Psychometric properties of the Dutch Chronic Fatigue Syndrome--Activities and Participation Questionnaire (CFS-APQ). (Research Report).Chronic fatigue syndrome chronic fatigue syndrome (CFS), collection of persistent, debilitating symptoms, the most notable of which is severe, lasting fatigue. In other countries it is known variously as myalgic encephalomyelitis, chronic fatigue and immune dysfunction syndrome, and (CFS CFS abbr. chronic fatigue syndrome CFS, n.pr See syndrome, chronic fatigue. CFS Chronic fatigue syndrome, see there ) is characterized char·ac·ter·ize tr.v. character·ized, character·iz·ing, character·iz·es 1. To describe the qualities or peculiarities of: characterized the warden as ruthless. 2. by persistent or relapsing relapsing /re·laps·ing/ (re-lap´sing) (re´lap-sing) recurrent; denoting an illness that is characterized by periods of remission alternating with attacks of symptomatic disease. fatigue fatigue, in engineering fatigue, in engineering, microscopic cracking of materials, especially metals, after repeated applications of stress. Fissures may be formed within pieces of metal during their manufacture when, while cooling from the molten state, lasting 6 or more consecutive months. (1,2) To fulfill ful·fill also ful·fil tr.v. ful·filled, ful·fill·ing, ful·fills also ful·fils 1. To bring into actuality; effect: fulfilled their promises. 2. the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation ) 1994 definition for CFS, (1) any medical condition that may explain the presence of chronic fatigue should be excluded. In addition, self-reported chronic fatigue should result in substantial reduction in previous levels of occupational, educational, social, or personal activities. No single underlying cause has been established for all patients with CFS, possibly due to the heterogeneity het·er·o·ge·ne·i·ty n. The quality or state of being heterogeneous. heterogeneity the state of being heterogeneous. of this patient group. Although the diagnosis of CFS requires severe activity limitations and participation restrictions (problems an individual may experience in involvement in life situations),(1,2) no disease-specific measures are currently available to assess these aspects of disability in people with CFS. Exercise capacity testing appears to be valid for monitoring cardiorespiratory fitness Cardiorespiratory fitness refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. Regular exercise makes these systems more efficient by enlarging the heart muscle, enabling more blood to be pumped , (3,4) albeit an expensive and time-consuming time-con·sum·ing adj. Taking up much time. time-consuming Adjective taking up a great deal of time Adj. 1. option for characterizing a component of CFS. Generic questionnaires, such as the Medical Outcomes Study 36-Item Short-Form Health Status Survey (SF-36) (3,5) are widely used in CFS research. The interpretation of data obtained with such generic measures is often difficult and time-consuming (eg, requiring interpretation of scores for 8 different subscales for the SF-36), which prohibits their routine application in practice. Furthermore, we believe that generic measures are unable to characterize all activity limitations and participation restrictions in patients with CFS and consequently have insufficient content validity content validity, n the degree to which an experiment or measurement actually reflects the variable it has been designed to measure. for this population. These limitations decrease the usefulness of general questionnaires, especially when identifying activity limitations, which we believe is crucial so that patients can be taught to manage their activity levels (also known as "pacing," a strategy where patients are encouraged to achieve an appropriate balance between activity and rest to avoid exacerbations and to set realistic goals for increasing activity). Therefore, an inexpensive, quick, and valid measure to assess activity limitations and participation restrictions in patients with CFS might be of great value, especially to establish goals and to examine the effectiveness of interventions. Indeed, the primary expectation of treatment for patients with less severe disability may not to be to reduce symptoms, but to regain full participation in work and social activities. Our group recently constructed a disease-specific and time-specific (reflecting the patients' health status during the last 7 days) questionnaire: the Chronic Fatigue Syndrome-Activities and Participation Questionnaire (CFS-APQ). (6) This new assessment tool was constructed based on self-reported activity limitations and participation restrictions of 141 patients with CFS (a retrospective LAW, RETROSPECTIVE. A retrospective law is one that is to take effect, in point of time, before it was passed. 2. Whenever a law of this kind impairs the obligation of contracts, it is void. 3 Dall. 391. analysis, of over 600 quality-of-life questionnaires). (6) In accordance Accordance is Bible Study Software for Macintosh developed by OakTree Software, Inc.[] As well as a standalone program, it is the base software packaged by Zondervan in their Bible Study suites for Macintosh. with the World Health Organization's taxonomy taxonomy: see classification. taxonomy In biology, the classification of organisms into a hierarchy of groupings, from the general to the particular, that reflect evolutionary and usually morphological relationships: kingdom, phylum, class, order, , the International Classification of Functioning, Disability and Health International Classification of Functioning, Disability and Health, also known as ICF, is a classification of the health components of functioning and disability. , (7) our new self-assessment Self-assessment in an organisational setting, according to the EFQM definition, refers to a comprehensive, systematic and regular review of an organisation's activities and results referenced against the EFQM Excellence Model. tool is designed to monitor activity limitations and participation restrictions in patients with CFS. In this study, the convergent validity Convergent validity is the degree to which an operation is similar to (converges on) other operations that it theoretically should also be similar to. For instance, to show the convergent validity of a test of mathematics skills, the scores on the test can be correlated with scores , 2 different aspects of content validity, and reliability of the CFS-APQ scores were examined in 47 patients with CFS. Method Subjects One hundred eleven consecutive patients with chronic fatigue who visited the Chronic Fatigue Clinic of the Vrije Universiteit Brussel The Vrije Universiteit Brussel (VUB) is a Flemish university situated in Brussels, Belgium. The university title means "Free University of Brussels". However, there is another Free University of Brussels, namely the French-speaking Université Libre de Bruxelles (ULB). for phlebotomy Phlebotomy Definition Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture in order to obtain a sample for analysis and diagnosis. between the beginning of March 2001 and the end of May 2001 completed the CFS-APQ. All questionnaires were administered by our secretaries. They asked the patients to complete the questionnaire but did not provide additional explanations, not even when patients asked for clarification. This was done to minimize administrator bias. An accompanying letter explaining the exact nature and purpose of the research stipulated that patients were not obliged o·blige v. o·bliged, o·blig·ing, o·blig·es v.tr. 1. To constrain by physical, legal, social, or moral means. 2. to participate and that anonymity was guaranteed. The introductory letter was followed by standardized standardized pertaining to data that have been submitted to standardization procedures. standardized morbidity rate see morbidity rate. standardized mortality rate see mortality rate. sheets for the assessment of the demographic features of each patient (age, sex, and illness duration). Patients who did not fulfill the 1994 definition for CFS (1) were excluded from the sample. To fulfill the CDC criteria for CFS, unexplained unexplained Adjective strange or unclear because the reason for it is not known Adj. 1. unexplained - not explained; "accomplished by some unexplained process" , persistent, or relapsing chronic fatigue that is of new or definite onset should result in a substantial reduction in previous levels of occupational, educational, social, or personal activities. (1) Furthermore, at least 4 of the following symptoms must have persisted or recurred during 6 or more consecutive months and must not have predated the fatigue: impairment Impairment 1. A reduction in a company's stated capital. 2. The total capital that is less than the par value of the company's capital stock. Notes: 1. This is usually reduced because of poorly estimated losses or gains. 2. in short-term memory short-term memory n. Abbr. STM The phase of the memory process in which stimuli that have been recognized and registered are stored briefly. or concentration, tender cervical cervical /cer·vi·cal/ (ser´vi-k'l) 1. pertaining to the neck. 2. pertaining to the neck or cervix of any organ or structure. cer·vi·cal adj. or axillary lymph nodes The Axillary lymph nodes are of large size, vary from twenty to thirty in number, and may be arranged in the following groups:
Pain in the upper portion of the head. Episodic tension headaches are the most common, usually causing mild to moderate pain on both sides. They result from sustained contraction of face and neck muscles, often due to fatigue, stress, or frustration. , unrefreshing sleep, and postexertional malaise malaise /mal·aise/ (mal-az´) a vague feeling of discomfort. mal·aise n. A vague feeling of bodily discomfort, as at the beginning of an illness. lasting longer than 24 hours. (1) Any active medical condition that may explain the presence of chronic fatigue prohibits the diagnosis of CFS. All subjects underwent an extensive medical evaluation, consisting of a physical examination, medical history, exercise capacity test, and routine laboratory tests. The laboratory tests included a complete blood cell count blood cell count, n an estimation of the number and types of circulating blood cells (e.g., red blood cells [erythrocytic series], white blood cells, differential). ; determination of erythrocyte sedimentation rate Erythrocyte Sedimentation Rate Definition The erythrocyte sedimentation rate (ESR), or sedimentation rate (sed rate), is a measure of the settling of red blood cells in a tube of blood during one hour. ; a serum electrolyte panel electrolyte panel Lab medicine A battery of tests used to evaluate serum–or rarely, stool electrolytes–eg, Na+, K+, chloride, CO2. See Panel. ; measures of renal renal /re·nal/ (re´n'l) pertaining to the kidney. re·nal adj. Of or in the region of the kidneys. Renal Relating to the kidney. , hepatic hepatic /he·pat·ic/ (he-pat´ik) pertaining to the liver. he·pat·ic adj. 1. Of, relating to, or resembling the liver. 2. Acting on or occurring in the liver. n. , and thyroid thyroid /thy·roid/ (thi´roid) 1. the thyroid gland; see under gland. 2. pertaining to the thyroid gland. 3. scutiform. 4. function; and rheumatic rheu·mat·ic adj. Relating to or characterized by rheumatism. n. One who is affected by rheumatism. rheumatic pertaining to or affected with rheumatism. and viral Meaning "related or caused by a virus," with regard to computers and information technology, the term refers less to a computer virus than it does to information that spreads quickly via the Internet. See viral marketing and viral video. screens. If the patients' medical history did not include information that excluded a psychiatric psy·chi·at·ric adj. Of or relating to psychiatry. psychiatric adjective Pertaining to psychiatry, mental disorders problem at the time of disease onset, then a structured psychiatric interview psychiatric interview Psychiatry The central vehicle for assessing a psychiatric Pt, during which there is a free exchange of information that forms the basis for therapy was performed. In a number of cases, further neurological neurological, neurologic pertaining to or emanating from the nervous system or from neurology. neurological assessment evaluation of the health status of a patient with a nervous system disorder or dysfunction. , gynecological gynecological /gy·ne·co·log·i·cal/ (-kah-loj´i-k'l) gynecologic. , endocrine endocrine /en·do·crine/ (en´do-krin, en´do-krin) 1. secreting internally. 2. pertaining to internal secretions; hormonal. See also under system. en·do·crine adj. , cardiac, or gastrointestinal gastrointestinal /gas·tro·in·tes·ti·nal/ (-in-tes´ti-n'l) pertaining to or communicating with the stomach and intestine. gas·tro·in·tes·ti·nal adj. Abbr. evaluations were performed to fulfill the CDC criteria for CFS. The medical records also were reviewed to determine whether patients had organic or psychiatric illnesses that could explain their symptoms. Furthermore, if patients did not complete more than 50% of the items on the questionnaire appropriately or if they were younger than 18 years of age, they were excluded from the sample. Underaged patients, we believe, have different activity limitations and participation restrictions as compared with adults. Forty-seven of the 111 study participants fulfilled ful·fill also ful·fil tr.v. ful·filled, ful·fill·ing, ful·fills also ful·fils 1. To bring into actuality; effect: fulfilled their promises. 2. the inclusion criteria
Inclusion criteria are a set of conditions that must be met in order to participate in a clinical trial. . Demographic features of the sample and descriptive statistics descriptive statistics see statistics. for the visual analog scales (VASs) for pain, fatigue, and ability to concentrate are presented in Table 1. The subjects had a mean age of 36.5 years (SD= 11.1, range= 18-60) and a mean illness duration of 4.8 years (SD=4.9, range=1.0-28.0), and 39 subjects (83.0%) were female. Fifty of the 111 study participants were excluded because their medical diagnosis was not established at the time of data analysis, mainly because they did not return for all required evaluations. Eight participants were excluded because they did not fulfill the CDC criteria for CFS (1) (6 had fibromyalgia syndrome fibromyalgia syndrome Fibrositis, tension myalgia Psychiatry A condition characterized by muscular pain, fatigue, sleep disorders, anxiety, depression, headaches, IBS–possibly linked to anxiety and panic disorders Management Exercise, benzodiazepines, SSRIs, , (8) 1 had leukemia leukemia (l  kē`mēə), cancerous disorder of the blood-forming tissues (bone marrow, lymphatics, liver, spleen) characterized by excessive production of immature or mature , and 1 was
judged to be cured). Two participants were younger than 18 years of age,
and another participant was excluded because the questionnaire was not
completed appropriately. The medical records of 3 participants were not
found, probably because they listed their maiden name maiden namen. A woman's family name before she is married. Used of a surname that is replaced by a woman when she marries. Also called birth name. on the questionnaire. All exclusion criteria exclusion criteria AIDS Donor exclusion criteria, see there are listed in Table 2. Forty-two (37.8%) of the 111 study participants returned the retest re·test tr.v. re·test·ed, re·test·ing, re·tests To test again. n. A second or repeated test. questionnaire. Thirty-four of the returned questionnaires were completed by patients who were eligible for study participation, and these questionnaires were used for the test-retest Test-retest is a statistical method used to examine how reliable a test is: A test is performed twice, e.g., the same test is given to a group of subjects at two different times. analysis. Three questionnaires were excluded from the data analysis because the medical diagnosis had not been established. One participant did not fulfill the current international definition for CFS, (1) and 4 questionnaires were not analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. because they were not completed appropriately (some data were missing for at least half of the questions). The demographic features of the retest sample (n=34) are presented in Table 3. These subjects had a mean age of 38.9 years (SD=9.2, range=20-59) and a mean illness duration of 5.6 years (SD=5.3, range= 1.0-26.0), and 30 subjects (88.2%) were female. No differences in age (t=-1.05, df=79, P=.298), illness duration (t=-0.65, df=79, P=.519), or sex characteristics (P=.753) were found between the retest sample (n=34) and the first sample (n=47). Measurement Instrument The Dutch version of the CFS-APQ* was used for the assessment of activity limitations and participation restrictions in our subjects. The construction of this measure, based on self-reported activity limitations and participation restrictions of 141 patients with CFS (retrospective analysis of over 600 questionnaires such as the Karnofsky Performance Questionnaire and a modified version of the Barthel Index Barthel index, n.pr standard, well-validated assessment that measures functional outcomes, including independence in mobility and self-care. Commonly used in rehabilitation medicine. ), is reported elsewhere. (7) Total scores were obtained in 2 ways. Primarily, the scoring system Noun 1. scoring system - a system of classifying according to quality or merit or amount rating system classification system - a system for classifying things of the Quality of Life Index, (9-11) which was developed using the premise that people value things differently, was used to calculate an overall score (total score 1). Items were rated on a 4-point Likert-type scale, with scores ranging from 1 ("totally not agree") to 4 ("totally agree") for the satisfaction section and from 1 ("very unimportant un·im·por·tant adj. Not important; petty. un  im·por tance n. ") to 4
("very important") for the importance verification. Item
scores were calculated by multiplying mul·ti·ply 1 v. mul·ti·plied, mul·ti·ply·ing, mul·ti·plies v.tr. 1. To increase the amount, number, or degree of. 2. Mathematics To perform multiplication on. the score on the satisfaction part of each question by the score on the importance verification. The reasoning behind this approach was based on the assumption that a patient with disability in activities of importance to areas of his or her life has a lower quality of life than those whose disabilities affect less important activities. (9) In addition, subjects were able to mark items as not applicable for their living environment. The overall score (total score 1) was obtained by counting all item scores and then dividing that sum by the number of properly completed questions (possible score range= 1-16). If the item was not applicable or when the question was not filled in properly (eg, was not completed), then that question was excluded. In this way, we dealt with missing data by assuming responses to the remaining data were the average calculated based on the available data. A second overall score (total score 2) was obtained by counting all satisfaction scores and then dividing that sum by the number of properly completed questions. In this way, the subjects' importance verification was not taken into account. Reliability Test-retest reliability test-retest reliability Psychology A measure of the ability of a psychologic testing instrument to yield the same result for a single Pt at 2 different test periods, which are closely spaced so that any variation detected reflects reliability of the instrument of data obtained with the self-report instrument was assessed by having the subjects complete a modified version of the questionnaire at home and returning it within 24 hours. The subjects were given a sealed envelope containing the modified version of the questionnaire, an instruction letter, and a stamped, addressed return envelope as they departed from the hospital and were instructed not to open the envelope until they arrived home. The modified version of the CFS-APQ (the retest questionnaire) had different fonts and a different question sequence, including VASs for pain, fatigue, ability to concentrate. The reasoning behind our using this approach was our effort to prevent subjects from replicating their answer sequence rather than responding to the questions. The instruction letter explained the nature and purpose of the research, and again we stipulated that patients were not obliged to participate and that anonymity was guaranteed. The same exclusion criteria were used as we did for the validity analysis. Validity To examine the unidemensionality of the questionnaire, the Cronbach alpha coefficient coefficient /co·ef·fi·cient/ (ko?ah-fish´int) 1. an expression of the change or effect produced by variation in certain factors, or of the ratio between two different quantities. 2. was calculated. To investigate the convergent validity of this new measure, 100-mm VASs for fatigue, pain, and ability to concentrate were used. The pain scores obtained with the VAS vas (vas) pl. va´ sa [L.] vessel.va´sal vas aber´rans 1. a blind tubule sometimes connected with the epididymis; a vestigial mesonephric tubule. 2. are believed to be reliable (12 13) and sensitive to change. (14) Additionally, before completing the questionnaire, participants were asked to list at least 5 activities or tasks that have become difficult for them to do. All answers were analyzed for their accordance with the contents of the questionnaire. Other researchers have used this method for investigating content validity. (15) The CFS-APQ is designed to monitor activity limitations and participation restrictions in patients with CFS. Therefore, every item of the questionnaire was checked in the International Classification of Impairments, Disability and Health (ICIDH ICIDH International Classification of Impairments, Disability and Handicaps ) beta II draft (16) to examine whether the items of this measurement tool assess activity limitations and participation restrictions. At the time this study was performed, the International Classification of Functioning, Disability and Health (ICF (Internet Connection Firewall) The built-in firewall in Windows XP. It provides a stateful inspection of packets which accepts only responses to requests originated by the user. , the latest revision of the ICIDH) was not available. Likewise, frequently reported answers to the open question that did not match the content of the questionnaire were searched in the ICIDH beta II draft. Data Analysis Spearman spear·man n. A man, especially a soldier, armed with a spear. rank correlation In statistics, rank correlation is the study of relationships between different rankings on the same set of items. It deals with measuring correspondence between two rankings, and assessing the significance of this correspondence. coefficients were calculated for the analysis of the data highlighting the convergent validity of the CFS-APQ scores with the VASs for pain, fatigue, and concentration. The significance level was set at .01 to help protect against potential Type I errors. Simple descriptive statistics (frequencies and percentages) were used for the analysis of the content validity data. The test-retest data were assessed using intraclass correlation In statistics, the intraclass correlation (or the intraclass correlation coefficient[1]) is a measure of correlation, consistency or conformity for a data set when it has multiple groups. coefficients (ICCs, two-way mixed model). (17) Possible differences in demographic characteristics between the first sample (n=47) and the retest sample (n=34) were assessed using the independent-samples Student t test for equality of means (age and illness duration) and the Fisher exact test (sex). Results CFS-APQ Scores The descriptive statistics of the overall and individual item scores are listed in Table 4. Total score 1, which includes the importance verification, had a median of 9 and an interquartile range In descriptive statistics, the interquartile range (IQR), also called the midspread, middle fifty and middle of the #s, is a measure of statistical dispersion, being equal to the difference between the third and first quartiles. of 3.6. A score of 1 indicates no activity limitations or participation restrictions, whereas a score of 16 represents the maximum score. Total score 2 (median = 2.8, interquartile range = 1) does not take the importance verification into account (potential range = 1-4). Reliability The Cronbach alpha was .94 when the total item scores were taken into account (satisfaction part multiplied mul·ti·ply 1 v. mul·ti·plied, mul·ti·ply·ing, mul·ti·plies v.tr. 1. To increase the amount, number, or degree of. 2. Mathematics To perform multiplication on. by the importance verification). A similar coefficient alpha (.94) was obtained with only the satisfaction parts of the questions (part A) included, whereas the Cronbach alpha was slightly lower (.89) for the importance verifications of the items (part B). Table 5 lists all ICCs for the total scores on the questionnaire, the individual questions as well as the VAS scores. The test-retest ICCs of the overall scores on this self-administered measure were .96 (total score 1) and .95 (total score 2). The ICCs of the total scores were >.80, except for the ICCs for questions 6 ("replacing a light-bulb," ICC ICC See: International Chamber of Commerce =.57), 9 ("standing for 1 hour," ICC=.80), and 18 ("reading," ICC=.77). The ICCs for the VAS scores for pain, fatigue, and ability to concentrate between the test and the retest were .83, .82, and .76, respectively. Convergent Validity Overall scores (total scores 1 and 2) correlated cor·re·late v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates v.tr. 1. To put or bring into causal, complementary, parallel, or reciprocal relation. 2. (P<.01) with the scores from the VASs for fatigue and pain. Correlation coefficients Correlation Coefficient A measure that determines the degree to which two variable's movements are associated. The correlation coefficient is calculated as: for total scores 2 and 1 for the fatigue VAS were .47 (P<.002) and .50 (P<.001). Correlation coefficients for total scores 2 and 1 for the pain VAS were .44 (P<.005) and .51 (P<.001). Total score 2 correlated with the VAS for ability to concentrate (R=.41, P<.008), but there was no correlation for total score 1. No correlations between illness duration and CFS-APQ scores were observed (data not shown). All data are presented in Table 6. Content Validity In response to the request to list at least 5 activities or tasks that have become difficult to do, 47 participants with CFS reported 183 answers. Table 7 presents all different answers and corresponding frequencies. One hundred fifty-seven Adj. 1. fifty-seven - being seven more than fifty 57, lvii cardinal - being or denoting a numerical quantity but not order; "cardinal numbers" answers (85.8%) matched the content of the CFS-APQ. "Work" was mentioned most frequently (21 times [11.5%]), even more than "housekeeping A set of instructions that are executed at the beginning of a program. It sets all counters and flags to their starting values and generally readies the program for execution. " (17 times [9.3%]), "walking" and "reading" (both 13 times [7.1%]), and "sports" and "driving a car" (both 11 times [6.0%]). Seven subjects (3.8%) mentioned "sleeping," indicating it was the ninth most prevalent item in this inquiry. In the ICIDH beta II taxonomy, however, "sleeping" is classified as a mental function and is therefore not suitable for a measure that assesses activity limitations and participation restrictions. Using the ICIDH beta II draft, 5 out of 26 questions of the CFS-APQ were found to measure different aspects of the participation level. These items were: "caring for a child," "sports and active recreation," "functioning at school/at work," "working full-time/ attending school full-time full-time adj. Employed for or involving a standard number of hours of working time: a full-time administrative assistant. full ," and "social activities." All other items were related to the activity-domain (Tab. 8.) Discussion and Conclusions Reliability The results of the test-retest reliability analysis, we contend, indicate what we would consider sufficient reliability, especially for overall scores (ICC=.96 for total score 1, ICC=.95 for total score 2) and the total scores on each question (apart from questions 6, 9, and 18, the ICCs were >.80). We conclude, therefore, that nearly all individual items of this new questionnaire can be presented with sufficient reliability, particularly because the correlation coefficients were similar to those obtained for the VASs for pain, fatigue, and ability to concentrate. The imperfect imperfect: see tense. (ie, not suggesting a linear correlation: R= 1) reliability coefficients for these symptoms suggest the difference in test-retest scores might be caused by a change in health status (reflected by the change in severity in pain, fatigue, and ability to concentrate). Cognitive disturbances (eg, processing speed See MHz. , impaired working memory, poor learning of information, improper
Validity The Cronbach alpha coefficient was .94 for both total scores, suggesting a high degree of consistency among the different items. Consequently, the calculated Cronbach alpha coefficients suggest that the different items of the questionnaire measure the same construct. These data suggest sufficient convergent validity of the CFS-APQ scores with VASs for pain and fatigue. The way the CFS-APQ was constructed, based on self-reported activity limitations and participation restrictions of 141 patients with CFS, (6) supports disease specificity and content validity of this new measure. In our study, 47 participants with CFS reported 183 activities that became difficult to do, and the majority (157 responses [85.8%]) complied with the content of the questionnaire (ie, the answers were found in the content of the questionnaire). The most prevalent of the nonfitting items ("sleeping") is a mental function, indicating it is unsuitable for a questionnaire aiming at monitoring activity limitations and participation restrictions. These results, we believe, substantiate To establish the existence or truth of a particular fact through the use of competent evidence; to verify. For example, an Eyewitness might be called by a party to a lawsuit to substantiate that party's testimony. the comprehensiveness of item selection. In addition, reviewing the content of the CFS-APQ in the ICIDH beta II draft indicated that this measure focuses on the activity and participation domains. Our results should be interpreted with some caution. The reliability and validity of scores obtained with the Dutch version of the CFS-APQ were assessed. No data are currently available to validate To prove something to be sound or logical. Also to certify conformance to a standard. Contrast with "verify," which means to prove something to be correct. For example, data entry validity checking determines whether the data make sense (numbers fall within a range, numeric data the English 1. English - (Obsolete) The source code for a program, which may be in any language, as opposed to the linkable or executable binary produced from it by a compiler. The idea behind the term is that to a real hacker, a program written in his favourite programming language is version of this questionnaire (Appendix). The patients included in this study and those used for constructing the questionnaire (6) all fulfilled the current American American, river, 30 mi (48 km) long, rising in N central Calif. in the Sierra Nevada and flowing SW into the Sacramento River at Sacramento. The discovery of gold at Sutter's Mill (see Sutter, John Augustus) along the river in 1848 led to the California gold rush of definition for CFS. (1) Because of the assumed socioeconomic so·ci·o·ec·o·nom·ic adj. Of or involving both social and economic factors. socioeconomic Adjective of or involving economic and social factors Adj. 1. similarities between American and Belgian Belgian having some relationship to Belgium. Belgian barge dog see schipperke. Belgian black pied cattle black, Belgian dairy cattle. Belgian blue dual-purpose cattle; blue, white or blue roan. citizens, the content of the Dutch CFS-APQ is likely to represent the most frequent activity limitations and participation restrictions in American patients with CFS. In Belgium Belgium (bĕl`jəm), Du. België, Fr. La Belgique, officially Kingdom of Belgium, constitutional kingdom (2005 est. pop. 10,364,000), 11,781 sq mi (30,513 sq km), NW Europe. , where predominantly pre·dom·i·nant adj. 1. Having greatest ascendancy, importance, influence, authority, or force. See Synonyms at dominant. 2. Dutch- and French-speaking adj. 1. able to communicate in French. Adj. 1. French-speaking - able to communicate in French communicatory, communicative - able or tending to communicate; "was a communicative person and quickly told all she knew"- W.M.Thackeray patients are seen in practice, validation See validate. validation - The stage in the software life-cycle at the end of the development process where software is evaluated to ensure that it complies with the requirements. of an English version is nearly impossible. We hope our report will convince English-speaking adj. 1. able to communicate in English. Adj. 1. English-speaking - able to communicate in English communicatory, communicative - able or tending to communicate; "was a communicative person and quickly told all she knew"- W.M. physical therapists that it would be worthwhile to investigate psychometric psy·cho·met·rics n. (used with a sing. verb) The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and properties of the English version of the CFS-APQ. Our questionnaire was designed to establish goals and outcomes of physical therapists' interventions. Our reliability data were obtained using mail for response. Therefore, we cannot be sure that each participant completed the questionnaire without assistance or within 24 hours following the first scoring. This is particularly relevant because a number of questionnaires were returned up to 5 weeks after the participants' initial visit to the Chronic Fatigue Clinic. The use of a mailed questionnaire may have biased the reliability analysis because we may have collected data from only highly motivated mo·ti·vate tr.v. mo·ti·vat·ed, mo·ti·vat·ing, mo·ti·vates To provide with an incentive; move to action; impel. mo respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. . Our sample was derived from consecutive patients and was not randomly selected, and this also is a limitation. The questionnaire was given to all patients with CFS visiting the Chronic Fatigue Clinic of the Vrije Universiteit Brussels; therefore, we relied on a sample of convenience. Selection bias can only be due to appointment scheduling, but our secretaries were blinded to patients' medical records when they scheduled the appointments. Moreover, a sample consisting of consecutive patients visiting a clinic is more likely to represent routine clinical practice. Our combining 2 different, but related, constructs (the satisfaction and importance verification of each question) might be inappropriate. Because the total score 1 as well as total score 2 (using only the satisfaction part) appeared to be reliable and valid, we believe this is unlikely to be the case. Likewise, the assumption that all item scores of the CFS-APQ can be summed together implies to us that activity limitations and participation restrictions represent a one-dimensional one-di·men·sion·al adj. 1. Having or existing in one dimension only. 2. Lacking depth; superficial. one-dimensional Adjective 1. having one dimension 2. construct. The revised World Health Organization's classification system (the ICF) combines activities and participation into one health-related domain. This indicates to us that the data from the CFS-APQ represent a one-dimensional construct. However, dimensionality studies of the CFS-APQ that can support the interpretation of a one-dimensional construct are currently lacking. In general, self-report questionnaires offer an easy and inexpensive way to monitor the patient's perceived quality of life, which cannot be offered by laboratory data. (20) In our opinion, the use of this self-administered assessment tool, which acknowledges that people value things differently, should enable physical therapists to treat the patient rather than treating the disease. Indeed, we believe that because of the incorporation of importance verification to each item in the questionnaire, this health status instrument can be used to monitor at least a part of patients' expectations for care. Our data, we argue, provide evidence for sufficient test-retest reliability, convergent validity, and 2 different aspects of content validity of the scores obtained with the Dutch CFS-APQ. Before the use of this new measure in clinical practice and research settings can be advised, however, responsiveness and other forms of validity should be examined.
Appendix.
Content of the Chronic Fatigue Syndrome-Activities and Participation
Questionnaire (CFS-APQ) In English
Chronic Fatigue Syndrome-Activities and Participation Questionnaire
Name: --
Date: --/--/--
Your complaints can restrict you from going about your normal daily
activities. This questionnaire contains statements formulated by
individuals with similar complaints as yourself describing how their
daily activities are influenced by these complaints. These statements
may apply, to your own situation, as you have experienced teem within
the past 7 days. For each statement, you can choose between possible
answers (circle the number corresponding to your answer). Choose the
answer corresponding best with your own situation during the past 7
days.
People value things differently. Therefore, please indicate how much
you value each item (you have 4 possibilities, circle the corresponding
number). You may, for instance, not be capable of lifting an object of
20 kg, but this may be unimportant to you.
Try not to think too long about answering a certain question. Please do
not leave any questions unanswered. This should be an easy
questionnaire, aiming at monitoring the consequences of your illness on
your daily activities.
This is a personal questionnaire, to be filled in by you alone; do not
discuss these items with others in your immediate surroundings. Please
do not ask questions concerning the content of the statements. If you
are not sure, answer the question according to what you think the
statement indicates.
1. Due to my symptoms, I am no longer able to clean.
totally do not agree agree
no most of the most of totally not
agreement time the time agree applicable
1 2 3 4 0
This activity is
not at all not really reasonably very
important important important important
to me to me to me to me
1 2 3 4
2. I am not able to wash dishes by myself and return them to the
cupboard.
3. My complaints make it impossible for me to do the ironing.
4. My symptoms make it impossible for me to do the laundry (using a
washing machine and tumble dryer).
5. Due to the complaints, I am no longer able to look after my own
garden.
6. Due to my complaints, I ask for others to replace a lightbulb.
7. Because of my symptoms, I walk at a slower pace.
8. My symptoms hinder me from climbing far more than one flight of
stairs.
9. My symptoms make it impossible for me to stand for 1 hour.
10. Due to my complaints, I am no longer able to sit for 2 hours.
11. Because of my symptoms, I avoid doing groceries on my own.
12. My complaints prevent me from performing computer work for 30
minutes.
13. In my current state, carrying heavy objects is out of the question.
14. I am not able to write a full-page letter.
15. My complaints hinder me from using a screwdriver.
16. My symptoms do not permit me to hammer a nail into a wall.
17. As a result of my symptoms, I am no longer able to make the bed.
18. Because of my complaints, I am not able to read for more than 30
minutes.
19. I participate less frequently in social activities due to my
symptoms.
20. Due to my complaints, I am no longer able to work full-time/attend
school full-time.
21. Because of my symptoms, my functioning at school/at work is
unsatisfactory.
22. My current state does not tolerate sporting activities or active
recreation.
23. Studying became impossible due to my symptoms.
24. Driving a car is impossible in my situation.
25. My complaints hinder me from preparing meals.
26. My present state does not allow me to care for children.
Table 1.
Demographic Characteristics and Mean Visual Analog Scale (VAS)
Scores for Pain, Fatigue, and Ability to Concentrate
Duration Female
Age (y) of Illness Subjects
N [bar]X SD Range [bar]X SD n %
47 36.5 11.1 18-60 4.8 4.9 39 83.0
VAS for VAS for VAS for Ability
Pain Fatigue to Concentrate
N Median IQR (a) Median IQR Median IQR
47 29.5 41.8 55.0 27.5 60.0 43.3
(a) IQR=interquartile range.
Table 2.
Reasons for Exclusion in the Validity Analysis (N=111) and the
Test-Retest Reliability Analysis (n=42)
No. of Patients
Excluded From
Exclusion No. of the Reliability
Criteria Patients Analysis
Age (<18 y) 2 0
Questionnaire not completed
properly 1 4
Medical record not found 3 0
Not fulfilling the criteria for
chronic fatigue syndrome 8 1
No diagnosis 50 3
Total 64 8
Table 3.
Demographic Characteristics and Visual Analog Scale (VAS)
Scores of the Sample (Reliability Analysis)
Duration Female
Age(y) of Illness Subjects
N [bar]X SD Range [bar]X SD n %
34 38.9 9.2 20-59 5.6 5.3 30 88.2
Retest
VAS for VAS for VAS for Ability
Pain Fatigue to Concentrate
N Median IQR (a) Median IQR Median IQR
34 30.0 43.0 61.0 30.5 59.0 46.5
39.0 50.8 71.0 41.0 64.0 45.0
(a) IQR = interquartile range.
Table 4.
Descriptive Statistics for the Chronic Fatigue Syndrome--Activities
and Participation Questionnaire (CFS-APQ) Overall Scores and
Individual Item Scores (a)
Confidence Limits
Interquartile Valid
Median Range -95% +95% n
Total score 1 9 3.6 7.8 9.2 47
Total score 2 2.8 1 2.6 3.0 47
QA1 3 1 2.8 3.3 45
QB1 3 1 2.8 3.3 45
QA2 2 2 1.6 2.3 40
QB2 3 1 2.5 3.0 40
QA3 3 1 2.4 3.0 40
QB3 3 1 2.5 3.1 40
QA4 1 1 1.4 1.9 35
QB4 3 1 2.5 3.1 35
QA5 4 1 3.1 3.6 35
QB5 3 2 2.5 3.1 35
QA6 2 2 1.6 2.4 36
QB6 2 1 2.1 2.8 36
QA7 4 1 3.0 3.6 46
QB7 3 1 3.1 3.5 45
QA8 3 2 2.5 3.2 44
QB8 3 0.5 2.9 3.3 44
QA9 4 1 3.1 3.6 47
QB9 3 2 2.8 3.3 47
QA10 2 2 1.9 2.5 44
QB10 3 1 2.9 3.3 44
QA11 3 3 2.2 3.0 42
QB11 3 1 3.0 3.4 42
QA12 3 2 2.5 3.2 36
QB12 3 2 2.5 3.1 36
QA13 4 1 3.2 3.7 41
QB13 2 1 2.3 2.8 41
QA14 3 2 2.4 3.1 42
QB14 3 1 2.4 3.0 41
QA15 2 2 1.8 2.6 37
QB15 2 2 1.7 2.3 37
QA16 2 2 1.7 2.5 37
QB16 2 1 1.5 2.1 37
QA17 2 1.5 1.6 2.3 40
QB17 2 1 2.3 2.8 40
QA18 3 1.5 2.7 3.3 44
QB18 3 1 3.1 3.6 44
QA19 4 1 3.4 3.8 46
QB19 4 1 3.4 3.8 46
QA20 4 1 3.3 3.8 46
QB20 4 0 3.4 3.9 45
QA21 4 0 3.3 3.9 33
QB21 4 0 3.9 4.0 33
QA22 4 1 3.4 3.8 44
QB22 3 1 3.1 3.6 44
QA23 3 1 3.1 3.6 31
QB23 4 1 3.2 3.7 31
QA24 2.5 1 2.2 2.8 44
QB24 4 1 3.2 3.6 44
QA25 2 1 2.0 2.5 42
QB25 3 1 3.1 3.5 42
QA26 3 1 2.5 3.1 33
QB26 4 1 3.1 3.8 33
(a) QA1 = question number 1, part A (satisfaction). QB1 = question
number 1, part B (importance verification). Total score 1 = overall
score, ranging from 1 to 16. Total score 2 = overall score without
taking the importance verification into account (range = 1-4). Valid
n = number of subjects who judged the question to be applicable
(each question that was not filled in properly or was marked as not
applicable was not taken into account for mean score calculation).
Table 5.
Intraclass Correlation Coefficients (ICCs, Two-Way Mixed Model)
for the Chronic Fatigue Syndrome--Activities and Participation
Questionnaire (CFS-APQ) Test-Retest Data (a)
Question ICC
Q1 .90
Q2 .82
Q3 .88
Q4 .91
Q5 .86
Q6 .57
Q7 .84
Q8 .88
Q9 .80
Q10 .88
Q11 .96
Q12 .93
Q13 .86
Q14 .92
Q15 .96
Q16 .84
Q17 .93
Q18 .77
Q19 .95
Q20 .95
Q21 .94
Q22 .88
Q23 .93
Q24 .93
Q25 .90
Q26 .85
Variable ICC
Total score 1 .95
Total score 2 .95
VAS for pain .83
VAS for fatigue .82
VAS for ability to concentrate .75
(a) Q1 = total score on question number 1. Total score 1 =
overall score 1 (CFS-APQ). Total score 2 = overall score without
taking the importance verification into account (CFS-APQ). VAS =
visual analog scale. N = 34 for all questions, except for Q8,
Q9, Q10, and Q12, where n = 33.
Table 6.
Convergent Validity (R) of the Chronic Fatigue Syndrome--Activities
and Participation Questionnaire (CFS-APQ) Data From Visual Analog
Scales (VASs) for Pain, Fatigue, and Ability to Concentrate
(n = 47) (a)
R VAS
for Pain P
Total score 1 .51 <.001 (b)
Total score 2 .44 <.005 (b)
R VAS
for Fatigue P
Total score 1 .50 <.001 (b)
Total score 2 .47 <.002 (b)
R VAS for
Ability to
Concentrate P
Total score 1 .35 .027
Total score 2 .41 <.008 (b)
(a) Total score 1 = overall score 1. Total score 2 = overall
score without taking the importance vertitication into account.
(b) Significant at the .01 level.
Table 7.
Content Validity of the Chronic Fatigue Syndrome--Activities
and Participation Questionnaire (CFS-APQ) Data Based on
Activities and Tasks That Became Difficult to Do as Reported by
47 Patients With Chronic Fatigue Syndrome
Activity Limitations and Corresponding
Participation Restrictions CFS-APQ Question Frequency
Work 20 and 21 21
Walking 7 13
Computer work 12 1
Reading 18 13
Housekeeping 1, 2, 3, and 4 17
Driving a car 24 11
Riding a bicycle 22 8
Exercise 20, 21, and 22 3
Studying 23 5
Following courses 20 and 21 1
School 20 and 21 1
Going out with friends 19 3
Doing groceries 11 1
Sports 22 11
Washing/drying dishes 2 1
Accompanying children 26 5
Lifting heavy objects 13 2
Sitting for a long time 10 3
Standing for a long time 9 6
Cleaning 1 4
Gardening 5 3
Climbing stairs 8 7
Social contacts/activities 19 9
Leisure time/hobby 19 and 22 4
Shopping (for groceries) 11 2
Caring for a child 26 1
Swimming 22 1
Total (answers fitting the
content of the CFS-APQ) 157
Watching television 3
Staying up late 2
Thinking 4
Having breakfast 1
Sex 2
Eating 1
Sleeping 7
Going on vacation 1
Having a conversation 4
Activities in a cold place/
environment 1
Total (answers not fitting the
content of the CFS-APQ) 26
Activity Limitations and Percentage
Participation Restrictions of Answers
Work 11.47
Walking 7.10
Computer work 0.55
Reading 7.10
Housekeeping 9.29
Driving a car 6.01
Riding a bicycle 4.37
Exercise 1.64
Studying 2.73
Following courses 0.55
School 0.55
Going out with friends 1.65
Doing groceries 0.55
Sports 6.01
Washing/drying dishes 0.55
Accompanying children 2.73
Lifting heavy objects 1.09
Sitting for a long time 1.64
Standing for a long time 3.28
Cleaning 2.19
Gardening 1.64
Climbing stairs 3.83
Social contacts/activities 4.92
Leisure time/hobby 2.19
Shopping (for groceries) 1.09
Caring for a child 0.55
Swimming 0.55
Total (answers fitting the
content of the CFS-APQ) 85.79
Watching television 1.64
Staying up late 1.09
Thinking 2.19
Having breakfast 0.55
Sex 1.09
Eating 0.55
Sleeping 3.83
Going on vacation 0.55
Having a conversation 2.19
Activities in a cold place/
environment 0.55
Total (answers not fitting the
content of the CFS-APQ) 14.21
Table 8.
Content Validity of the Chronic Fatigue Syndrome--Activities and
Participation Questionnaire (CFS-APQ) Data Using the International
Classification Impairments, Disability and Health (ICIDH) Beta II
Draft (a)
Item Chapter Subgroup
1. Cleaning Domestic Household activities
activities
2. Washing dishes Domestic Household activities
activities
2. Returning dishes to Movement Activities of carrying,
cupboard activities moving, and
manipulating objects
3. Ironing Domestic Household activities
activities
4. Doing laundry Domestic Household activities
activities
5. Gardening Domestic Activities of caring for
activities possessions and
assisting others
6. Replacing a Movement Activities of carrying,
lightbulb activities moving, and
manipulating objects
7. Walking Activities of Walking and related
moving around activities
8. Climbing one flight Activities of Walking and related
of stairs moving around activities
9. Standing for 1 hour Movement Activities of maintaining
activities and changing body
position
10. Sitting for 2 Movement Activities of maintaining
hours activities and changing body
position
11. Doing groceries Domestic Activities of acquiring
activities necessities
12. 30 minutes of Communication Activities of producing
computer work activities messages
13. Carrying heavy Movement Activities of carrying,
objects activities moving, and
manipulating objects
14. Writing full-page Communication Activities of producing
letter activities messages
15. Using a Movement Activities of carrying,
screwdriver activities moving, and
manipulating objects
Domestic Activities of caring for
activities possessions and
assisting others
16. Hammering a nail Movement Activities of carrying,
activities moving, and
manipulating objects
Domestic Activities of caring for
activities possessions and
assisting others
17. Making the bed Domestic Household activities
activities
18. Reading Communication Activities of
activities understanding messages
19. Social activities Interpersonal General interpersonal
activities activities
Particular interpersonal
activities
Participation in
social
relationships
Participation in
community,
social, and
civic life
20. Attending school Participation in
full-time education
20. Working full-time Participation in
work and
employment
21. Functioning at Performing tasks Activities of performing
school and major in major life
life activities situations
Participation in
education
21. Functioning at Performing tasks Activities of performing
work and major in major life
life activities situations
Participation in
work and
employment
22. Sports Performing tasks Activities of performing
and major in major life
life activities situations
Participation in
community,
social, and
civil life
23. Studying Activities of Learning activities
learning and
applying
knowledge
24. Driving a car Activities of Activities of moving
moving around around using
transportation
25. Preparing meals Domestic Household activities
activities
26. Caring for a child Domestic Activities of caring for
activities possessions and
assisting others
Participation in
home life
and assistance
to others
Item Chapter Type
1. Cleaning Domestic Housework activities
activities
2. Washing dishes Domestic Activities for
activities preparation of meals
2. Returning dishes to Movement Lifting and carrying
cupboard activities activities
Activities of hand and
arm use
3. Ironing Domestic Housework activities
activities
4. Doing laundry Domestic Housework activities
activities
5. Gardening Domestic Activities of caring for
activities possessions
6. Replacing a Movement Activities of hand and
lightbulb activities arm use
7. Walking Activities of Walking activities
moving around
8. Climbing one flight Activities of Walking activities
of stairs moving around
9. Standing for 1 hour Movement Activities of maintaining
activities a body position
10. Sitting for 2 Movement Activities of maintaining
hours activities a body position
11. Doing groceries Domestic Activities of acquiring
activities daily necessities
12. 30 minutes of Communication Activities of producing
computer work activities written messages
13. Carrying heavy Movement Lifting and carrying
objects activities activities
14. Writing full-page Communication Activities of producing
letter activities written messages
15. Using a Movement Activities of fine hand
screwdriver activities use
Activities of hand and
arm use
Domestic Activities of caring for
activities possessions ("making
and repairing personal
properties")
16. Hammering a nail Movement Activities of fine hand
activities use
Activities of hand and
arm use
Domestic Activities of caring for
activities possessions ("making
and repairing personal
properties")
17. Making the bed Domestic Housework activities
activities
18. Reading Communication Activities of
activities understanding written
messages (reading)
19. Social activities Interpersonal Basic interpersonal
activities activities
Complex interpersonal
activities
Activities of maintaining
interaction
Activities of initiating
interaction
Participation in Participation in family
social relationships
relationships Participation in informal
social relationships
Participation in Participation in
community, community
social, and Participation in
civic life recreation and leisure
Participation in religion
and spirituality
20. Attending school Participation in Participation in
full-time education education in school
Participation in higher
education
20. Working full-time Participation in Participation in self-
work and employment
employment Participation in
remunerative employment
Participation in
nonremunerative work
21. Functioning at Performing tasks Activities of performing
school and major in school
life activities
Participation in Participation in
education education in school
Participation in higher
education
21. Functioning at Performing tasks Activities of performing
work and major in work
life activities
Participation in Participation in self-
work and employment
employment Participation in
remunerative employment
22. Sports Performing tasks Activities for
and major performance in
life activities recreation
Participation in Participation in
community, community
social, and Participation in
civil life recreation and leisure
23. Studying Activities of Purposeful sensory
learning and activities
applying Basic learning activities
knowledge
24. Driving a car Activities of Activities of using
moving around transportation as a
driver
25. Preparing meals Domestic Activities for
activities preparation of meals
26. Caring for a child Domestic Activities of assisting
activities others
Participation in Participating in caring
home life for others
and assistance Participation in
to others nutrition for others
Participation in health
maintenance for others
Participation in mobility
and transportation for
others
(a) The headings (chapter, subgroup, and type) are meant to indicate
the ICIDH beta II draft, dividing the activity and participation domain
into chapters. Each chapter is further subdivided into a number of
subgroups, which in turn are specified in different types.
References (1) Fukuda Fukuda (福田 K, Strauss Strauss (strous, Ger. shtrous), family of Viennese musicians. Johann Strauss, 1804–49, learned to play the violin against his parents' wishes. SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann ANN, Scotch law. Half a year's stipend over and above what is owing for the incumbency due to a minister's relict, or child, or next of kin, after his decease. Wishaw. Also, an abbreviation of annus, year; also of annates. In the old law French writers, ann or rather an, signifies a year. Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine. in·tern or in·terne n. Med. 1994; 121:953-959. (2) Holmes GP, Kaplan Kaplan may refer to one of the following:
 This article needs copy editing for grammar, style, cohesion, tone and/or spelling.You can assist by [ editing it] now. NM, et al. Chronic fatigue syndrome: a working case definition. Ann Intern Med. 1988;108:387-389. (3) Manu Manu (mŭ`n ), semilegendary Hindu lawgiver. Traditionally ascribed to him are the Laws of Manu, best known of the Sanskrit smriti texts (see Sanskrit literature). P, Affleck G, Tennen H, et al. Hypochondriasis hypochondriasisMental disorder in which an individual is excessively preoccupied with his own health and inclined to treat insignificant physical signs or symptoms as evidence of a serious disease. influences quality-of-life outcomes in patients with chronic fatigue. Psychother Psychosom. 1996;65:76-81. (4) Peterson DL. Chronic fatigue syndrome and disability: editorials. Journal of Chronic Fatigue Syndrome. 1997;3:5-7. (5) MacHale SM, Cavanagh JT, Bennie J, et al. Diurnal diurnal /di·ur·nal/ (di-er´nal) pertaining to or occurring during the daytime, or period of light. di·ur·nal adj. 1. Having a 24-hour period or cycle; daily. 2. variation of adrenocortical adrenocortical /adre·no·cor·ti·cal/ (-kor´ti-k'l) pertaining to or arising from the adrenal cortex. ad·re·no·cor·ti·cal adj. Of, relating to, or derived from the adrenal cortex. activity in chronic fatigue syndrome. Neuropsychobiol. 1998;38:213-317. (6) Nijs J, Vaes P, Van Hoof hoof, horny epidermal casing at the end of the digits of an ungulate (hoofed) mammal. In the even-toed ungulates, such as swine, deer, and cattle, the hoof is cloven; in the odd-toed ungulates, such as the horse and the rhinoceros, it is solid. E, et al. Activity limitations and participation restrictions in patients with chronic fatigue syndrome: construction of a disease-specific questionnaire. Journal of Chronic Fatigue Syndrome. 2002;10:3-23. (7) International Classification of Functioning, Disability and Health. Available at: http://www3.who.int/icf/icftemplate.cfm. (8) Wolfe F, Smythe HA, Yunus MB, et al. The American College American College is the name of:
rheu·ma·tol·o·gy n. 1990 criteria for the classification of fibromyalgia fibromyalgia Chronic syndrome that is characterized by musculoskeletal pain, often at multiple sites. The cause is unknown. A significant number of persons with fibromyalgia also have mental disorders, especially depression. : report of the multicenter multicenter adjective Referring to that which occurs in many hospitals, as in a randomized multicenter study criteria committee. Arthritis arthritis, painful inflammation of a joint or joints of the body, usually producing heat and redness. There are many kinds of arthritis. In its various forms, arthritis disables more people than any other chronic disorder. Rheum rheum (rldbomacm) any watery or catarrhal discharge. rheum n. A watery or thin mucous discharge from the eyes or nose. rheum any watery or catarrhal discharge. . 1990;33: 160-172. (9) Anderson Anderson, river, Canada Anderson, river, c.465 mi (750 km) long, rising in several lakes in N central Northwest Territories, Canada. It meanders north and west before receiving the Carnwath River and flowing north to Liverpool Bay, an arm of the Arctic JS, Ferrans CE. The quality of life of persons with chronic fatigue syndrome. J Nero Ment Dis. 1997;185:359-367. (10) Ferrans CE, Powers MJ. Psychometric assessment of the Quality of Life Index. Res Nurs Health. 1992;15:29-38. (11) Ferrans CE, Powers MJ. Quality of Life Index: development and psychometric properties. Adv Nurs Sci. 1985;8:15-24. (12) Harms-Ringdahl K, Carlsson AM, Ekholm J, et al. Pain assessment with different intensity scales in response to loading joint structures. Pain. 1986;27:401-412. (13) Jensen MD, Koroly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27:117-126. (14) Joyce CR, Zutshi DW, Hrubes V, et al. Comparison of fixed interval and visual analogue (electronics) analogue - (US: "analog") A description of a continuously variable signal or a circuit or device designed to handle such signals. The opposite is "discrete" or "digital". scales for rating chronic pain. Eur J Clin Pharmacol. 1975;8:415-420. (15) Luteijn F, Hamel Ham´el v. t. 1. Same as Hamble. LF, Bouwman TK, Kok AR. Hopkins Hopkins, city (1990 pop. 16,534), Hennepin co., SE Minn., a suburb of Minneapolis; inc. as West Minneapolis 1893, name changed 1928. The city manufactures machinery, computer and electronic parts, steel products, air pollution equipment, ophthalmic lenses, tools, Symptom Checklist Symptom Checklist SCL-90R Psychology An instrument that assess 9 domains of psychiatric Sx–anxiety, depression, hostility, interpersonal sensitivity, obsessive-compulsiveness, paranoid ideation, phobic anxiety, pychoticism, somatization : Handleiding. Lisse, the Netherlands: Swets & Zeitlinger; 1984:10. (16) International Classification of Impairments, Disability and Health (ICIDH) beta II draft. Available at: http://www.WHO.ch/icidh2. (17) Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. London, England: Prentice Hall Prentice Hall is a leading educational publisher. It is an imprint of Pearson Education, Inc., based in Upper Saddle River, New Jersey, USA. Prentice Hall publishes print and digital content for the 6-12 and higher education market. History In 1913, law professor Dr. ; 2000:560-567. (18) Michiels V, Cluydts R. Neuropsychological neu·ro·psy·chol·o·gy n. The branch of psychology that deals with the relationship between the nervous system, especially the brain, and cerebral or mental functions such as language, memory, and perception. functioning in chronic fatigue syndrome: a review. Acta Psychiatr Scand. 2001;103:84-93. (19) Ross Ross , Sir Ronald 1857-1932. British physician. He won a 1902 Nobel Prize for proving that malaria is transmitted to humans by the bite of the mosquito. S, Fantie B, Straus SF, et al. Divided attention deficits in patients with chronic fatigue syndrome. Appl Neuropsychol. 2001;8:4-11. (20) Evers AW, Taal Taal 1 A lake of southwest Luzon, Philippines, south of Manila. It contains Volcano Island, the site of the active volcano Mount Taal. Noun 1. E, Kraaimaat FW, et al. A comparison of two recently developed health status instruments for patients with arthritis: Dutch-AIMS2 and IRGL IRGL Interagency Regulatory Liaison Group . Br J Rheumatol. 1998;37:157-164. * The English version of the CFS-APQ is shown in the Appendix. The Dutch version of the questionnaire (as well as a French version) is available upon request from the corresponding author. J Nijs, PT, MSc, MT, is Assistant at the Department of Human Physiology Human physiology is the science of the mechanical, physical, and biochemical functions of humans in good health, their organs, and the cells of which they are composed. The principal level of focus of physiology is at the level of organs and systems. , Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium. Address all correspondence to Mr Nijs at Vakgroep MFAB/Sportgeneeskunde, AZ-VUB KRO KRO Katholieke Radio Omroep KRO Kurgan (Russia) KRO Korean Ragnarok Online (computer game) KRO Keep Right On (Birmingham City FC) Gebouw 1, Laarbeeklaan 101, 1090 Brussels, Belgium (Jo.Nijs@vub.ac.be). P Vaes, PT, PhD, is Professor, Department of Physical Therapy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel. N McGregor, PhD, MDSc, is Faculty Member, Collaborative Pain Research Unit, Department of Biological Sciences, Faculty of Science, University of Newcastle University of Newcastle can refer to:
E Van Hoof, Clin Psychol, is Clinical Psychologist psy·chol·o·gist n. A person trained and educated to perform psychological research, testing, and therapy. psychologist , Department of Human Physiology, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel. K De Meirleir, MD, PhD, is Staff Member, Chronic Fatigue Clinic, Vrije Universiteit Brussel, and is Professor and Head, Department of Human Physiology, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel. Mr Nijs, Dr Vaes, and Ms Van Hoof provided concept/research design. Mr Nijs, Dr Vaes, Dr McGregor, and Ms Van Hoof provided writing. Mr Nijs and Dr De Meirleir provided data collection, and Mr Nijs, Dr Vaes, and Dr McGregor provided data analysis. Mr Nijs provided project management, and Dr De Meirleir provided fund procurement The fancy word for "purchasing." The procurement department within an organization manages all the major purchases. , subjects, facilities/equipment, and institutional liaisons. Dr Vaes, Dr McGregor, and Ms Van Hoof provided consultation (including review of manuscript manuscript, a handwritten work as distinguished from printing. The oldest manuscripts, those found in Egyptian tombs, were written on papyrus; the earliest dates from c.3500 B.C. before submission). This article was submitted August 1, 2002, and was accepted December 3, 2002. |
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