Chronisch Vermoeidheidssyndroom: diagnose, behandeling en ...

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68 Chronic Fatigue Syndrome KCE reports 88 Conversely, a sense of control over symptoms and not attributing illness to a physical cause were all associated with a good outcome. Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome. Whereas no significant predictor of return to work was identified, the probability to return to work is lower for those who had a diagnosis of major depression at baseline. Moreover, patients who had been ill for many years and experienced long periods of sickness absence have more difficulties to return to work than workers having short periods of sickness absence. A prospective study in a clinic-based cohort followed the natural course of a cohort of patients with CFS (n=93) over a 1.5-year period. 153 Approximately 18% of the patients no longer met criteria for CFS at their last research appointment 1.5 years after their index visit. Results of general linear mixed model analyses showed that (estimate [standard deviation], p-value): less education (-0.42 [0.18], p=0.02), being unemployed (1.29 [0.58], p=0.03), worse mental health (-0.05 [0.01], p
KCE Reports 88 Chronic Fatigue Syndrome 69 Key messages • Three quarters of CFS patients are women, and this disorder is most common in young persons between the ages of 25 and 50 years. • Physical and cognitive impairments experienced by CFS patients are endured for many years (range 2 – 8 years). • More than a half of CFS patients are unemployed or loss their job due to their condition. • Among employed CFS patients, less than 20% work full-time. • There is no evidence that older age and high fatigue severity at baseline would be predictive of a worse outcome. • No baseline demographic, clinical or psychiatric traits can predict CFS patients’ improvement and ability to return to work. • However, more somatic attributions for illness are likely to be associated with worse symptom severity over time. • Recovery is most common within the first 5 years of illness. The proportion of CFS patients who fully recover without systematic intervention is low (median rate of 7%) but the proportion of CFS patients who improve is higher (median rate of 39.5%); these proportions increase over time (after 5 and 10 years). • The worsening of symptoms during follow-up occurs in 5-20% of CFS patients. • Patients who had been ill for many years and experienced long periods of sickness absence have more difficulties to return to work. • Prognosis for CFS children and teenagers is more encouraging, with partial or total recovery obtained after 3-4 years. • Measuring outcomes in terms of patients needs (e.g. quality of life, relieving fatigue and pain) and societal needs (e.g. return to employment, fewer expenses devoted to diagnosis and rehabilitation) are both valuable.
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