Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management

Abstract

Objectives: To establish the relationship between the functional impairment experienced by Chronic fatigue syndrome (CFS) patients and the symptoms frequently experienced by those with CFS; specifically cognitive impairment, fatigue and orthostatic symptoms. Design: Cross sectional questionnaire survey. Setting: Specialist CFS Clinical Service. Subjects: Ninety-nine Fukuda diagnosed CFS and 64-matched controls. Main outcome measures: Symptom and functional assessment tools completed and returned by post included; PROMIS HAQ (Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire), CFQ (Cognitive Failures Questionnaire), FIS (Fatigue Impact Scale) and OGS (Orthostatic Grading Scale) assessment tools. Results: CFS patients experience greater functional impairment than controls [mean (95% CI) PROMIS HAQ scores CFS 36 (31–42) vs. controls 6 (2–10); P < 0.0001], especially in the functional domains of activities and reach. Poorer functional ability impairment is significantly associated with greater cognitive impairment (P = 0.0002, r = 0.4), fatigue (P < 0.0001, r = 0.5) and orthostatic symptoms (P < 0.0001, r = 0.6). However, only orthostatic symptoms (OGS) independently associated with functional impairment (β = 0.4, P = 0.01). Conclusions: Treatment of orthostatic symptoms in CFS has the potential to improve functional capacity and so improve quality of life.