Oxford criteria

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The Oxford criteria are a set of criteria for the diagnosis Chronic Fatigue Syndrome published in 1991 by a group mostly consisting of psychiatrists, and was designed for research.[1] They identify two broad syndromes and are used primarily for research purposes.[2] The Oxford criteria was used for PACE trial participation.[3][4]

Authors

Michael Sharpe, Len Archard, Jangu Banatvala, Leszek Borysiewicz, Anthony Clare, Anthony David, Richard Edwards, Keith Hawton, Harold Lambert, Russell Lane

Definition

Chronic fatigue syndrome

Post-infectious Fatigue Syndrome (PIFS)

A sub-type of CFS which either follows an infection or is associated with a current infection (although whether such associated infection is of aetiological significance (i.e. whether it is the cause of the symptoms) is a topic for research).

To meet the research criteria for PIFS patients must:

  • i. fulfil the criteria for CFS as defined above (i.e. the Oxford definition)
  • ii. should also fulfil the following additional criteria:
  • (a) There is definite evidence of infection at onset or presentation (a patient’s self-report is unlikely to be sufficiently reliable).
  • (b) the syndrome is present for a minimum of 6 months after onset of infection.
  • (c) the infection has been corroborated by laboratory evidence.

Oxford Definition CFS and PIFS

Criticisms

"For every 15 patients selected under Oxford criteria, 14 will be false positives when compared to Canadian Consensus Criteria. The Pace trial and FINE trial used Oxford criteria."
"When studies using the broad Oxford criteria (Sharpe et al., 1991) were excluded, a virtual disappearance of effect for graded exercise therapy (GET), cognitive behaviour therapy (CBT) and other psychological therapies recommended by the NICE guidelines (National Institute for Health and Care Excellence (NICE), 2007) was revealed. "
"Consensus groups and researchers should consider retiring the Oxford case definition because it differs from the other case definitions and is the least restrictive, probably including individuals with other overlapping conditions"
  • 2015, Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop[7](Full Text)
    :"The Oxford CFS case definition is the least restrictive, and its use as entry criteria could have resulted in selection of participants with other fatiguing illnesses or illnesses that resolve spontaneously with time (16, 71)."
  • Post-exertional malaise is not a listed symptom. When this symptom is not mandatory, patients with Chronic Fatigue and not the grossly misnamed disease Chronic Fatigue Syndrome are swept into the study.[citation needed]
  • Depression is not an absolute exception for a possible cause of Chronic Fatigue (not to be confused with Chronic Fatigue Syndrome). This allows for patients with depression to be misdiagnosed with CFS.[citation needed]
  • Many psychiatric disorders are not excluded, even though the disorder is designed for research. Although schizophrenia, substance abuse, bipolar disorder, eating disorders, and verified organic brain disorders are excluded from diagnosis in the Oxford criteria, anxiety disorders, depressive disorders, and hyperventilation can be included. This allows for a more heterogeneous patient sample which can render clinical study results indeterminate.[8]
  • US NIH Report Calls for UK Definition of ME/CFS to be Scrapped - The Argus Report By: Penny Swift.
Excerpt
The United States National Institutes of Health (NIH) has issued a draft report that highlights the dire need for scientific research that will help find a cure for the millions of people suffering from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) worldwide. The report also highlights the fact that the decades-old UK Royal Society of Medicine’s Oxford criteria for ME/CFS are severely “flawed,” and that continuing to use these criteria may “cause harm.” Further, the NIH report says that the Royal Society definition should “be retired” and replaced with a single case definition agreed to by the ME/CFS community.[9]
  • 2017, Chronic Fatigue Syndrome prevalence is grossly overestimated using Oxford criteria compared to Centers for Disease Control (Fukuda) criteria in a U.S. population study[10](Full text)

Research using the Oxford criteria

  • 2010: Psychiatric misdiagnoses in patients with chronic fatigue syndrome
    • "Conclusions: Doctors assessing patients in a chronic fatigue syndrome clinic miss psychiatric diagnoses more often than misdiagnosing them. Missed diagnoses are common. CFS clinic doctors should be trained to diagnose psychiatric disorders."[11]

Learn more

See also

References

  1. 1.01.1 A report - chronic fatigue syndrome: guidelines for research Journal of the Royal Society of Medicine Volume 84 February 1991 118-121
  2. Symptoms and diagnosis of ME/CFS - ME Association
  3. Pace Trial - Centre for Psychiatry - QMUL
  4. PACE study results – Medical Research Council (UK) news report, 18 February 2011 - ME Association
  5. Nacul, Luis; Lacerda, Eliana M; Kingdon, Caroline C; Curran, Hayley; Bowman, Erinna W (Mar 1, 2017). "How have selection bias and disease misclassification undermined the validity of myalgic encephalomyelitis/chronic fatigue syndrome studies?". Journal of Health Psychology: 1359105317695803. doi:10.1177/1359105317695803. ISSN 1359-1053. PMC 5581258Freely accessible. PMID 28810428. 
  6. Haney, Elizabeth; Smith, M.E. Beth; McDonagh, Marian; Pappas, Miranda; Daeges, Monica; Wasson, Ngoc; Nelson, Heidi D. (Jun 16, 2015). "Diagnostic Methods for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop". Annals of Internal Medicine. 162 (12): 834. doi:10.7326/m15-0443. ISSN 0003-4819. 
  7. Smith, M.E. Beth; Haney, Elizabeth; McDonagh, Marian; Pappas, Miranda; Daeges, Monica; Wasson, Ngoc; Fu, Rongwei; Nelson, Heidi D. (Jun 16, 2015). "Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop". Annals of Internal Medicine. 162 (12): 841. doi:10.7326/m15-0114. ISSN 0003-4819. 
  8. Mary Gloria C. Njoku (2016), Myalgic, Encephalomyelitis/Chronic Fatigue Syndrome: History, Diagnostic Criteria and Prevalence (ebook), ISBN 978-1-4689-7326-6 
  9. US NIH Report Calls for UK Definition of ME/CFS to be Scrapped - The Argus Report By: Penny Swift
  10. Baraniuk, James N. (Oct 2, 2017). "Chronic fatigue syndrome prevalence is grossly overestimated using Oxford criteria compared to Centers for Disease Control (Fukuda) criteria in a U.S. population study". Fatigue: Biomedicine, Health & Behavior. 5 (4): 215–230. doi:10.1080/21641846.2017.1353578. ISSN 2164-1846. PMC 6407870Freely accessible. PMID 30854252. 
  11. Lawn, Tara; Kumar, Praveen; Knight, Bernice; Sharpe, Michael; White, Peter D (Sep 6, 2010). "Psychiatric misdiagnoses in patients with chronic fatigue syndrome". JRSM Short Reports. 1 (4). doi:10.1258/shorts.2010.010042. ISSN 2042-5333. PMC 2984352Freely accessible. PMID 21103120. 

Graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

Graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

Cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

NICE guidelines - Clinical guidelines used in the UK.

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

ME/CFS - An acronym that combines myalgic encephalomyelitis with chronic fatigue syndrome. Sometimes they are combined because people have trouble distinguishing one from the other. Sometimes they are combined because people see them as synonyms of each other.

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

The information provided at this site is not intended to diagnose or treat any illness.
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.