On the clinical assessment of persistent fatigue and pain

Patients with persistent fatigue and pain, most of them women, often struggle with decreased function and related concerns. They commonly receive an inconclusive investigation and a delayed diagnosis. Neuropathic aspects of the condition may be missed. Clinical screening is vital because it can support medical and healthcare decision-making early in the course of an illness. Two go-to tools of the typical assessment, the Beighton score and the pain drawing, are appreciated in praxis but lack substantial evidence base. The overarching aim of this thesis was to contribute to improvements in the management and diagnostics for these patients. All research questions originated from clinical praxis. The studies are based on data from one group among the very large population of patients who have persistent fatigue and pain: those presenting with suspected myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In study I, the Beighton score was evaluated within clinical routine assessment for its capacity to identify a physique with systemic joint laxity. Systemic joint laxity is a risk factor for developing persistent health issues and should warrant considerations in treatment. Normally, this feature would need to be assessed routinely in the investigation of persistent fatigue or pain. This study involved different competencies of the assessors (physician and physiotherapist). Despite these differences and a lack of joint training in the method, inter-rater reliability was acceptable, demonstrating the stability of the Beighton score as a measurement. The sum score, however, must not be interpreted as a definitive answer regarding whether systemic joint laxity is present but must be read instead within the context of a targeted medical history. Study II concerned the pain drawing used to assess body pain extent. Methods of interpretation, however, have not been standardized in clinic and little evidence is available regarding its use for assessing the cervical spine. Study II involved evaluation of a method of ...