Anonymous
Not logged in
Talk
Contributions
Create account
Log in
Search
Editing
Chalder fatigue scale
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Namespaces
Page
Discussion
More
More
Page actions
Read
Edit
Edit source
History
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
The '''Chalder fatigue scale''' (CFQ) is a questionnaire created by the research team of [[Trudie Chalder]] at [[King's College London]] to measure the severity of tiredness in [[Chronic fatigue|fatiguing illnesses]].<ref name=":0">{{Cite journal | last = Chalder | first = T. | last2 = Berelowitz | first2 = G. | last3 = Pawlikowska | first3 = T. | last4 = Watts | first4 = L. | last5 = Wessely | first5 = S. | last6 = Wright | first6 =D. | last7 = Wallace | first7 = E.P. | date = 1993 | title = Development of a fatigue scale | url =https://www.ncbi.nlm.nih.gov/pubmed/8463991 | journal = Journal of Psychosomatic Research | volume = 37 | issue = 2 | pages = 147–153|issn=0022-3999|pmid=8463991|quote= | authorlink = Trudie Chalder | author-link2 = | author-link3 = | author-link4 = | author-link5 = Simon Wessely|via=}}</ref> The Fatigue Scale has been used in multiple randomized trials of behavioral interventions in patients with [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]] (ME/CFS),<ref>{{Cite journal | last = Deale | first = A. | last2 = Chalder | first2 = T. | last3 = Marks | first3 = I. | last4 = Wessely | first4 = S. | date = Mar 1997 | title = Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial | url = https://www.ncbi.nlm.nih.gov/pubmed/9054791 | journal = The American Journal of Psychiatry | volume = 154 | issue = 3 | pages = 408–414|doi=10.1176/ajp.154.3.408|issn=0002-953X|pmid=9054791|quote= | authorlink = Alicia Deale | author-link2 = Trudie Chalder | author-link3 = Isaac Marks | author-link4 = Simon Wessely | author-link5 = |via=}}</ref><ref>{{Cite journal | last = Powell | first = P. | last2 = Bentall | first2 = R.P. | last3 = Nye | first3 = F.J. | last4 = Edwards | first4 = R.H. | date = 2001-02-17 | title = Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/11179154 | journal = BMJ (Clinical research ed.) | volume = 322 | issue = 7283 | pages = 387–390|issn=0959-8138|pmid=11179154}}</ref><ref>{{Cite journal | last = Wearden | first = Alison J. | last2 = Dowrick | first2 = Christopher | last3 = Chew-Graham | first3 = Carolyn | last4 = Bentall | first4 = Richard P. | last5 = Morriss | first5 = Richard K. | last6 = Peters | first6 = Sarah | last7 = Riste | first7 = Lisa | last8 = Richardson | first8 = Gerry | last9 = Lovell | first9 = Karina | date = 2010-04-23 | title = Nurse led, home based self help treatment for patients in primary care with chronic fatigue syndrome: randomised controlled trial | url = https://www.ncbi.nlm.nih.gov/pubmed/20418251 | journal = BMJ (Clinical research ed.) | volume = 340| pages=c1777|doi=10.1136/bmj.c1777|issn=1756-1833|pmc=2859122|pmid=20418251}}</ref> including the disreputed [[PACE trial|PACE trial.]]<ref name=":15">{{Cite journal | last = White | first = P.D. | last2 = Goldsmith | first2 = K.A. | last3 = Johnson | first3 = A.L. | last4 = Potts | first4 = L. | last5 = Walwyn | first5 = R. | last6 = DeCesare | first6 = J.C. | last7 = Baber | first7 = H.L. | last8 = Burgess | first8 = M. | last9 = Clark | first9 = L.V. | date = 2011-03-05 | title = Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial | url = https://www.ncbi.nlm.nih.gov/pubmed/21334061 | journal = Lancet (London, England) | volume = 377 | issue = 9768 | pages = 823–836|doi=10.1016/S0140-6736(11)60096-2|issn=1474-547X|pmc=3065633|pmid=21334061|quote= | authorlink = Peter White | author-link2 = Kimberley Goldsmith | author-link3 = Anthony Johnson | author-link4 = Laura Potts | author-link5 = Rebecca Walwyn|via= | author-link6 = Julia DeCesare | author-link8 = Mary Burgess | author-link8 = Hannah Baber | author-link9 = Lucy Clark}}</ref> While the scale has good internal consistency<ref name=":1">{{Cite journal | last = Cella | first = Matteo | last2 = Chalder | first2 = Trudie | date = Jul 2010 | title = Measuring fatigue in clinical and community settings |url =https://www.ncbi.nlm.nih.gov/pubmed/20630259 | journal = Journal of Psychosomatic Research | volume = 69 | issue = 1 | pages = 17–22|doi=10.1016/j.jpsychores.2009.10.007|issn=1879-1360|pmid=20630259}}</ref><ref name=":3">{{Cite journal | last = Loge | first = J.H. | last2 = Ekeberg | first2 = O. | last3 = Kaasa | first3 = S. | date = Jul 1998 | title = Fatigue in the general Norwegian population: normative data and associations |url =https://www.ncbi.nlm.nih.gov/pubmed/9720855 | journal = Journal of Psychosomatic Research | volume = 45 | issue = 1 | pages = 53–65|issn=0022-3999|pmid=9720855}}</ref> and convergent validity,<ref name=":4">{{Cite journal | last = De Vries | first = J | last2 = Michielsen | first2 = H | last3 = Van Heck | first3 = G L | date = Jun 2003 | title = Assessment of fatigue among working people: a comparison of six questionnaires |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765720/ | journal = Occupational and Environmental Medicine | volume = 60 | issue = Suppl 1| pages=i10–i15|doi=10.1136/oem.60.suppl_1.i10|issn=1351-0711|pmc=1765720|pmid=12782741}}</ref> it has been criticized for having ceiling effects<ref name=":12">{{Cite journal | last = Stouten | first = Bart | date = 2005-05-13 | title = Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution | url =https://www.ncbi.nlm.nih.gov/pubmed/15892882 | journal = BMC health services research | volume = 5 | pages = 37|doi=10.1186/1472-6963-5-37|issn=1472-6963|pmc=1175848|pmid=15892882 | issue = |quote= | authorlink = Bart Stouten|via=}}</ref><ref name=":13">{{Cite journal | last = Kindlon | first = Tom | date = 2019-02-13 | title = Data on the level of maximal scoring (on the Chalder Fatigue Scale) would be useful|journal =The BMJ | url = https://www.bmj.com/rapid-response/2011/11/02/data-level-maximal-scoring-chalder-fatigue-scale-would-be-useful|language=en}}</ref> and other operational flaws.<ref name=":2">{{Cite web | url = https://www.s4me.info/threads/s4me-submission-to-the-public-review-on-common-data-elements-for-me-cfs-problems-with-the-chalder-fatigue-questionnaire.2065/ | title = S4ME: Submission to the public review on common data elements for ME/CFS: Problems with the Chalder Fatigue Questionnaire | website = Science for ME|language=en-US|access-date=2019-02-15}}</ref> The Chalder fatigue scale has not been accepted as a tool for research use by the US National Institute of Neurologic Diseases and Stroke (NINDS) Common Data Element committee.<ref>{{Cite web | url = https://www.commondataelements.ninds.nih.gov/cde_detailed_report/25203/Fatigue/Outcomes%20and%20End%20Points/Myalgic%20Encephalomyelitis%252FChronic%20Fatigue%20Syndrome/Fatigue%20Severity%20Scale%20(FSS) | title = CDE Detailed Report {{!}} NINDS Common Data Elements | website = commondataelements.ninds.nih.gov|access-date=2020-12-06}}</ref> == Background == === Origin === The Chalder fatigue scale was developed by the research team of Trudie Chalder at King's College London in 1993.<ref name=":0" /> The scale was based on a similar questionnaire that had been used in a hospital-based case study comparing [[ME/CFS]] patients to patients with neuromuscular and affective illnesses,<ref>{{Cite journal | last = Wessely | first = S | last2 = Powell | first2 = R | date = Aug 1989 | title = Fatigue syndromes: a comparison of chronic "postviral" fatigue with neuromuscular and affective disorders. | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1031831/ | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 52 | issue = 8 | pages = 940–948|issn=0022-3050|pmc=1031831|pmid=2571680}}</ref> and a study testing the efficacy of [[cognitive behavioral therapy]] (CBT) in ME/CFS patients.<ref>{{Cite journal | last = Butler | first = S | last2 = Chalder | first2 = T | last3 = Ron | first3 = M | last4 = Wessely | first4 = S | date = Feb 1991 | title = Cognitive behaviour therapy in chronic fatigue syndrome. | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1014351/ | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 54 | issue = 2 | pages = 153–158|issn=0022-3050|pmc=1014351|pmid=2019842}}</ref> === From 14 to 11 items === Three versions of the CFQ exist. Originally the scale had 14 questions but following a principal component analysis (PCA) and item discriminative properties based on receiver-operating characteristic (ROC) analysis, 3 items were excluded.<ref name=":0" /> While the 14-item scale was used in several studies in the 1990s, the 11-item version is the most used version, today. # Do you have problems with tiredness? # Do you need to rest more? # Do you feel [[Somnolence|sleepy]] or drowsy? # Do you have problems starting things? # Do you lack energy? # Do you have [[Muscle fatigability|less strength in your muscles]]? # Do you feel weak? # Do you have [[Cognitive dysfunction|difficulties concentrating]]? # Do you make [[Speech difficulties|slips of the tongue when speaking]]? # Do you find it more [[Word-finding problems|difficult to find the right word]]? # How is your [[Memory problems|memory]]? The deteled items from the 14-item scale are: * Do you start things without difficulty but get weak as you go on? * Do you think as clearly as usual? * Are you still interested in the things you used to do? === Likert or bimodal scoring === The Chalder fatigue has two scoring system. In the bimodal scoring system, respondents answer each question with a 1 or a 0 to indicate the questions apply to them or not. In the Likert scoring system, respondents can give a score of 0 to 3 to indicate how each statement applies to them, from “less than usual” to “much more than usual”.<ref name=":16">[http://www.goodmedicine.org.uk/files/assessment,%20chalder%20fatigue%20scale.pdf goodmedicine.org.uk. Chalder Fatigue Scale.]</ref> {| class="wikitable" | colspan="3" |'''Scoring schemes for the Chalder Fatigue Scale''' |- | |Bimodal score |Likert score |- |Less than usual |0 |0 |- |No more than usual |0 |1 |- |More than usual |1 |2 |- |Much more than usual |1 |3 |} While the first version counts the number of symptoms, the other weights the intensity of the symptoms. Some have argued that these changes should not be seen as merely different scoring schemes, but as different versions of the same scale.<ref name=":2" /> In the PACE trial both scoring schemes of the Chalder fatigue scale were recorded. The data showed that 22 participants showed improvement at the primary trial endpoint based on one scoring method, while the other scoring method showed a decline.<ref>Dataset available at <nowiki>https://sites.google.com/site/pacefoir/pace-ipd_foia-qmul-2014-f73.xlsx?attredirects=0</nowiki>, ‘readme’ file <nowiki>https://sites.google.com/site/pacefoir/pace-ipd-readme.txt?attredirects=0</nowiki></ref> === Physical and mental fatigue === The 11-item chalder fatigue scale is often divided into two components: one that measures physical fatigue (questions 1-7) and one that measures mental fatigue (questions 8-11).<ref name=":0" /> These components were confirmed by an analysis of a sample of 361 ME/CFS patients and 1615 healthy persons.<ref name=":1" /> Other analyses however found only 1<ref name=":4" /><ref name=":9">{{Cite journal | last = Chalder | first = Trudie | last2 = Ali | first2 = Sheila | last3 = Matcham | first3 = Faith | last4 = Norton | first4 = Sam | date = 2016-04-01 | title = 126 Psychometric Properties of Two Fatigue Scales in Rheumatology Outpatients: Unidimensional Scales Measuring Multifaceted Constructs |url =https://academic.oup.com/rheumatology/article/55/suppl_1/i113/1794176 | journal = Rheumatology|language=en | volume = 55 | issue = suppl_1| pages=i113–i114|doi=10.1093/rheumatology/kew130.010|issn=1462-0324}}</ref><ref name=":10">{{Cite journal | last = Jing | first = Meng-Juan | last2 = Lin | first2 = Wei-Quan | last3 = Wang | first3 = Qiang | last4 = Wang | first4 = Jia-Ji | last5 = Tang | first5 = Jie | last6 = Jiang | first6 = En-She | last7 = Lei | first7 = Yi-Xiong | last8 = Wang | first8 = Pei-Xi | date = Jan 2016 | title = Reliability and Construct Validity of Two Versions of Chalder Fatigue Scale among the General Population in Mainland China | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730538/ | journal = International Journal of Environmental Research and Public Health | volume = 13 | issue = 1|doi=10.3390/ijerph13010147|issn=1661-7827|pmc=4730538|pmid=26805863}}</ref> or more than two components<ref name=":5">{{Cite journal | last = Morriss | first = R.K. | last2 = Wearden | first2 = A.J. | last3 = Mullis | first3 = R. | date = Nov 1998 | title = Exploring the validity of the Chalder Fatigue scale in chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/9835234 | journal = Journal of Psychosomatic Research | volume = 45 | issue = 5 | pages = 411–417|issn=0022-3999|pmid=9835234}}</ref><ref name=":6">{{Cite journal | last = Fong | first = Ted C.T. | last2 = Chan | first2 = Jessie S.M. | last3 = Chan | first3 = Cecilia L.W. | last4 = Ho | first4 = Rainbow T.H. | last5 = Ziea | first5 = Eric T.C. | last6 = Wong | first6 = Vivian C.W. | last7 = Ng | first7 = Bacon F.L. | last8 = Ng | first8 = S.M. | date = Sep 2015 | title = Psychometric properties of the Chalder Fatigue Scale revisited: an exploratory structural equation modeling approach | url = https://www.ncbi.nlm.nih.gov/pubmed/25688039 | journal = Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation | volume = 24 | issue = 9 | pages = 2273–2278|doi=10.1007/s11136-015-0944-4|issn=1573-2649|pmc=4529874|pmid=25688039}}</ref> in the 11-item Chalder fatigue scale. == Reliability == === Internal consistency and convergent validity === The Chalder fatigue scale has been shown to have good internal consistency, as indicated by a split half reliabilities of 0.85<ref name=":0" /> and a Cronbach alpha that ranges between 0.86 and 0.92. {| class="wikitable" ! colspan="2" |Cronbach alpha for the 11-item fatigue scale |- |Chalder et al. 1993<ref name=":0" /> |0.88-0.90 |- |Loge et al. 1998<ref name=":3" /> |0.86 |- |Cella et al. 2010<ref name=":1" /> |0.88-0.92 |- |Wong & Fielding 2010<ref name=":7">{{Cite journal | last = Wong | first = Wing S. | last2 = Fielding | first2 = Richard | date = Jan 2010 | title = Construct validity of the Chinese version of the Chalder Fatigue Scale in a Chinese community sample | url =https://www.ncbi.nlm.nih.gov/pubmed/20004305 | journal = Journal of Psychosomatic Research | volume = 68 | issue = 1 | pages = 89–93|doi=10.1016/j.jpsychores.2009.05.008|issn=1879-1360|pmid=20004305}}</ref> |0,86 |} [[De Vries]] et al. 2003 demonstrated that the CFQ had good test-retest reliability and convergent validity, as it correlated strongly with other fatigue questionnaires.<ref name=":4" /> This was confirmed by [[Leonard Jason|Jason]] et al. who noted a good correlation between the CFQ and the fatigue severity scale by Krupp et al.<ref name=":8">{{Cite journal | last = Jason | first = Leonard A. | last2 = Evans | first2 = Meredyth | last3 = Brown | first3 = Molly | last4 = Porter | first4 = Nicole | last5 = Brown | first5 = Abigail | last6 = Hunnell | first6 = Jessica | last7 = Anderson | first7 = Valerie | last8 = Lerch | first8 = Athena | date = 2011 | title = Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity | url= https://www.ncbi.nlm.nih.gov/pubmed/21966179 | journal = Disability Studies Quarterly | volume = 31 | issue = 1|issn=2159-8371|pmc=3181109|pmid=21966179}}</ref> The correlation of the CFQ with other measures of health has been conflicting. [[Fong]] et al.<ref name=":6" /> noted that the CFQ correlated modestly with a poor physical and mental quality of life, while [[Wong]] & [[Fielding]] found that the CFQ was weakly correlated with physical quality of life.<ref name=":7" /> According to Jason et al. the CFQ correlated poorly with characteristic CFS-symptoms such as [[post-exertional malaise]] (PEM) or [[Myalgia|muscle pain]], compared to another fatigue questionnaire.<ref name=":8" /> === Content validity === Some authors have questioned whether the CFQ adequately assesses fatigue. [[Gerwyn Morris|Morris]] et al.<ref name=":5" /> noted that the item “[[Somnolence|feeling sleepy]] or drowsy” seems more related to sleepiness and problems with [[Insomnia|maintaining sleep at night]], than fatigue. [[Tom Kindlon]] has argued that the item “do you have problems starting things” seems more related to motivation instead of fatigue.<ref name=":14">{{Cite web | url = https://www.s4me.info/threads/my-feedback-on-content-of-cdes-fatigue-myalgic-encephalomyelitis-chronic-fatigue-syndrome-me-cfs-cde-public-review.2017/ | last = Kindlon | first = Tom | authorlink = Tom Kindlon | title = My feedback on content of CDEs (Fatigue) - Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) CDE Public Review | website = Science for ME|language=en-US|access-date=2019-02-16}}</ref> Both these questioned received low scores in a study of [[Myalgic encephalomyelitis|ME]] patients.<ref name=":11">{{Cite journal |url = https://www.researchgate.net/publication/260987489_Fatigue_in_Myalgic_Encephalomyelitis | last = Goudsmit | first = Ellen M. | authorlink = Ellen Goudsmit | last2 = Stouten | first2 =Bart | last3 = Howes | first3 = S | author-link3 = Sandra Howes|journal = Bulletin of the IACFS/ME | date = 2008| title = Fatigue in Myalgic Encephalomyelitis.}}</ref> [[Carolyn Wilshire|Wilshere]] et al.<ref name=":2" /> pointed out that four items of the CFQ measure cognitive difficulties ([[Cognitive dysfunction|difficulties concentrating]], [[Speech difficulties|slips of the tongue]], difficulty finding the [[Word-finding problems|right word]] and [[memory problems]]) instead of [[fatigue]]. Since a bimodal score of four or more on the CFQ has been defined as caseness of fatigue, it’s possible for a patient to be a fatigue case if their only symptoms are these [[Nervous system|neurological]] symptoms. A detailed critique of the CFQ, written by members of the online forum Science for ME, concluded: <blockquote>“The scale assumes that memory problems, speech errors, [[Somnolence|sleepiness]]/drowsiness, [[Paresis|muscle weakness]] and so on are indicators of fatigue, and that the more such symptoms a patient reports, the greater their overall fatigue. These assumptions are untested and their basis is unclear.”<ref name=":2" /> </blockquote> === Discrimination === The Chalder fatigue scale has been used in studies of various diseases such as [[cancer]],<ref>{{Cite journal | last = Armes | first = Jo | last2 = Chalder | first2 = Trudie | last3 = Addington-Hall | first3 = Julia | last4 = Richardson | first4 = Alison | last5 = Hotopf | first5 = Matthew | date = 2007-09-15 | title = A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue | url =https://www.ncbi.nlm.nih.gov/pubmed/17661342 | journal = Cancer | volume = 110 | issue = 6 | pages = 1385–1395|doi=10.1002/cncr.22923|issn=0008-543X|pmid=17661342}}</ref> [[multiple sclerosis]] (MS),<ref name=":17">{{Cite journal | last = van Kessel | first = Kirsten | last2 = Moss-Morris | first2 = Rona | last3 = Willoughby | first3 = Ernest | last4 = Chalder | first4 = Trudie | last5 = Johnson | first5 = Malcolm H. | last6 = Robinson | first6 = Elizabeth | date = Feb 2008 | title = A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue | url =https://www.ncbi.nlm.nih.gov/pubmed/18256342 | journal = Psychosomatic Medicine | volume = 70 | issue = 2 | pages = 205–213|doi=10.1097/PSY.0b013e3181643065|issn=1534-7796|pmid=18256342}}</ref> and [[rheumatoid arthritis]].<ref name=":9" /> It has been translated into different languages including Brazilian<ref>{{Cite journal | last = Cho | first = Hyong Jin | last2 = Costa | first2 = Erico | last3 = Menezes | first3 = Paulo Rossi | last4 = Chalder | first4 = Trudie | last5 = Bhugra | first5 = Dinesh | last6 = Wessely | first6 = Simon | date = Mar 2007 | title = Cross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care | url =https://www.ncbi.nlm.nih.gov/pubmed/17324680 | journal = Journal of Psychosomatic Research | volume = 62 | issue = 3 | pages = 301–304|doi=10.1016/j.jpsychores.2006.10.018|issn=0022-3999|pmid=17324680}}</ref> and Chinese.<ref name=":10" /> The use of the CFQ in patients with ME/CFS, however, has been criticized. Most studies on the validity of the CFQ in this patient population used the [[Oxford criteria]], a definition of ME/CFS that has been rejected by American health authorities.<ref>{{Cite journal | last = Green | first = Carmen R. | last2 = Cowan | first2 = Penney | last3 = Elk | first3 = Ronit | last4 = O'Neil | first4 = Kathleen M. | last5 = Rasmussen | first5 = Angela L. | date = 2015-06-16 | title = National Institutes of Health Pathways to Prevention Workshop: Advancing the Research on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/26075757 | journal = Annals of Internal Medicine | volume = 162 | issue = 12 | pages = 860–865|doi=10.7326/M15-0338|issn=1539-3704|pmid=26075757}}</ref><ref>{{Cite book | url =https://www.ncbi.nlm.nih.gov/books/NBK379582/ | title = July 2016 Addendum | last = McDonagh | first = Marian | last2 = Wasson | first2 = Ngoc | last3 = Daeges | first3 = Monica | last4 = Pappas | first4 = Miranda | last5 = Haney | first5 = Elizabeth | last6 = Nelson | first6 = Heidi D. | last7 = Smith | first7 = M. E. Beth | date = Dec 2014| publisher = Agency for Healthcare Research and Quality (US)|language=en}}</ref> [[David Cella|Cella]] et al.<ref name=":1" /> reported that high scores on the CFQ effectively discriminate between ME/CFS patients and the general population. In their study, a person with a [[Likert score]] of 29, had less than a 5% chance of not having CFS. Good sensitivity of the CFQ in selecting patients with ME/CFS was confirmed by Jason et al.<ref name=":8" />The same study indicated however, that the CFQ lacks adequate specificity: some patients without ME/CFS also obtained high scores. High sensitivity but low specificity was also the conclusion of a study that used the CFQ as an early screening tool in making the diagnosis of ME/CFS. While the CFQ was able to distinguish ME/CFS patients from healthy persons, it failed to differentiate ME/CFS from other fatiguing illnesses such as multiple sclerosis and [[Systemic lupus erythematosus|lupus]].<ref>{{Cite journal |url = https://www.researchgate.net/publication/232521164_A_screening_instrument_for_Chronic_Fatigue_Syndrome_Reliability_and_validity |vauthors = Jason LA, Ropacki MT, Santoro NB, Richman JA, Heatherly W, Taylor R, Ferrari JR, Haneydavis TM, Rademaker A, Dupuis J, Golding J|journal =Journal of Chronic Fatigue Syndrome|volume =3|issue =1| pages =39-59 |doi=10.1300/J092v03n01_04 | date = 1997| title = A screening instrument for Chronic Fatigue Syndrome: Reliability and validity}}</ref> A further study by [[Fred Friedberg|Friedberg]] & [[Leonard Jason|Jason]] concluded that the CFQ was unable to distinguish individuals with CFS from those with primary [[depression]].<ref>Friedberg F, Jason LA. Selecting a fatigue rating scale. The CFS Research Review. 2002; 35:7–11</ref> Only one studied the validity of the CFQ in patients with ME. [[Ellen Goudsmit|Goudsmit]] et al.<ref name=":11" /> report that the fatigue scale failed to discriminate between patients with moderate and severe ME. There was a large overlap in fatigue scores between these two groups. In a study of 168 CFS patients, the total score of the CFQ was unable to differentiatie patients on long-term sick leave from those who remained able to work.<ref>{{Cite journal | last = Chalder | first = Trudie | last2 = Harvey | first2 = Samuel B. | last3 = Henderson | first3 = Max | last4 = Knudsen | first4 = Ann Kristin | date = Nov 2011 | title = Long-term sickness absence among patients with chronic fatigue syndrome | url =https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/longterm-sickness-absence-among-patients-with-chronic-fatigue-syndrome/FF29B25634980EBEF557E5C8754040B9#fndtn-supplementary-materials | journal = The British Journal of Psychiatry|language=en | volume = 199 | issue = 5 | pages = 430–431|doi=10.1192/bjp.bp.110.082974|issn=0007-1250}}</ref> == Criticism == === Ceiling effects === The use of the Chalder Fatigue Scale in ME/CFS has been criticized because ME/CFS patients often record the maximum score on most of the 11 questions.<ref name=":13" /> As a result, patients can no longer indicate a worsening of their fatigue, a phenomenon that is called the ceiling effect. This can influence the findings of randomized trials. As explained by [[Rebecca Goldin]]: <blockquote>“Let us suppose for a moment that 100 people are experiencing extreme fatigue. They each answer “much worse than usual” on the Questionnaire (a 3) to all 11 questions, resulting in a score of 33. Over the course of a year, there are random fluctuations in their health—half get worse, and half get better. Now they take the questionnaire again. Those who get worse still answer “3” to all questions (final score: 33). Those who improve now answer a “2” to all questions, stating that they are just “worse than usual” but not “much worse” (final score: 22). The new average is now 27.5, a significant improvement over the original score of 33.”<ref>{{Cite web | url = http://senseaboutscienceusa.org/pace-research-sparked-patient-rebellion-challenged-medicine/ | title = PACE: The research that sparked a patient rebellion and challenged medicine | last = sasusa | date = 2016-03-21 | website = Sense About Science USA|language=en-US|access-date=2019-02-16}}</ref></blockquote>In other words, if patients record the maximum score and half of them improve while the other half deteriorates during follow-up then only the improvement will become visible on the questionnaire.<ref name=":14" /> [[Bart Stouten]]<ref name=":12" /> calculated lower bounds for the number of items with the maximum score on the CFQ for several behavioral intervention studies. High ceiling effects were noted in multiple trials. In the randomized trials of Deale et al. and Powell et al. the intervention group recorded the maximum bimodal score on more than 90% of the questions on the CFQ. A study on 25 patients with ME, found that 50% of the patients recorded the maximum score using the bimodal method. The problem is less pronounced using the [[Likert score]], though 15% of ME patients still indicated the maximum score of 33. In the FINE and PACE trial, 29.1% and 14.5% of the participants respectively scored the maximum score at baseline.”<ref name=":14" /> === Problems with the Likert score === Due to ceiling effects, the [[Likert score|Likert scoring]] has become the more popular version of the CFQ. The [[PACE trial]], for example, changed their primary outcome of fatigue from bimodal scoring as chosen by the protocol, to Likert scoring.<ref name=":15" /> Separate problems have been noted with this scoring method. The introduction to this version of the CFQ, asks respondents to compare themselves to how they felt when they were last well.<ref name=":16" /> A response of ‘no more than usual’ (score 1) would thus indicate full recovery. Persons without fatigue problems would score 11/33, indicating that they had fatigue ‘no more than usual’.<ref name=":14" /> Indeed, the use of the CFQ in healthy community samples yielded scores of 12-14.<ref>{{Cite journal | last = Pawlikowska | first = T. | last2 = Chalder | first2 = T. | last3 = Hirsch | first3 = S.R. | last4 = Wallace | first4 = P. | last5 = Wright | first5 =D.J. | last6 = Wessely | first6 = S.C. | date = 1994-03-19 | title = Population based study of fatigue and psychological distress |url =https://www.ncbi.nlm.nih.gov/pubmed/7908238 | journal = BMJ (Clinical research ed.) | volume = 308 | issue = 6931 | pages = 763–766|issn=0959-8138|pmc=2539651|pmid=7908238}}</ref><ref name=":1" /><ref name=":3" /> The Likert score of the CFQ also offers the option “less than usual” (score 0). It’s not clear what such an answer means. It seems to indicate an abnormal absence of fatigue complaints. Evidence that this option confuses respondents, comes from a trial on cognitive behavioral therapy in patients with multiple sclerosis. Post-treatment MS patients recorded a score of less than 10, indicating they had less fatigue than healthy persons. Even the control which received relaxation therapy had lower fatigue scores than healthy persons.<ref name=":17" /> This may indicate that they misinterpreted the "less than usual” (score 0) option, or that their "healthy" level involved some level of tiredness that disappeared with treatment, or simply that they felt abnormally alert. Results like these can question the reliability of the Likert scoring system of the CFQ. '''<big>Clinical useful difference and similar terms</big>''' In the PACE Trial, a post-hoc analysis defined a clinical useful difference as a change of 2 or more. a This was questioned by Giakoumakis. b This contrasted with a statement in an earlier paper c: “Because the Chalder fatigue scale is relatively new, there is no published definition of equivalence. The researchers in this trial include several of those involved in developing and testing the instrument. Our consensus view was that a difference of less than four, using a Likert scale, is not important.” The researchers in the trial included Trudie Chalder (one of the principal investigators in the PACE Trial) and Simon Wessely. d ''a. White PD, Goldsmith KA, Johnson AL et al. on behalf of the PACE trial management group Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011; 377: 823-836'' ''b. Giakoumakis J. The PACE trial in chronic fatigue syndrome. Lancet. 2011, 377:1831'' ''c. Ridsdale L, Godfrey E, Seed P: Chronic Fatigue in general practice: authors reply. Br J Gen Pract 2001, 51:317–318.'' ''d. Ridsdale L, Godfrey E, Chalder T, Seed P, King M, Wallace P, Wessely S; Fatigue Trialists' Group. Chronic fatigue in general practice: is counselling as good as cognitive behaviour therapy? A UK randomised trial. Br J Gen Pract. 2001 51:19-24.'' ==Notable studies== *1993, [https://www.ncbi.nlm.nih.gov/pubmed/8463991 Development of a fatigue scale]<ref name="Chalder, 1993" /> *1998, [[pubmed:9835234|Exploring the validity of the Chalder Fatigue scale in chronic fatigue syndrome.]]<ref name=":5" /> *2010, [[pubmed:20630259|Measuring fatigue in clinical and community settings.]]<ref name=":1" /> *2011, [[pubmed:21334061|Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial.]]<ref name=":15" /> [This study is under significant doubt due to inconsistencies in data. Recommendations from this trial are now considered unreliable and are being withdrawn from some national ME/CFS guidelines.)]<ref name=":2" /> *2017, Public Review - Draft of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome [[ME/CFS Common Data Elements Working Group|(ME/CFS) Common Data Elements]] (CDE); Fatigue Subgroup Materials<ref name="Common Data Elements, 2017" /> [https://www.commondataelements.ninds.nih.gov/Doc/MECFS/03_Fatigue_Subgroup_CDE_Draft_Recommendations.pdf (Full Text)] ==See also== *[[Trudie Chalder]] ==Learn more== *[http://www.goodmedicine.org.uk/files/assessment,%20chalder%20fatigue%20scale.pdf Chalder fatigue scale] *[http://evaluatingpace.phoenixrising.me/aps3chalder.html ME analysis - The Chalder fatigue scale] *2016, [https://lucibee.wordpress.com/2016/04/02/fatigued-by-scales-as-outcome-measures/ Fatigued by scales as outcome measures] *2018, [https://www.s4me.info/threads/s4me-submission-to-the-public-review-on-common-data-elements-for-me-cfs-problems-with-the-chalder-fatigue-questionnaire.2065/ Analysis of the Chalder fatigue scale submitted by a team of Science for ME forum members to the NIH/CDC Common Data Elements review.] ==References== <references> <ref name="Chalder, 1993">{{Citation | last1 = Chalder | first1 = T | author-link1 = Trudie Chalder | last2 = Berelowitz | first2 = G | author-link2 = | last3 = Pawlikowska | first3 = T | author-link3 = | last4 = Watts | first4 = L | author-link4 = | last5 = Wessely | first5 = S | author-link5 = Simon Wessely | last6 = Wright | first6 = D | author-link6 = | last7 = Wallace | first7 = EP | author-link8 = | title = Development of a fatigue scale | journal = J Psychosom Res | volume = 37 | issue = | page = 147-153 | date = 1993 | pmid = 8463991 | doi = }}</ref> <ref name="Common Data Elements, 2017">{{Citation | last1 = Cella | first1 = David | author-link1 = David Cella | last2 = Dimmock | first2 = Mary| author-link2 = Mary Dimmock | last3 = Friedberg | first3 = Fred | author-link3 = Fred Friedberg | last4 = Lin | first4 = Jin-Mann Sally | author-link4 = Jin-Mann Sally Lin | last5 = Nacul | first5 = Luis| author-link5 = Luis Nacul | last6 = Saligan | first6 = Leorey | author-link6 = Leorey Saligan | title = NINDS/CDC Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Common Data Elements (CDE); Fatigue Subgroup Materials | date =Dec 2017 | url = https://www.commondataelements.ninds.nih.gov/Doc/MECFS/03_Fatigue_Subgroup_CDE_Draft_Recommendations.pdf }}</ref> </references> [[Category:Symptom scales]]
Summary:
Please make sure your edits are consistent with
MEpedia's guidelines
.
By saving changes, you agree to the
Terms of use
, and you irrevocably agree to release your contribution under the
CC BY-SA 3.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)
Templates used on this page:
Template:Citation
(
edit
)
Template:Cite book
(
edit
)
Template:Cite journal
(
edit
)
Template:Cite web
(
edit
)
Module:Citation/CS1
(
edit
)
Module:Citation/CS1/COinS
(
edit
)
Module:Citation/CS1/Configuration
(
edit
)
Module:Citation/CS1/Date validation
(
edit
)
Module:Citation/CS1/Identifiers
(
edit
)
Module:Citation/CS1/Utilities
(
edit
)
Module:Citation/CS1/Whitelist
(
edit
)
Module:No globals
(
edit
)
Navigation
Navigation
Skip to content
Main page
Browse
Become an editor
Random page
Popular pages
Abbreviations
Glossary
About MEpedia
Links for editors
Contents
Guidelines
Recent changes
Pages in need
Search
Help
Wiki tools
Wiki tools
Special pages
Page tools
Page tools
User page tools
More
What links here
Related changes
Page information
Page logs