Operationalizing Substantial Reduction in Functioning Among Young Adults with Chronic Fatigue Syndrome



Chronic fatigue syndrome and myalgic encephalomyelitis are fatiguing illnesses that often result in long-term impairment in daily functioning. In reviewing case definitions, Thrope et al. (Fatigue 4(3):175–188, 2016) noted that the vast majority of case definitions used to describe these illnesses list a “substantial reduction” in activities as a required feature for diagnosis. However, there is no consensus on how to best operationalize the criterion of substantial reduction.


The present study used a series of receiver operating curve (ROC) analyses to explore the use of the Medical Outcomes Study Short-Form-36 Health Survey (SF-36), designed by Ware and Shelbourne for operationalizing the substantial reduction criterion in a young adult population (18–29 years old). We compared the sensitivity and specificity of various cutoff scores for the SF-36 subscales and assessed their usefulness in discriminating between a group of young adults with a known diagnosis of chronic fatigue syndrome or myalgic encephalomyelitis (n = 98) versus those without that diagnosis (n = 272).


The four top performing subscales and their associated cutoffs were determined: Physical Functioning ≤ 80, General Health ≤ 47, Role Physical ≤ 25, and Social Functioning ≤ 50. Used in combination, these four cutoff scores were shown to reliably discriminate between the patients and controls in our sample of young adults.


The implications of these findings for employing the substantial reduction criterion in both clinical and research settings are discussed.

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Funding was provided by the National Institute of Allergy and Infectious Diseases (grant number AI105781).

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Correspondence to Leonard A. Jason.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Gleason, K.D., Stoothoff, J., McClellan, D. et al. Operationalizing Substantial Reduction in Functioning Among Young Adults with Chronic Fatigue Syndrome. Int.J. Behav. Med. 25, 448–455 (2018). https://doi.org/10.1007/s12529-018-9732-1

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  • Chronic fatigue syndrome
  • Myalgic encephalomyelitis
  • Substantial reduction
  • CFS case definitions
  • Young adults