Defining recovery in chronic fatigue syndrome: a critical review

  title={Defining recovery in chronic fatigue syndrome: a critical review},
  author={Jenna L Adamowicz and Indre Caikauskaite and Fred Friedberg},
  journal={Quality of Life Research},
AbstractPurposeIn chronic fatigue syndrome (CFS), the lack of consensus on how recovery should be defined or interpreted has generated controversy and confusion. The purpose of this paper was to systematically review, compare, and evaluate the definitions of recovery reported in the CFS literature and to make recommendations about the scope of recovery assessments. MethodsA search was done using the MEDLINE, PubMed, PsycINFO, CINAHL, and Cochrane databases for peer review papers that contained… 

Recovery from chronic fatigue syndrome: a systematic review—heterogeneity of definition limits study comparison

Definitions of recovery in paediatric CFS/ME, the rate of recovery and the time to recovery were described, and it was recommended that recovery may be best defined from the child's own perspective.

Defining and measuring recovery from myalgic encephalomyelitis and chronic fatigue syndrome: the physician perspective

Recovery from myalgic encephalomyelitis and chronic fatigue syndrome should be viewed as multidimensional, considering patients’ daily life, psychosocial functioning, and overall physical functioning, according to physicians’ views.

A definition of recovery in myalgic encephalomyelitis and chronic fatigue syndrome should be based upon objective measures

It is crucial to accurately diagnose patients using well-defined criteria for ME and CFS and an objective assessment of various typical symptoms, since subjective measures such as “fatigue” will perpetuate the debate.

Assessment of recovery status in chronic fatigue syndrome using normative data

The “normalization of symptoms and function” holds promise as a means of defining recovery from CFS at the current time, however, care is required regarding how such requirements are operationalized, otherwise recovery rates may be overstated, and perpetuate the confusion and controversy noted.

Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome

Treatment strategies should include proper administration of nutritional supplements in CFS/ME patients with demonstrated deficiencies and personalized pacing programs to relieve symptoms and improve performance of daily activities, but a larger randomized controlled trial (RCT) evaluation is required to confirm these preliminary observations.

Patients’ hopes for recovery from myalgic encephalomyelitis and chronic fatigue syndrome: Toward a “recovery in” framework

Outcome research should incorporate well-being measures like identity, meaning and quality of life, and personal empowerment to enhance recovery definitions, and when communicating treatment goals, providers might convey cautious optimism for complete symptom remission.

Chronic fatigue syndrome and quality of life

  • Deb Roberts
  • Medicine, Psychology
    Patient related outcome measures
  • 2018
A valid and reliable PROM is explored that can monitor change and evaluate the UK National Institute of Clinical Excellence rehabilitation program, as delivered by specialist National Health Service units, and the World Health Organization’s quality-of life instrument (WHOQoL)-Bref26 is reviewed.

The PACE trial of treatments for chronic fatigue syndrome: a response to WILSHIRE et al

It is concluded that neither the criticisms nor the reanalysis offer any convincing reason to change the conclusions of the PACE trial.

Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial

The claim that patients can recover as a result of CBT and GET is not justified by the data, and is highly misleading to clinicians and patients considering these treatments.

Authors’ response to commentary by Twisk

The recovery assessment that is suggested is based on a transdiagnostic model; it is intended to document what is commonly understood as indicating recovery, i.e., a sustained reduction of symptoms to normative levels and restoration of premorbid functioning.



A systematic review describing the prognosis of chronic fatigue syndrome.

Full recovery from untreated CFS is rare, however, there is increasing evidence for the effectiveness of cognitive behavioural and graded exercise therapies and medical retirement should be postponed until a trial of such treatment has been given.

Development of Outcome Measures for Therapeutic Trials of Chronic Fatigue Syndrome

The goal of the workshop was to begin a systematic consideration of clinical trials issues and outcome measures that could be used to evaluate CFS therapies in a definitive manner for safety and efficacy.

The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study

We have developed a conceptual framework and a set of research guidelines for use in studies of the chronic fatigue syndrome. The guidelines cover the clinical and laboratory evaluation of persons

Is a Full Recovery Possible after Cognitive Behavioural Therapy for Chronic Fatigue Syndrome?

Significant improvement following CBT is probable and a full recovery is possible after chronic fatigue syndrome, and sharing this information with patients can raise the expectations of the treatment, which may enhance outcomes without raising false hopes.

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

‘Recovery’ does not mean recovery as understood by Nisenbaum but ‘recovery from the current episode of the illness’, a state described by N Eisenbaum as ‘remission’.

A population-based study of the clinical course of chronic fatigue syndrome

The persistence of sleep complaints and identification of sleep disorders suggest that CFS subjects be evaluated for sleep disturbances, which could be treated, and thus early detection of CFS is of utmost importance.

Can we predict recovery in chronic fatigue syndrome?

Findings support previous research that complete recovery from CFS is rare and that patients with less severe illness at the initial clinic visit are more likely to have a positive prognosis for recovery and suggest that accurate prediction of recovery in individual CFS patients is not currently feasible.

Letter to the Editor: ‘Recovery from chronic fatigue syndrome after treatments given in the PACE trial’: data on the recovery groups as a whole would be useful

  • D. Cox
  • Psychology
    Psychological Medicine
  • 2013
White et al. (2013) report various recovery rates from chronic fatigue syndrome (CFS) following the PACE Trial, using a selection of broad criteria to define recovery, none of which allow one to be confident recovery has been achieved.

Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors.

Further research should clarify the aim and outcome of different treatment strategies in CFS/FM, as well as the underlying mechanisms of change, including those facilitating neurobiological recovery.

Faces of Fatigue: Ethical Considerations on the Treatment of Chronic Fatigue Syndrome

  • S. Ene
  • Psychology, Medicine
  • 2013
A multifaceted approach is taken in investigating ethical issues related to the CFS illness course and the implications of theoretical views of chronic fatigue as psychiatric in origin are considered.