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Chalder fatigue scale
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== 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>
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