{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:29Z","timestamp":1787017049708,"version":"build-2736575974"},"reference-count":18,"publisher":"BMJ","issue":"11","funder":[{"name":"The Fund for Osteopathic Research into Myalgic Encephalomyelitis"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,9,29]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess five physical signs to see whether they can assist in the screening of patients with chronic fatigue syndrome\/myalgic encephalomyelitis (CFS\/ME) and potentially lead to quicker treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a diagnostic accuracy study with inter-rater agreement assessment. Participants recruited from two National Health Service hospitals, local CFS\/ME support groups and the community were examined by three practitioners on the same day in a randomised order. Two allied health professionals (AHPs) performed independent examinations of physical signs including: postural\/mechanical disturbances of the thoracic spine, breast varicosities, tender Perrin\u2019s point, tender coeliac plexus and dampened cranial flow. A physician conducted a standard clinical neurological and rheumatological assessment while looking for patterns of illness behaviour. Each examination lasted approximately 20\u2009min.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety-four participants were assessed, 52 patients with CFS\/ME and 42 non-CFS\/ME controls, aged 18\u201360. Cohen\u2019s kappa revealed that agreement between the AHPs was substantial for presence of the tender coeliac plexus (\u03ba=0.65, p&lt;0.001) and moderate for postural\/mechanical disturbance of the thoracic spine (\u03ba=0.57, p&lt;0.001) and Perrin\u2019s point (\u03ba=0.56, p&lt;0.001). A McNemar\u2019s test found no statistically significant bias in the diagnosis by the experienced AHP relative to actual diagnosis (p=1.0) and a marginally non-significant bias by the newly trained AHP (p=0.052). There was, however, a significant bias in the diagnosis made by the physician relative to actual diagnosis (p&lt;0.001), indicating poor diagnostic utility of the clinical neurological and rheumatological assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using the physical signs appears to improve the accuracy of identifying people with CFS\/ME and shows agreement with current diagnostic techniques. However, the present study concludes that only two of these may be needed. Examining for physical signs is both quick and simple for the AHP and may be used as an efficient screening tool for CFS\/ME. This is a small single-centre study, and therefore, further validation in other centres and larger populations is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-017521","type":"journal-article","created":{"date-parts":[[2017,11,13]],"date-time":"2017-11-13T12:27:10Z","timestamp":1510576030000},"page":"e017521","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome\/myalgic encephalomyelitis? A diagnostic accuracy study"],"prefix":"10.1136","volume":"7","author":[{"given":"Lucy","family":"Hives","sequence":"first","affiliation":[{"name":"School of Dentistry, University of Central Lancashire, Preston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Neurophysiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4004-3115","authenticated-orcid":false,"given":"Jim","family":"Richards","sequence":"additional","affiliation":[{"name":"Allied Health Research Unit, University of Central, Lancashire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Sutton","sequence":"additional","affiliation":[{"name":"Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Selfe","sequence":"additional","affiliation":[{"name":"Department of Health Professions, Manchester Metropolitan University, Manchester, Greater Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaskar","family":"Basu","sequence":"additional","affiliation":[{"name":"University Hospital of South Manchester NHS Foundation Trust\/ Central, Manchester University Hospitals NHS Foundation Trust, Rehabilitation Medicine, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry","family":"Maguire","sequence":"additional","affiliation":[{"name":"Department of Osteopathy, The Good Health Centre, County Clare, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Sumner","sequence":"additional","affiliation":[{"name":"Back to Health Physiotherapy, Bolton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Gaber","sequence":"additional","affiliation":[{"name":"Taylor Rehabilitation Unit leigh, Leigh Infirmary, Leigh, Greater Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annice","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond N","family":"Perrin","sequence":"additional","affiliation":[{"name":"Allied Health Research Unit, University of Central, Lancashire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,11,13]]},"reference":[{"key":"2025121409422538000_7.11.e017521.1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-121-12-199412150-00009"},{"key":"2025121409422538000_7.11.e017521.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2011.02428.x"},{"key":"2025121409422538000_7.11.e017521.3","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2006.042754"},{"key":"2025121409422538000_7.11.e017521.4","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.18.2129"},{"key":"2025121409422538000_7.11.e017521.5","unstructured":"National Institute for Health and Care Excellence. Chronic fatigue syndrome\/myalgic encephalomyelitis (or encephalopathy): diagnosis and management of chronic fatigue syndrome\/myalgic encephalomyelitis (or encephalopathy) in adults and children. London: NICE, 2007."},{"key":"2025121409422538000_7.11.e017521.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2011.06.016"},{"key":"2025121409422538000_7.11.e017521.7","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200131030-00003"},{"key":"2025121409422538000_7.11.e017521.8","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-102-1-7"},{"key":"2025121409422538000_7.11.e017521.9","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2007.050054"},{"key":"2025121409422538000_7.11.e017521.10","first-page":"595","article-title":"Chronic fatigue syndrome and arthralgia following parvovirus B19 infection","volume":"29","author":"Kerr","year":"2002","journal-title":"J Rheumatol"},{"key":"2025121409422538000_7.11.e017521.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2008.08.003"},{"key":"2025121409422538000_7.11.e017521.12","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.2.221"},{"key":"2025121409422538000_7.11.e017521.13","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ijosm.2010.12.002","article-title":"Muscle fatigue in chronic fatigue syndrome\/myalgic encephalomyelitis (CFS\/ME) and its response to a manual therapeutic approach: a\u00a0pilot study","volume":"14","author":"Perrin","year":"2011","journal-title":"Int J Osteopath Med"},{"key":"2025121409422538000_7.11.e017521.14","unstructured":"Perrin R . The involvement of cerebrospinal fluid and lymphatic drainage in chronic fatigue syndrome\/ME. PhD\u00a0[thesis]. University of Salford: Salford, 2005."},{"key":"2025121409422538000_7.11.e017521.15","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1177\/147323001103900122","article-title":"Increased tenderness in the left third intercostal space in adult patients with myalgic encephalomyelitis: a controlled study","volume":"39","author":"Puri","year":"2011","journal-title":"J Int Med Res"},{"key":"2025121409422538000_7.11.e017521.16","first-page":"218","article-title":"Lymphatic drainage of the neuraxis in chronic fatigue syndrome: a hypothetical model for the cranial rhythmic impulse","volume":"107","author":"Perrin","year":"2007","journal-title":"J Am Osteopath Assoc"},{"key":"2025121409422538000_7.11.e017521.17","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.18.2129"},{"key":"2025121409422538000_7.11.e017521.18","unstructured":"NHS Choices. 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