Clinically accessible tools for documenting the impact of orthostatic intolerance on symptoms and function in ME/CFS

Work. 2020;66(2):257-263. doi: 10.3233/WOR-203169.


Background: Clinical observations have indicated that hours of upright activity (HUA) reported by Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients correlated with orthostatic symptoms and impaired physical function. This study examined the relationship between HUA and orthostatic intolerance (OI).

Methods: Twenty-five female ME/CFS subjects and 25 age and race matched female healthy controls (HCs) were enrolled. Subjects reported HUA (defined as hours per day spent with feet on the floor) and completed questionnaires to assess the impact of OI on daily activities and symptoms. ME/CFS patients were categorized into those with <5 HUA and ≥5 HUA and analyzed by employment status. Data analysis used one-way ANOVA.

Results: ME/CFS patients had fewer HUA, worse symptoms and greater interference with daily activities due to OI than HCs. The <5 HUA ME/CFS subjects had more severe OI related symptoms than ≥5 HUA ME/CFS subjects even though OI interfered with daily activities similarly. Only 33% of ME/CFS subjects were employed and all were ≥5 HUA ME/CFS subjects with an average HUA of 8.

Conclusions: ME/CFS subjects experienced more frequent and severe OI symptoms, higher interference with daily activities, and reduced ability to work than HCs. Reported HUA and assessment of OI using standardized instruments may be useful clinical tools for physicians in the diagnosis, treatment and management of ME/CFS patients.

Keywords: ME/CFS; hours of upright activity; impaired physical function; orthostatic intolerance.

MeSH terms

  • Adult
  • Analysis of Variance
  • Case-Control Studies
  • Documentation / methods*
  • Documentation / standards
  • Documentation / trends
  • Fatigue Syndrome, Chronic / complications
  • Fatigue Syndrome, Chronic / physiopathology*
  • Female
  • Humans
  • Middle Aged
  • Orthostatic Intolerance / diagnosis*
  • Orthostatic Intolerance / physiopathology
  • Surveys and Questionnaires