Assessment of activity limitations and participation restrictions with persons with chronic fatigue syndrome: a systematic review

Disabil Rehabil. 2015;37(19):1706-16. doi: 10.3109/09638288.2014.978507. Epub 2014 Nov 3.


Purpose: To summarize measurement instruments used to evaluate activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS) and review the psychometric properties of these instruments.

Method: General information of all included measurement instruments was extracted. The methodological quality was evaluated using the COSMIN checklist. Results of the measurement properties were rated based on the quality criteria of Terwee et al. Finally, overall quality was defined per psychometric property and measurement instrument by use of the quality criteria by Schellingerhout et al.

Results: A total of 68 articles were identified of which eight evaluated the psychometric properties of a measurement instrument assessing activity limitations and participation restrictions. One disease-specific and 37 generic measurement instruments were found. Limited evidence was found for the psychometric properties and clinical usability of these instruments. However, the CFS-activities and participation questionnaire (APQ) is a disease-specific instrument with moderate content and construct validity.

Conclusion: The psychometric properties of the reviewed measurement instruments to evaluate activity limitations and participation restrictions are not sufficiently evaluated. Future research is needed to evaluate the psychometric properties of the measurement instruments, including the other properties of the CFS-APQ. If it is necessary to use a measurement instrument, the CFS-APQ is recommended.

Implications for rehabilitation: Chronic fatigue syndrome (CFS). Chronic fatigue syndrome causes activity limitations and participation restrictions in one or more areas of life. Standardized, reliable and valid measurement instruments are necessary to identify these limitations and restrictions. Currently, no measurement instrument is sufficiently evaluated with persons with CFS. If a measurement instrument is needed to identify activity limitations and participation restrictions with persons with CFS, it is recommended to use the CFS-APQ in clinical practice and scientific research.

Keywords: Activity limitation; chronic fatigue syndrome; participation restriction.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Activities of Daily Living*
  • Checklist
  • Disability Evaluation*
  • Fatigue Syndrome, Chronic / physiopathology*
  • Fatigue Syndrome, Chronic / rehabilitation
  • Humans
  • Psychometrics / instrumentation*
  • Surveys and Questionnaires / standards*