Diagnostic Methods for ME-CFS: A Systematic Review for a NIH Pathways to Prevention Workshop

[Dolphin]

Free at: http://annals.org/article.aspx?articleid=2322800

Reviews | 16 June 2015
Diagnostic Methods for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop FREE
Elizabeth Haney, MD; M.E. Beth Smith, DO; Marian McDonagh, PharmD; Miranda Pappas, MA; Monica Daeges, BA; Ngoc Wasson, MPH; and Heidi D. Nelson, MD, MPH

Ann Intern Med. 2015;162(12):834-840. doi:10.7326/M15-0443


Abstract

Background: The diagnosis of myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is based on clinical criteria, yet there has been no consensus regarding which set of criteria best identifies patients with the condition. The Institute of Medicine has recently proposed a new case definition and diagnostic algorithm.

Purpose: To review methods to diagnose ME/CFS in adults and identify research gaps and needs for future research.

Data Sources: MEDLINE, PsycINFO, and Cochrane databases (January 1988 to September 2014); clinical trial registries; and reference lists.

Study Selection: English-language studies describing methods of diagnosis of ME/CFS and their accuracy.

Data Extraction: Data on participants, study design, analysis, follow-up, and results were extracted and confirmed. Study quality was dual-rated by using prespecified criteria, and discrepancies were resolved through consensus.

Data Synthesis: Forty-four studies met inclusion criteria. Eight case definitions have been used to define ME/CFS; a ninth, recently proposed by the Institute of Medicine, includes principal elements of previous definitions. Patients meeting criteria for ME represent a more symptomatic subset of the broader ME/CFS population. Scales rating self-reported symptoms differentiate patients with ME/CFS from healthy controls under study conditions but have not been evaluated in clinically undiagnosed patients to determine validity and generalizability.

Limitations: Studies were heterogeneous and were limited by size, number, applicability, and methodological quality. Most methods were tested in highly selected patient populations.

Conclusion: Nine sets of clinical criteria are available to define ME/CFS, yet none of the current diagnostic methods have been adequately tested to identify patients with ME/CFS when diagnostic uncertainty exists. More definitive studies in broader populations are needed to address these research gaps.

Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42014009779)

 

[Dolphin]

One can (presumably) see part of the reason the review is the way it is, or why the final version is different from the draft, from this thread and link

AHRQ's responses to comments on draft AHRQ review on CFS
http://forums.phoenixrising.me/inde...o-comments-on-draft-ahrq-review-on-cfs.37774/

 

[Dolphin]

The full AHRQ report is available for free here:

Evidence Report/Technology Assessment Number
Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov

http://www.effectivehealthcare.ahrq.gov/ehc/products/586/2004/chronic-fatigue-report-141209.pdf

 

[Dolphin]

The appendices contain summaries of the information in papers. These could potentially be useful ways to search for information quickly:

Appendix Table 1.Included Studies of Methods Used to Diagnose Myalgic Encephalomyelitis/Chronic Fatigue Syndrom

Appendix Table 2.Included Studies Evaluating the Concordance of Different Diagnostic Criteria and Comparisons
Between Populations

Appendix Table 3.Included Studies of Harms of Diagnosis

Appendix Table 4.Measures Used as Diagnostic Tests for ME/CFS

Comment on Appendix 4: This doesn't give the questionnaire wordings. Instead it describes them.
Also:
- Validation Studies in ME/CFS Population
- Studies Using the Measure

 

[Dolphin]

Perhaps somebody might find this ["Comparisons of Symptoms Using Different Case Definitions"] of use:

 

[Dolphin]

The Oxford criteria are discussed a little:

The Oxford case definition incorporates the fewest symptoms (new onset of fatigue with impairment of physical and mental function), suggesting that it includes patients who would not meet other criteria for ME/CFS (19).

Consensus groups and researchers should consider retiring the Oxford case definition because it differs from the other case definitions and is the least restrictive, probably including individuals with other overlapping conditions.

 

[Dolphin]

In general, populations defined by ME or ME/CFS criteria had more severe symptoms or more functional impairment than those defined by CFS criteria alone (1, 10, 20 –24).

 

[Dolphin]

Given the devastating effect of this condition on patients and families, researchers should involve patients and advocates in trial planning and development so that future research is relevant and meaningful to those affected by ME/CFS.

 

[Dolphin]

Would be good if one or more people replied to this http://annals.org/article.aspx?articleid=2322800 (click on "comments")

Comment
Posted on July 6, 2015

James Webster, MD, MS, MACP

Feinberg School of Medicine of Northwestern University

Conflict of Interest: None Declared

As recommended by Haney et. al. (1) the diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is best made using nine sets of "inadequately tested" clinical criteria. These are quite non-specific symptoms and there are no associated positive laboratory findings. Thus it is not surprising that most physicians have problems with the diagnosis much less with the difficult diffuse treatment approaches (2) for this entity.

In a large, but admittedly convenience, sample of patients with the symptoms outlined (1) for ME/CFS the experience was that the overlap with the diagnosis of major depression and persistent (formerly dysphoric) depressive disorder (DSM V, 300.4) was huge. For these illnesses there are diagnostic criteria and proven effective therapies which were used to benefit a number of these latter patients. The differential diagnosis of ME/CFS and depressive disorders is difficult, but not impossible (3). The patients with the symptoms of depression and ME/CFS do indeed have real illnesses (4), but to ignore clear psychiatric possibilities and aspects, including the potential for a therapeutic trial, does them a great disservice.


1. Haney E, Smith MEB, McDonagh M, et al. Diagnostic methods for myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review for a national institutes of health pathways to prevention workshop. Ann Intern Med. 2015:162:834-840.


2. Smith MEB, Haney E, McDonagh M, et al. Treatment of myalgic encephalomyelitis/chronic fatigue syndrome. A systematic review for a national institutes of health pathways to prevention workshop. Ann Intern Med. 2015;162:841-850.

3. Hawk C, Jason LA, Torres-Harding S. Int J Behav Med. 2006;13:244-51

4. Komaroff AL. Myalgic encephalomyelitis/chronic fatigue syndrome: A real illness. Ann Intern Med. 2015;162:871-872.