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| Chronic fatigue syndrome: | Title page | Contents | Overview | |
Purpose |
These guidelines are primarily aimed at assisting general practitioners, but they will also be useful to specialist physicians and other health care professionals involved in managing people with fatigue states, including physiotherapists, occupational therapists, psychologists and social workers. They are based on the best information available at the date of publication, and are intended to provide a general guide to appropriate practice. However, it should be emphasised that evidence-based clinical practice involves not only use of the best available research evidence, but also exercise of the practitioner's clinical judgement, taking account of individual patient preferences.
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 "To study the phenomena of disease without books is to sail in an uncharted sea, while to study books without patients is not to go to sea at all." -- Sir William Osler, Books and Men 1901
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Background |
In 1990, the Royal Australasian College of Physicians (RACP) published a brief position paper on the investigation and management of chronic fatigue syndrome (CFS) in the RACP magazine, Fellowship Affairs. In 1993, as a result of perceived variations in clinical practice, the Commonwealth Minister for Health established a CFS Review Committee to make recommendations on "diagnostic and management regimens that the medical profession would regard as appropriate for sufferers of CFS". The Review Committee approached the RACP for an up-to-date position, and the College passed the request to the Australasian Society of Clinical Immunology and Allergy (ASCIA). In 1994 a fully revised discussion paper prepared by ASCIA was circulated to all physicians in Fellowship Affairs, together with a questionnaire, and the paper and results were subsequently made available to the Ministerial Review Committee.
In 1995, as a result of the Review Committee's recommendations, the Commonwealth Department of Health funded the Royal Australian College of General Practitioners to conduct a survey of general practitioners' opinions and practices in relation to CFS. Meanwhile, representatives of the Review Committee, the RACP and ASCIA met and agreed to develop an expert consensus position regarding the diagnosis and management of CFS. Fortuitously, in October 1995, the National Health and Medical Research Council (NHMRC) published Guidelines for the development and implementation of clinical practice guidelines, which provided an ideal framework for this purpose. Consequently, in 1996, a multidisciplinary Working Group (including a consumer representative) was established under the auspices of the RACP to develop and disseminate evidence-based guidelines, following the procedures recommended by the NHMRC. The Commonwealth Department of Health and Family Services provided funding.
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Guideline development |
The Working Group conducted an exhaustive review of the relevant scientific literature on prolonged fatigue, chronic fatigue and CFS, and the evidence was rated according to a modification of the schema recommended by the NHMRC (see part 6). In addition, the Ministerial Review Committee report and a variety of other local and international public domain documents were examined.
Submissions were also invited from interested practitioners, consumers and patient support groups. Eighty submissions were received from people with CFS, carers, concerned individuals and CFS Societies, and these were compiled and summarised for the Working Group by the consumer representative. A copy of the consumer perspective summary document is available on the world wide web at http://www.racp.edu.au/consumer.htm.
The Working Group prepared an exposure draft of the guidelines which was disseminated widely to relevant specialist societies, Royal Colleges, the NHMRC, complementary practitioner associations, patient support groups, and interested individual practitioners and consumers. The exposure draft was also produced on the world wide web site of The Medical Journal of Australia at http:// www.mja.com.au/public/guides/cfs/cfs1.html. The final document was then revised in the light of the comments received.
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| Chronic fatigue syndrome: | Title page | Contents | Overview | |