by this particular team have ME and CFS. The RCT cohort is the same
cohort used in the PACE trial which were defined using the rarely used
1991 Oxford definition authored and financed by some the PACE study
authors including Dr. Sharpe.
The abstract does not state whether the clinic specializing in CFS is
the one run by by the King's College Institute of Psychiatry, but it
may be reasonable to assume so - with the same inherent problems as
the PACE trial cohort. That either cohort is more likely to have
depression or anxiety, or affective disorders alone, has been
questioned by other researchers. Whether the group improving with CBT
had ME and CFS as defined by specificity and severity is unknown as
comparisons between groups initially screened according to various
definitions comparing the Oxford definition to the 2003 Canadian
Consensus Definition or the 2011 ICC definition for ME has not been
done at this time. Improvement with CBT has been measured using
self-report, but not objectively measured changes in pathophysiology.
According to ME and CFS expert Dr. Nancy Klimas, CBT is no more
effective in patients with ME and CFS than in other patients who also
have an organic disease.
Mental disorders are currently defined by DSM-IV (American Psychiatric
Association, 1994) as clinically significant behavioural or
psychological syndromes associated with painful symptoms and/or
impairment in one or more important areas of functioning. A WSAS score
above 20 appears to suggest moderately severe or worse
psychopathology. Scores between 10 and 20 are associated with
significant functional impairment, but less severe clinical
symptomology. Scores below 10 appear to be associated with subclinical
populations.
A copy of the Work and Social Adjustment Scale can be found here:
http://www.serene.me.uk/tests/wsas.pdf
J Psychosom Res. 2011 Sep;71(3):124-8. Epub 2011 Apr 3.
Measuring disability in patients with chronic fatigue syndrome:
reliability and validity of the Work and Social Adjustment Scale.
Cella M, Sharpe M, Chalder T.
Institute of Psychiatry, King's College London, UK; Department of
Clinical, Educational & Health Psychology, University College London,
UK.
Abstract
BACKGROUND:
Disability is a defining feature of chronic conditions, and it is an
increasingly used measure of therapy effectiveness. The Work and
Social Adjustment Scale (WSAS) is a simple and clear measure of
disability. Although the scale is widely used, no study has yet
investigated its psychometric properties in patients with chronic
fatigue syndrome (CFS).
METHODS:
Data from two samples of patients were used, one from a multicenter
randomized controlled clinical trial of treatments for CFS (n =3D639)
and the other from a clinic that specializes in CFS (n=3D384). All
patients completed the WSAS as well as other measures.
RESULTS:
Internal consistency and the Spearman-Brown split-half coefficient
values indicated that the scale is reliable. CFS patients who had
comorbid diagnoses of depression, anxiety or fibromyalgia had higher
WSAS scores. High levels of disability were associated with high
number of physical symptoms, severe fatigue, depression, anxiety, poor
sleep quality and poor physical fitness, with correlation coefficients
ranging between 0.41 and 0.11.
Lower scores on the WSAS were modestly associated with better physical
functioning as well as higher levels of physical capacity as assessed
by a walking test. Sensitivity to change was evaluated in a subgroup
of patients who had undergone a course of cognitive behavioral
therapy. Disability significantly decreased after therapy and remained
stable at follow-ups.
CONCLUSION:
The WSAS is a reliable and valid assessment tool for disability in
patients with CFS.
Copyright =A9 2011 Elsevier Inc. All rights reserved.
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