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Chalder fatigue scale
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=== 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.''
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