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J Pediatr. 2018 Sep;200:249-253.e1. doi: 10.1016/j.jpeds.2018.05.012. Epub 2018 Jun 1.

Two-Year Follow-Up of Impaired Range of Motion in Chronic Fatigue Syndrome.

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Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address:
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Health Behavior, University of Alabama at Birmingham School of Public Health, Birmingham, AL.
Rick Violand PT, LLC, Ellicott City, MD.



To measure changes in range of motion (ROM) over time in a cohort of 55 adolescents and young adults with chronic fatigue syndrome and to determine whether changes in ROM correlated with changes in health-related quality of life.


Participants underwent a standardized examination of 11 areas of limb and spine ROM at baseline and at 3- to 6-month intervals for 2 years, resulting in a ROM score that ranged from 0 (normal throughout) to 11 (abnormal ROM in all areas tested). We measured the time until the ROM score was ≤2 (the score in healthy age-matched controls). Change in ROM was measured by subtracting the 24-month from the baseline ROM score and by summing the degrees of change in the 10 tests with continuous outcomes. Health-related quality of life was measured using the Pediatric Quality of Life Inventory 4.0 (PedsQL).


The mean age at enrollment was 16.5 years (range 10-23). Two-year follow-up was available for 53 (96%). The proportion with a ROM score of >2 fell gradually over 2 years, from 78% at entry to 20% at 24 months (P < .001). ROM scores improved from a median of 5 at entry to 2 at 24 months (P < .001). The change in the summed degrees of improvement in ROM correlated positively with improvement in the PedsQL physical function subscale (r = 0.30; P < .03).


In association with multimodal therapy, young people with chronic fatigue syndrome experienced progressively less impairment in ROM over 2 years, correlating with improvements in the physical function subscale of the PedsQL.


Myalgic encephalomyelitis; adverse neural tension; fatigue; neurodynamics

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