Quality of Life Research

, Volume 23, Issue 9, pp 2407–2416

Defining recovery in chronic fatigue syndrome: a critical review

  • Jenna L. Adamowicz
  • Indre Caikauskaite
  • Fred Friedberg

DOI: 10.1007/s11136-014-0705-9

Cite this article as:
Adamowicz, J.L., Caikauskaite, I. & Friedberg, F. Qual Life Res (2014) 23: 2407. doi:10.1007/s11136-014-0705-9



In chronic fatigue syndrome (CFS), the lack of consensus on how recovery should be defined or interpreted has generated controversy and confusion. The purpose of this paper was to systematically review, compare, and evaluate the definitions of recovery reported in the CFS literature and to make recommendations about the scope of recovery assessments.


A search was done using the MEDLINE, PubMed, PsycINFO, CINAHL, and Cochrane databases for peer review papers that contained the search terms “chronic fatigue syndrome” and “recovery,” “reversal,” “remission,” and/or “treatment response.”


From the 22 extracted studies, recovery was operationally defined by reference with one or more of these domains: (1) pre-morbid functioning; (2) both fatigue and function; (3) fatigue (or related symptoms) alone; (4) function alone; and/or (5) brief global assessment. Almost all of the studies measuring recovery in CFS did so differently. The brief global assessment was the most common outcome measure used to define recovery. Estimates of recovery ranged from 0 to 66 % in intervention studies and 2.6 to 62 % in naturalistic studies.


Given that the term “recovery” was often based on limited assessments and less than full restoration of health, other more precise and accurate labels (e.g., clinically significant improvement) may be more appropriate and informative. In keeping with common understandings of the term recovery, we recommend a consistent definition that captures a broad-based return to health with assessments of both fatigue and function as well as the patient’s perceptions of his/her recovery status.


Recovery Chronic fatigue syndrome Operational definition 

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Jenna L. Adamowicz
    • 1
  • Indre Caikauskaite
    • 1
  • Fred Friedberg
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesStony Brook UniversityStony BrookUSA

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