Checklist Individual Strength

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Jump to: navigation, search

The Checklist Individual Strength (CIS) is a 20-item fatigue questionnaire developed by the Dutch research team of Vercoulen et al. in 1994.[1] The questionnaire has been translated into multiple languages and is used in various illnesses, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). An 8-item subscale of CIS that measures subjective fatigue regularly acts as a primary outcome in randomized trials on the effects cognitive behavior therapy in ME/CFS. The use of this subscale in a ME/CFS patient population however has been criticized for displaying ceiling effects.

Background[edit | edit source]

Origin[edit | edit source]

De Checklist Individual Strength (Checklist individuele Spankracht) was developed by the Dutch research team of Vercoulen et al. in 1994 at the universities of Amsterdam and Rotterdam.[1] CIS was intended to be a questionnaire to test the “behavioural, emotional, social, and cognitive aspects” of ME/CFS and to identify the multiple dimensions of ME/CFS patients’ disability.

20 questions, 4 subscales:[edit | edit source]

Initially the questionnaire consisted of 24 items but after testing in 298 patients who suffered from unexplained chronic fatigue for more than a year, 4 items were removed.[1] The factor analysis indicated 4 components[1] in the remaining 20 questions.  These were easy to interpret and were called:

  1. Subjective fatigue (8 items)
  2. Concentration (5 items)
  3. Motivation (4 items)
  4. Physical activity (3 items)

1-7 Likert score:[edit | edit source]

De CIS consists of 20 statements on fatigue-related problems respondents might have experienced in the past 2 weeks.[2] A Likert scoring scheme is used. With each statement respondents have to indicate a score from 1 to 7, indicating either “yes, that is true” or “no, that is not true.”  Examples of statements are:  “I feel tired”, “I have trouble concentrating” or “, I don’t do much during the day” etc.[3]  Almost half of the questions are inverted, meaning the statements indicate fitness instead of fatigue and the scoring system is reversed.  “Yes, that is true” would then indicate a score of 1 instead of 7. Examples of such statements are: “. I feel fit, “I feel rested” or “I am full of plans”.[4]

Reliability[edit | edit source]

Internal consistency[edit | edit source]

CIS has shown good internal consistency, with a Cronbach alpha of 0.90[5] and a Gutman split-half reliability coefficient of 0.92.[1][2]

Convergent validity[edit | edit source]

Research has shown that the results of the CIS  are comparable to those other measure of fatigue, such as fatigue measured on a unidimensional five point Likert scale or the scale exhaustion of the Maslach burnout inventory—general survey (MBI-GS).[6] Using a large sample of 351 persons of the working population, De Vries et al. showed that the CIS correlated with other fatigue questionnaires such as the Chalder Fatigue Scale.[7] In other studies, the concentration subscale of the CIS correlated with the subscale concentration problems of the Sickness Impact Profile (SIP)[8], while the subscale fatigue severity correlated with activity levels measured by an Actometer[9].

Discriminative valditiy[edit | edit source]

Discriminative validity of the CIS was tested by Beurskens et al.[6] in five sets of employees with expected differences in fatigue. The CIS was able to differentiate between healthy employees and those with a somatic or mental reason for fatigue. Vercoulen et al. showed that the CIS discriminates between ME/CFS patients from healthy controls and patients with functional bowel syndrome[1] or multiple sclerosis[10].

Use[edit | edit source]

Multiple languages and diseases[edit | edit source]

The CIS has been translated into different languages, including English, Portuguese[11], Polish[12], Japanese[13] and Turkish[14]. The questionnaire has been used in various illnesses including fibromyalgia[15], rheumatoid arthritis[16], multiple sclerosis[17], cancer[18], asthma[19], amyotrophic lateral sclerosis[20], sarcoidosis[21] and mitochondrial disorders[22].

Average scores[edit | edit source]

Indicative scores and standard deviations for the CIS and the subjective fatigue subscale are given below.[4][5]

  CIS-20 total score CIS-8 subjective fatigue
Healthy persons 41.5 (19.8) 17.3 (10.1)
Chronic fatigue syndrome 113.1 (14.6) 51.7 (4.6)
Multiple Sclerosis 85.1 (21.9) 40.2 (11.8)
Functional bowel disorder 71.1 (18.1) 34.1 (8.5)

In a study on work absence due to fatigue, a cut-off score of 76 on the CIS indicates a risk for subsequent sick leave or work disability.[23]  On the subjective fatigue subscale of CIS, a score of 35 is seen as indicative of severe fatigue.[24]

Criticism[edit | edit source]

Ceiling effects[edit | edit source]

The subjective fatigue (also called fatigue severity) subscale of the CIS has been the most widely used in the field of ME/CFS.[25][26][27][28] Because this subscale asks general questions about fatigue such as “I “feal tired” or “I feal weak”, ME/CFS often score close to the maximum score.[29]The fatigue severity subscale asks 8 questions which gives a score from 8 to 56. While healthy persons score on average 17.3 and patients with other chronic conditions usually score below 40, ME/CFS patients easily reach a score above 50. For example, in a study of homebound ME/CFS patients (which included some of the authors of the CIS), it was noted that “The CIS-fatigue score involves an overall rating and in CFS samples easily reaches the extreme end of its scale.”[30]

As a result ME/CFS 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. For example: If ME/CFS patients record the maximum score on the CIS and half of them improves while the other half deteriorates with the same amount during follow-up, then only the improvement will become visible on the questionnaire.[31] If such a result were used as a primary outcome in randomized trial, it might overestimate improvements in fatigue and underestimate deterioration or harms by the intervention.[32] Stouten B calculated the lower bounds for the number of items with the maximum score on the CIS fatigue severity subscale. In some studies this was as high as 46%.[29]

References[edit | edit source]

  1. 1.01.11.21.31.41.5 Vercoulen, J. H.; Swanink, C. M.; Fennis, J. F.; Galama, J. M.; van der Meer, J. W.; Bleijenberg, G. (Jul 1994). "Dimensional assessment of chronic fatigue syndrome". Journal of Psychosomatic Research. 38 (5): 383–392. ISSN 0022-3999. PMID 7965927. 
  2. 2.02.1 https://meetinstrumentenzorg.blob.core.windows.net/test-documents/Instrument160/160_1_N.pdf
  3. https://meetinstrumentenzorg.blob.core.windows.net/documents/Instrument160/CIS%20meetinstr.pdf
  4. 4.04.1 https://www.me-pedia.org/images/f/f8/Checklist_Individual_Strength_overzicht.pdf
  5. 5.05.1 Schulte-van Maaren, Yvonne Wilhelmina Maria; LUMC (Jan 21, 2014). "NormQuest : reference values for ROM instruments and questionnaires". openaccess.leidenuniv.nl. Retrieved Feb 17, 2019. 
  6. 6.06.1 Beurskens, A. J.; Bültmann, U.; Kant, I.; Vercoulen, J. H.; Bleijenberg, G.; Swaen, G. M. (May 2000). "Fatigue among working people: validity of a questionnaire measure". Occupational and Environmental Medicine. 57 (5): 353–357. ISSN 1351-0711. PMC 1739950Freely accessible. PMID 10769302. 
  7. De Vries, J; Michielsen, H; Van Heck, G L (Jun 2003). "Assessment of fatigue among working people: a comparison of six questionnaires". Occupational and Environmental Medicine. 60 (Suppl 1): i10–i15. doi:10.1136/oem.60.suppl_1.i10. ISSN 1351-0711. PMC 1765720Freely accessible. PMID 12782741. 
  8. Vercoulen, J H; Swanink, C M; Fennis, J F; Galama, J M; van der Meer, J W; Bleijenberg, G (May 1, 1996). "Prognosis in chronic fatigue syndrome: a prospective study on the natural course". Journal of Neurology, Neurosurgery & Psychiatry. 60 (5): 489–494. doi:10.1136/jnnp.60.5.489. ISSN 0022-3050. 
  9. Vercoulen, J.H.M.M.; Bazelmans, E.; Swanink, C.M.A.; Fennis, J.F.M.; Galama, J.M.D.; Jongen, P.J.H.; Hommes, O.; Van Der Meer, J.W.M.; Bleijenberg, G. (Nov 1997). "Physical activity in chronic fatigue syndrome: Assessment and its role in fatigue". Journal of Psychiatric Research. 31 (6): 661–673. doi:10.1016/s0022-3956(97)00039-3. ISSN 0022-3956. 
  10. Vercoulen, J. H.; Hommes, O. R.; Swanink, C. M.; Jongen, P. J.; Fennis, J. F.; Galama, J. M.; van der Meer, J. W.; Bleijenberg, G. (Jul 1996). "The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects". Archives of Neurology. 53 (7): 642–649. ISSN 0003-9942. PMID 8929171. 
  11. Maes, Stan; Leal, Isabel; Cordeiro, Andreia; Gouveia, Maria João; Gucht, Véronique De; Marques, Marta (Mar 28, 2013). "Psychometric Properties of the Portuguese Version of the Checklist of Individual Strength (CIS20-P)". Psychology, Community & Health. 2 (1): 11–18. doi:10.5964/pch.v2i1.57. ISSN 2182-438X. 
  12. Makowiec-Dabrowska, Teresa; Koszada-Włodarczyk, Wiesława (2006). "[The CIS20R Questionnaire and its suitability for prolonged fatigue studies]". Medycyna Pracy. 57 (4): 335–345. ISSN 0465-5893. PMID 17133914. 
  13. Aratake, Yutaka; Tanaka, Katsutoshi; Wada, Koji; Watanabe, Mayumi; Katoh, Noritada; Sakata, Yumi; Aizawa, Yoshiharu (Nov 2007). "Development of Japanese version of the checklist individual strength questionnaire in a working population". Journal of Occupational Health. 49 (6): 453–460. ISSN 1341-9145. PMID 18075205. 
  14. Ergin, Gülbin; Yildirim, Yücel (Nov 2012). "A validity and reliability study of the Turkish Checklist Individual Strength (CIS) questionnaire in musculoskeletal physical therapy patients". Physiotherapy Theory and Practice. 28 (8): 624–632. doi:10.3109/09593985.2011.654321. ISSN 1532-5040. PMID 22324761. 
  15. Zijlstra, T. R.; Taal, E.; van de Laar, M. A. F. J.; Rasker, J. J. (Jun 6, 2006). "Validation of a Dutch translation of the fibromyalgia impact questionnaire". Rheumatology. 46 (1): 131–134. doi:10.1093/rheumatology/kel171. ISSN 1462-0332. 
  16. van Hoogmoed, Dewy; Fransen, Jaap; Bleijenberg, Gijs; van Riel, Piet (Jul 2010). "Physical and psychosocial correlates of severe fatigue in rheumatoid arthritis". Rheumatology (Oxford, England). 49 (7): 1294–1302. doi:10.1093/rheumatology/keq043. ISSN 1462-0332. PMID 20353956. 
  17. van der Werf, S. P.; Jongen, P. J.; Lycklama à Nijeholt, G. J.; Barkhof, F.; Hommes, O. R.; Bleijenberg, G. (Oct 8, 1998). "Fatigue in multiple sclerosis: interrelations between fatigue complaints, cerebral MRI abnormalities and neurological disability". Journal of the Neurological Sciences. 160 (2): 164–170. ISSN 0022-510X. PMID 9849800. 
  18. Servaes, P.; van der Werf, S.; Prins, J.; Verhagen, S.; Bleijenberg, G. (Jan 2001). "Fatigue in disease-free cancer patients compared with fatigue in patients with chronic fatigue syndrome". Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer. 9 (1): 11–17. ISSN 0941-4355. PMID 11147137. 
  19. Van Herck, Maarten; Spruit, Martijn A.; Burtin, Chris; Djamin, Remco; Antons, Jeanine; Goërtz, Yvonne M. J.; Ebadi, Zjala; Janssen, Daisy J. A.; Vercoulen, Jan H. (Nov 23, 2018). "Fatigue is Highly Prevalent in Patients with Asthma and Contributes to the Burden of Disease". Journal of Clinical Medicine. 7 (12). doi:10.3390/jcm7120471. ISSN 2077-0383. PMID 30477110. 
  20. Panitz, S.; Kornhuber, M.; Hanisch, F. (Jun 2015). "The checklist individual strength (CIS20-R) in patients with amyotrophic lateral sclerosis - a longitudinal study". Acta Neurologica Scandinavica. 131 (6): 372–380. doi:10.1111/ane.12349. ISSN 1600-0404. PMID 25639482. 
  21. Korenromp, Ingrid H. E.; Heijnen, Cobi J.; Vogels, Oscar J. M.; van den Bosch, Jules M. M.; Grutters, Jan C. (Aug 2011). "Characterization of chronic fatigue in patients with sarcoidosis in clinical remission". Chest. 140 (2): 441–447. doi:10.1378/chest.10-2629. ISSN 1931-3543. PMID 21330380. 
  22. Smits, Bart; van den Heuvel, Lambert; Knoop, Hans; Küsters, Benno; Janssen, Antoon; Borm, George; Bleijenberg, Gijs; Rodenburg, Richard; van Engelen, Baziel (Sep 2011). "Mitochondrial enzymes discriminate between mitochondrial disorders and chronic fatigue syndrome". Mitochondrion. 11 (5): 735–738. doi:10.1016/j.mito.2011.05.005. ISSN 1872-8278. PMID 21664495. 
  23. Bültmann, U.; de Vries, M.; Beurskens, A. J.; Bleijenberg, G.; Vercoulen, J. H.; Kant, I. (Oct 2000). "Measurement of prolonged fatigue in the working population: determination of a cutoff point for the checklist individual strength". Journal of Occupational Health Psychology. 5 (4): 411–416. ISSN 1076-8998. PMID 11051524. 
  24. "An analysis of Dutch hallmark studies confirms the outcome of the PACE trial: cognitive behaviour therapy with a graded activity protocol is not effective for chronic fatigue syndrome and Myalgic Encephalomyelitis". www.oatext.com. Retrieved Feb 17, 2019. 
  25. Prins, Judith B; Bleijenberg, Gijs; Bazelmans, Ellen; Elving, Lammy D; de Boo, Theo M; Severens, Johan L; van der Wilt, Gert Jan; Spinhoven, Philip; van der Meer, Jos WM (Mar 2001). "Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial". The Lancet. 357 (9259): 841–847. doi:10.1016/s0140-6736(00)04198-2. ISSN 0140-6736. 
  26. Wiborg, Jan F.; van Bussel, Jose; van Dijk, Agaat; Bleijenberg, Gijs; Knoop, Hans (2015). "Randomised Controlled Trial of Cognitive Behaviour Therapy Delivered in Groups of Patients with Chronic Fatigue Syndrome". Psychotherapy and Psychosomatics. 84 (6): 368–376. doi:10.1159/000438867. ISSN 0033-3190. 
  27. Knoop, Hans; van der Meer, Jos W. M.; Bleijenberg, Gijs (Oct 2008). "Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial". British Journal of Psychiatry. 193 (04): 340–341. doi:10.1192/bjp.bp.108.051292. ISSN 0007-1250. 
  28. Janse, A.; Worm-Smeitink, M.; Bleijenberg, G.; Donders, R.; Knoop, H. (Feb 2018). "Efficacy of web-based cognitive–behavioural therapy for chronic fatigue syndrome: randomised controlled trial". The British Journal of Psychiatry. 212 (02): 112–118. doi:10.1192/bjp.2017.22. ISSN 0007-1250. 
  29. 29.029.1 Stouten, Bart (May 13, 2005). "Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution". BMC health services research. 5: 37. doi:10.1186/1472-6963-5-37. ISSN 1472-6963. PMC 1175848Freely accessible. PMID 15892882. 
  30. Van der Werf S, Prins J, Klein-Rouweler E, Alberts M, van der Meer J, Bleijenberg G: Homebound chronic fatigue syndrome patients. Determinants and consequences of experienced fatigue in chronic fatigue syndrome and neurological conditions. PhD thesis 2000:31-41
  31. "My feedback on content of CDEs (Fatigue) - Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) CDE Public Review". Science for ME. Retrieved Feb 17, 2019. 
  32. sasusa (Mar 21, 2016). "PACE: The research that sparked a patient rebellion and challenged medicine". Sense About Science USA. Retrieved Feb 17, 2019. 

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.