Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-27T03:33:31.412Z Has data issue: false hasContentIssue false
  • English
  • Français

Heterogeneity in chronic fatigue syndrome – empirically defined subgroups from the PACE trial

Published online by Cambridge University Press:  23 January 2017

T. E. Williams ,
T. Chalder ,
M. Sharpe  and
P. D. White
T. E. Williams
Affiliation:
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, London, UK
T. Chalder
Affiliation:
Academic Department of Psychological Medicine, King's College London, Weston Education Centre, London, UK
M. Sharpe
Affiliation:
Department of Psychiatry, Psychological Medicine Research, University of Oxford, Oxford, UK
P. D. White*
Affiliation:
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, London, UK
*
*Address for correspondence: P. D. White, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, London, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Chronic fatigue syndrome is likely to be a heterogeneous condition. Previous studies have empirically defined subgroups using combinations of clinical and biological variables. We aimed to explore the heterogeneity of chronic fatigue syndrome.

Method

We used baseline data from the PACE trial, which included 640 participants with chronic fatigue syndrome. Variable reduction, using a combination of clinical knowledge and principal component analyses, produced a final dataset of 26 variables for 541 patients. Latent class analysis was then used to empirically define subgroups.

Results

The most statistically significant and clinically recognizable model comprised five subgroups. The largest, ‘core’ subgroup (33% of participants), had relatively low scores across all domains and good self-efficacy. A further three subgroups were defined by: the presence of mood disorders (21%); the presence of features of other functional somatic syndromes (such as fibromyalgia or irritable bowel syndrome) (21%); or by many symptoms – a group which combined features of both of the above (14%). The smallest ‘avoidant–inactive’ subgroup was characterized by physical inactivity, belief that symptoms were entirely physical in nature, and fear that they indicated harm (11%). Differences in the severity of fatigue and disability provided some discriminative validation of the subgroups.

Conclusions

In addition to providing further evidence for the heterogeneity of chronic fatigue syndrome, the subgroups identified may aid future research into the important aetiological factors of specific subtypes of chronic fatigue syndrome and the development of more personalized treatment approaches.

Keywords

Chronic fatigue syndromeheterogeneitylatent class analysisnosologysubgroups
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 8 , June 2017 , pp. 1454 - 1465
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aaron, LA, Buchwald, D (2001). A review of the evidence for overlap among unexplained clinical conditions. Annals of Internal Medicine 134, 868–881.CrossRefGoogle ScholarPubMed
Aslakson, E, Vollmer-Conna, U, White, PD (2006). The validity of an empirical delineation of heterogeneity in chronic unexplained fatigue. Pharmacogenomics 7, 365–373.Google Scholar
Aslakson, E, Vollmer-Conna, U, William, C, White, PD (2009). Replication of an empirical approach to delineate the heterogeneity of chronic unexplained fatigue. Population Health Metrics 7, 17.CrossRefGoogle ScholarPubMed
Bourke, JH, Langford, RM, White, PD (2015). The common link between functional somatic syndromes may be central sensitisation. Journal of Psychosomatic Research 78, 228–236.CrossRefGoogle ScholarPubMed
Brurberg, KG, Fønhus, M, Larun, L, Flottorp, S, Malterud, K (2014). Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. BMJ Open 4, e003973.Google Scholar
Cella, M, Chalder, T, White, PD (2011 a). Does the heterogeneity of chronic fatigue syndrome moderate the response to cognitive behaviour therapy? An exploratory study. Psychotherapy and Psychosomatics 80, 353–358.CrossRefGoogle ScholarPubMed
Cella, M, Sharpe, M, Chalder, T (2011 b). Measuring disability in patients with chronic fatigue syndrome: reliability and validity of the work and social adjustment scale. Journal of Psychosomatic Research 71, 124–128.CrossRefGoogle ScholarPubMed
Chalder, T, Berelowitz, G, Pawlikowska, T, Watts, L, Wessely, S, Wright, D, Wallace, EP (1993). Development of a fatigue scale. Journal of Psychosomatic Research 37, 147–153.CrossRefGoogle ScholarPubMed
Collin, SM, Nikolaus, S, Heron, J, Knoop, H, White, PD, Crawley, E (2016). Chronic fatigue syndrome (CFS) symptom-based phenotypes in two clinical cohorts of adult patients in the UK and The Netherlands. Journal of Psychosomatic Research 81, 14–23.CrossRefGoogle ScholarPubMed
Fukuda, K, Straus, SE, Hickie, I, Sharpe, MC, Dobbins, JG, Komaroff, A (1994). The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Annals of Internal Medicine 121, 953–959.CrossRefGoogle ScholarPubMed
Gotts, Z, Deary, V, Newton, J, Van der Dussen, D, De Roy, P, Ellis, J (2013). Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis. BMJ Open 3, e002999.Google Scholar
Hadzi-Pavlovic, D, Hickie, IB, Wilson, AJ, Davenport, T, Lloyd, AR, Wakefield, D (2000). Screening for prolonged fatigue syndromes: validation of the SOFA scale. Social Psychiatry and Psychiatric Epidemiology 35, 471–479.CrossRefGoogle ScholarPubMed
Harvey, SB, Wessely, S, Kuh, D, Hotopf, M (2009). The relationship between fatigue and psychiatric disorders: evidence for the concept of neurasthenia. Journal of Psychosomatic Research 66, 445–454.CrossRefGoogle ScholarPubMed
Hickie, I, Lloyd, A, Hadzi-Pavlovic, D, Parker, G, Bird, K, Wakefield, D (1995). Can the chronic fatigue syndrome be defined by distinct clinical features? Psychological Medicine 25, 925–935.CrossRefGoogle ScholarPubMed
Janssens, K, Zijlema, W, Joustra, M, Rosmalen, J (2015). Mood and anxiety disorders in chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome: results from the LifeLines cohort study. Psychosomatic Medicine 77, 449–457.CrossRefGoogle ScholarPubMed
Jenkins, CD, Stanton, BA, Niemcryk, SJ, Rose, RM (1988). A scale for the estimation of sleep problems in clinical research. Journal of Clinical Epidemiology 41, 313–321.CrossRefGoogle ScholarPubMed
Kato, K, Sullivan, P, Evengård, B, Pedersen, N (2009). A population-based twin study of functional somatic syndromes. Psychological Medicine 39, 497–505.CrossRefGoogle ScholarPubMed
Komaroff, A (2015). Myalgic encephalomyelitis/chronic fatigue syndrome: a real illness. Annals of Internal Medicine 162, 871–872.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, R, Williams, J (2002). The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine 16, 258–266.CrossRefGoogle Scholar
Lorig, K, Sobel, D, Ritter, P, Laurent, D, Hobbs, M (2001). Effect of a self-management program on patients with chronic disease. Effective Clinical Practice 4, 256–262.Google ScholarPubMed
McBeth, J, Tomenson, B, Chew-Graham, CA, MacFarlane, GJ, Jackson, J, Littlewood, A, Creed, FH (2015). Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue. Journal of Psychosomatic Research 79, 484–491.CrossRefGoogle ScholarPubMed
Mundt, JC, Marks, IM, Shear, MK, Greist, JH (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461–464.CrossRefGoogle Scholar
National Institute for Health and Clinical Excellence (2007). Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management. Clinical guideline [CG53] (https://www.nice.org.uk/Guidance/cg53).Google Scholar
Petrella, R, Cunningham, D, Paterson, D (2001). A self-paced step test to predict aerobic fitness in older adults in the primary care clinic. Journal of the American Geriatrics Society 49, 632–638.CrossRefGoogle ScholarPubMed
Prins, JB, van der Meer, JW, Bleijenberg, G (2006). Chronic fatigue syndrome. Lancet 367, 346–355.Google Scholar
Reeves, WC, Lloyd, A, Vernon, SD, Klimas, N, Jason, LA, Bleijenberg, G, Evengard, B, White, PD, Nisenbaum, R, Unger, ER; International Chronic Fatigue Syndrome Study Group (2003). Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution. BMC Health Services Research 3, 25.CrossRefGoogle ScholarPubMed
Roberts, E, Wessely, S, Chalder, T, Chang, C, Hotopf, M (2016). Mortality of people with chronic fatigue syndrome: a retrospective cohort study in England and Wales from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) Register. Lancet 387, 1638–1643.CrossRefGoogle ScholarPubMed
Sharpe, MC, Archard, LC, Banatvala, JE, Borysiewicz, LK, Clare, AW, David, A, Edwards, RH, Hawton, KE, Lambert, HP, Lane, RJ (1991). A report – chronic fatigue syndrome: guidelines for research. Journal of the Royal Society of Medicine 84, 118–121.CrossRefGoogle ScholarPubMed
Skerrett, T, Moss-Morris, R (2006). Fatigue and social impairment in multiple sclerosis: the role of patients’ cognitive and behavioral responses to their symptoms. Journal of Psychosomatic Research 61, 587–593.CrossRefGoogle ScholarPubMed
Sullivan, PF, Smith, W, Buchwald, D (2002). Latent class analysis of symptoms associated with chronic fatigue syndrome and fibromyalgia. Psychological Medicine 32, 881–888.CrossRefGoogle ScholarPubMed
The National Task Force on Chronic Fatigue Syndrome (1994). Report from the National Task Force on Chronic Fatigue Syndrome (CFS)/Post Viral Fatigue Syndrome (PVMS)/Myalgic Encephalomyelitis (ME). Westcare: Bristol.Google Scholar
Tryon, WW (2004). Issues of validity in actigraphic sleep assessment. Sleep 27, 158–165.CrossRefGoogle ScholarPubMed
Vollmer-Conna, U, Aslakson, E, White, PD (2006). An empirical delineation of the heterogeneity of chronic unexplained fatigue in women. Pharmacogenomics 7, 355–364.CrossRefGoogle ScholarPubMed
Wakefield, JC (2013). The DSM-5 debate over the bereavement exclusion: psychiatric diagnosis and the future of empirically supported treatment. Clinical Psychology Review 33, 825–845.CrossRefGoogle ScholarPubMed
Ware, J, Sherbourne, C (1992). The MOS 36-item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Medical Care 30, 473–483.CrossRefGoogle ScholarPubMed
Wessely, S, Chalder, T, Hirsch, S, Wallace, P, Wright, D (1996). Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. American Journal of Psychiatry 153, 1050–1059.Google ScholarPubMed
White, PD, Goldsmith, K, 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 (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, 823–836.CrossRefGoogle Scholar
White, PD, Sharpe, MC, Chalder, T, DeCesare, JC, Walwyn, R; PACE trial group (2007). Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy. BMC Neurology 7, 6.CrossRefGoogle ScholarPubMed
Wilson, A, Hickie, I, Hadzi-Pavlovic, D, Wakefield, D, Parker, G, Straus, SE, Dale, J, McCluskey, D, Hinds, G, Brickman, A, Goldenberg, D, Demitrack, M, Blakely, T, Wessely, S, Sharpe, M, Lloyd, A (2001). What is chronic fatigue syndrome? Heterogeneity within an international multicentre study. Australian and New Zealand Journal of Psychiatry 35, 520–527.CrossRefGoogle ScholarPubMed
Wolfe, F, Smythe, H, Yunus, M, Bennett, R, Bombardier, C, Goldenberg, D, Tugwell, P (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis and Rheumatism 33, 160–172.CrossRefGoogle ScholarPubMed
Zigmond, S, Snaith, R (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361–370.CrossRefGoogle ScholarPubMed
Supplementary material: File

Williams supplementary material

Appendix

Download Williams supplementary material(File)
File 96.8 KB