Prognosis and Duration of disabling effects
People with mild illness may recover spontaneously, or with some general advice or a limited treatment programme over the course of the following six months. These people are likely to be treated in a general practice setting.
People with established CFS/ME of moderate severity lasting one to two years or more are likely to need a more extensive management programme, as described above, lasting 6 to 12 months or more. Most people who are able to attend hospital for treatment are likely to make a significant improvement with appropriate management. Some people will recover fully, but others will not achieve their previous level of functioning. Some may not improve. Those who recover may be at risk of recurrence. Those who improve are at risk of relapse. In many patients, disability and quality of life can be improved, sometimes to a significant extent.
Severe cases are less likely to recover completely or benefit substantially from a management programme.
Indicators of a good prognosis are:
- Male sex,
- A definite history of an acute viral illness like glandular fever at the onset,
- Mild disability and few symptoms,
- Clinical features showing a pattern of evolution towards functional recovery,
- Early diagnosis aimed at eliminating associated physical disorders and/or identifying psychiatric illness along with other complicating psychological or social factors,
- A management approach which may encompass physical, psychological and social elements that allows a stepwise approach to functional improvement using rehabilitation.
Indicators of a poor prognosis are:
- Onset of symptoms without any clear precipitating factor,
- Clinical features characterised by severe and unremitting symptoms,
- Severe and persistent disability,
- A management approach that overemphasises the importance of either complete rest or which advocates a rapid return to pre-illness levels of physical activity,
- Those with co-morbid significant medical conditions or mood disorders,
- A complex background of adverse psychological and social factors.
