before even when spending the same time on it. Its cause I keep screwing things up so do them wrong which causes more issues or forget parts Ive already done and keep redoing them.

eg say Im trying to get a form done. I find I've misplaced the form and burn myself out just looking for it. I end up having to get help to find it another day.. I'll then may start it but then loose it again and then go and even forget I had the form so at a later date I apply for yet another form. Im going around and around in circles with different things.

or I order something and then a few weeks later my order comes back to me telling me I did the order wrong, so I had to redo it (I've had incidences where my orders have come back to me a second time as I just went and screwed up another area on a form to what i did the first time I tried).

Try to make meals but burn them so have to do all over again (thou usually I give up that happens as I dont have the energy to try again). im not very efficiently doing things even when I do them.