Survey of stigma across healthcare workers in an urban, academic medical center regarding perinatal patients using opioids.

BACKGROUND AND OBJECTIVES: To examine healthcare workers' attitudes towards pregnant woman using opioids across provider type, specialty, and years of service. METHODS: Cross-sectional, anonymous survey of healthcare workers at an urban, academic medical center regarding attitudes towards pregnant women using opioids. RESULTS: One hundred and nineteen surveys were completed. Nurses were less likely to feel sympathetic towards pregnant women that use opioids (p = .016). DISCUSSION AND CONCLUSIONS: Differences in attitudes towards pregnant women using opioids were found between clinicians and nurses. SCIENTIFIC SIGNIFICANCE: Training and experience may contribute to attitude differences towards pregnant women using opioids.

Perceiving Therapeutic Communication: Client-Therapist Discrepancies.

IMPORTANCE: Few studies have examined differences in clients' and therapists' perspectives on therapeutic communication; this article contributes to the knowledge base. OBJECTIVE: To examine clients' and therapists' real-time perceptions of therapeutic communication. DESIGN: Observational, quantitative, cross-sectional study. SETTING: Inpatient and outpatient units of a large urban teaching hospital. PARTICIPANTS: Clients (n = 110) and rehabilitation therapists (n = 38; occupational, physical, and speech). OUTCOMES AND MEASURES: Demographic characteristics, Clinical Assessment of Modes (CAM). RESULTS: Clients perceived that therapists communicated by instructing more, and therapists reported empathizing more. CONCLUSIONS AND RELEVANCE: The findings suggest that clients and therapists may perceive therapeutic communication differently. What This Article Adds: This article supports therapists' use of the CAM to examine multiple perspectives on their communication mode use, as described in the Intentional Relationship Model.

Communicating With Intention: Therapist and Parent Perspectives on Family-Centered Care in Early Intervention.

IMPORTANCE: Responsive communication is critical to ensuring family-centered care in early intervention (EI). The Intentional Relationship Model (IRM) offers a framework for examining therapist-parent communication and offers strategies for supporting therapist responsiveness. OBJECTIVE: To explore family-centered care and therapists' communication in EI using the IRM. DESIGN: Prospective descriptive study. SETTING: Illinois EI program. PARTICIPANTS: Convenience sample of 101 therapists and 19 parents enrolled in an EI program. Therapist disciplines included developmental (n = 24), occupational (n = 32), physical (n = 17), and speech (n = 28) therapy. OUTCOMES AND MEASURES: Demographic questionnaire, Early Interventionist Self-Efficacy Scale, Early Intervention Parenting Self-Efficacy Scale, Measure of Processes of Care (MPOC)-Short Form, MPOC-Service Provider, Clinical Assessment of Modes (CAM), and Clinical Assessment of Suboptimal Interaction-Short Form (CASI-SF). RESULTS: Therapists used family-centered practices specific to relationship building more frequently than information sharing (especially sharing of general information). Therapists used the empathizing, encouraging, and instructing modes most frequently in their interactions with families. Participants' scores on the MPOC, CAM, and CASI-SF were significantly correlated. CONCLUSIONS AND RELEVANCE: Therapist-parent interactions were aligned with family-centered care. Opportunities for practitioners were identified in (1) sharing specific and general information and (2) expanding the use of collaborating, problem-solving, and advocating modes. What This Article Adds: In this study, we explored how the IRM can inform family-centered practices in EI through examination of therapists' interpersonal competency and therapeutic mode use.

Contemporary occupational priorities at the end of life mapped against Model of Human Occupation constructs: A scoping review.

INTRODUCTION: People with end-of-life care needs are seen in an increasingly diverse range of health and community settings. Opportunity for continued occupational participation is highly valued by people at the end of life. This scoping review sought to identify the priorities and preferences for participation at the end of life and to map findings using the model of human occupation. METHODS: A search strategy informed by the research question was developed in collaboration with a research librarian. Data sources used were Ovid Medline(R), CINAHL, Ovid Emcare, Scopus, Web of Science and PsychInfo. Studies that focused on clinician perspectives, clinical care, grief and loss, did not clearly identify end-stage diseases, <18 years and written in languages other than English were excluded. FINDINGS: Forty-four studies were included with a total of 1,070 study participants. Inductively developed themes were mapped against the model of human occupation constructs of volition (personal causation, values, interests), habituation (habits of occupational performance and routine), performance capacity and the lived body within the physical, social and occupational environment. The majority of findings sat within the construct of volition, particularly around sense of personal capacity, self-efficacy and values. At the end of life, people prioritise ongoing engagement in valued occupations even if participation is effortful. As disease progresses, opportunity to exert influence and control over this participation and engagement increases in importance. Personal causation plays an important role in the experience of occupational participation at this time. CONCLUSION: This review provides important insights into the occupational priorities of people at the end of life and the importance of supporting agency and volition at this time. The model of human occupation and its client-centred focus offer a framework for a more robust examination of ways to enhance volitional capacity and enable occupational participation for people at the end of life.

Evaluating Students' Use of Therapeutic Communication in Entry-Level Education: The Observer Version of the Clinical Assessment of Modes (CAM-Observer).

IMPORTANCE: The Intentional Relationship Model (IRM) guides learning about therapeutic use of self. The observer version of the Clinical Assessment of Modes (CAM-Observer) may be used to evaluate students' therapeutic communication as the process is defined in the IRM. OBJECTIVE: To assess the structural validity of the CAM-Observer. DESIGN: Cross-sectional, psychometric study. SETTING: Master's in occupational therapy program. PARTICIPANTS: One hundred thirty-four entry-level students. OUTCOMES AND MEASURES: The overall CAM-Observer and the individual subscales (Advocating, Collaborating, Empathizing, Encouraging, Instructing, Problem-Solving) were used to assess students' communication from the instructor's perspective. RESULTS: The overall CAM-Observer and six subscales demonstrated appropriate rating scale functioning and dimensionality. The Advocating subscale demonstrated poor item fit, floor effects, and low person separation. One Collaborating item demonstrated poor fit to the overall CAM-Observer and the Collaborating subscale, requiring revision. Instructing and Encouraging items were most likely to be endorsed by the instructor-observers, resulting in a ceiling effect for the Instructing and Encouraging subscales. The Advocating and Problem-Solving items were least likely to be endorsed by the instructor-observers. Except for the Problem-Solving subscale, the overall CAM-Observer and the individual subscales could reliably separate items according to difficulty. Except for the Advocating subscale, the overall CAM-Observer and the individual subscales could reliably separate people into high- and low-performance groups. CONCLUSIONS AND RELEVANCE: The CAM-Observer offers a structurally valid and theoretically grounded assessment of students' therapeutic communication as the process is defined in the IRM. The CAM-Observer can be integrated into occupational therapy education to guide students' critical reflection on their interpersonal communication. WHAT THIS ARTICLE ADDS: The CAM-Observer offers a means of evaluating students' therapeutic use of self.

Validation of the Clinical Assessment of Modes-Therapist Version (CAM-T) in Acute Rehabilitation Settings.

IMPORTANCE: Assessments that evaluate health care providers' communication in acute rehabilitation settings remain scarce; this article contributes to the knowledge base. OBJECTIVE: To assess the reliability and validity of the Clinical Assessment of Modes-Therapist version (CAM-T) from the provider's perspective. DESIGN: Cross-sectional, psychometric study. SETTING: Acute care and acute inpatient rehabilitation. PARTICIPANTS: Ninety-six clients and 32 providers (occupational therapy, physical therapy, and nursing). MEASURES: The CAM-T was psychometrically evaluated using classical test theory and Rasch analytic approaches. RESULTS: The findings offer strong evidence for the CAM-T's reliability and validity for evaluating overall communication and adequate evidence for evaluating individual communication modes. CONCLUSION AND RELEVANCE: The CAM-T may be used by providers as a self-assessment of communication in occupational therapy and in associated rehabilitation professions. WHAT THIS ARTICLE ADDS: This article offers evidence in support of the CAM-T's reliability and validity for evaluating health care providers' communication with clients in acute rehabilitation settings. The CAM-T may be used to evaluate providers' overall communication and individual mode use as described in the Intentional Relationship Model.

Development and Validation of the Occupational Self-Assessment-Short Form (OSA-SF).

IMPORTANCE: The Occupational Self-Assessment, Version 2.2 (OSA 2.2), is a client-centered measure of clients' perceived occupational competence and value. The OSA 2.2 has previously demonstrated good structural validity and internal consistency; however, the administration length could deter therapists from using this assessment in acute care and acute inpatient rehabilitation. OBJECTIVE: To evaluate reliability and validity of the OSA 2.2 in acute care and acute inpatient rehabilitation and to develop and validate the OSA-Short Form (OSA-SF). DESIGN: We performed a descriptive psychometric analysis using the Rasch analytic approach. SETTING: The data were collected in acute care and acute inpatient rehabilitation. PARTICIPANTS: Our convenience sample consisted of 86 patients in acute care and acute inpatient rehabilitation. OUTCOMES AND MEASURES: Participants rated their perceived occupational competence and value by completing the OSA 2.2. RESULTS: We examined psychometric properties of the OSA 2.2 and OSA-SF using a partial credit Rasch model. The 21-item OSA 2.2 was reduced to a 12-item OSA-SF through iterative removal of items on the basis of item-misfit statistics. The OSA-SF demonstrated adequate rating scale functioning, dimensionality, item and person goodness of fit, item targeting, item hierarchies, and item and person separation. CONCLUSIONS AND RELEVANCE: Findings indicate that the OSA-SF is a valid and reliable measure that can guide client-centered goal setting and intervention planning for adults receiving acute care and acute inpatient rehabilitation. WHAT THIS ARTICLE ADDS: The OSA 2.2 and the OSA-SF offer a client-centered approach to evaluating patients' self-reported ability and ratings of the importance of performing everyday occupations. These assessments can guide client-centered goal setting in acute care and acute inpatient rehabilitation.

Illness progression in chronic fatigue syndrome: a shifting immune baseline.

BACKGROUND: Validation of biomarkers for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) across data sets has proven disappointing. As immune signature may be affected by many factors, our objective was to explore the shift in discriminatory cytokines across ME/CFS subjects separated by duration of illness. METHODS: Cytokine expression collected at rest across multiple studies for female ME/CFS subjects (i) 18 years or younger, ill for 2 years or less (n = 18), (ii) 18-50 years of age, ill for 7 years (n = 22), and (iii) age 50 years or older (n = 28), ill for 11 years on average. Control subjects were matched for age and body mass index (BMI). Data describing the levels of 16 cytokines using a chemiluminescent assay was used to support the identification of separate linear classification models for each subgroup. In order to isolate the effects of duration of illness alone, cytokines that changed significantly with age in the healthy control subjects were excluded a priori. RESULTS: Optimal selection of cytokines in each group resulted in subsets of IL-1α, 6, 8, 15 and TNFα. Common to any 2 of 3 groups were IL-1α, 6 and 8. Setting these 3 markers as a triple screen and adjusting their contribution according to illness duration sub-groups produced ME/CFS classification accuracies of 75-88 %. The contribution of IL-1α, higher in recently ill adolescent ME/CFS subjects was progressively less important with duration. While high levels of IL-8 screened positive for ME/CFS in the recently afflicted, the opposite was true for subjects ill for more than 2 years. Similarly, while low levels of IL-6 suggested early ME/CFS, the reverse was true in subjects over 18 years of age ill for more than 2 years. CONCLUSIONS: These preliminary results suggest that IL-1α, 6 and 8 adjusted for illness duration may serve as robust biomarkers, independent of age, in screening for ME/CFS.

Tracking post-infectious fatigue in clinic using routine Lab tests.

BACKGROUND: While biomarkers for chronic fatigue syndrome (CFS) are beginning to emerge they typically require a highly specialized clinical laboratory. We hypothesized that subsets of commonly measured laboratory markers used in combination could support the diagnosis of post-infectious CFS (PI-CFS) in adolescents following infectious mononucleosis (IM) and help determine who might develop persistence of symptoms. METHODS: Routine clinical laboratory markers were collected prospectively in 301 mono-spot positive adolescents, 4 % of whom developed CFS (n = 13). At 6, 12, and 24 months post-diagnosis with IM, 59 standard tests were performed including metabolic profiling, liver enzyme panel, hormone profiles, complete blood count (CBC), differential white blood count (WBC), salivary cortisol, and urinalysis. Classification models separating PI-CFS from controls were constructed at each time point using stepwise subset selection. RESULTS: Lower ACTH levels at 6 months post-IM diagnosis were highly predictive of CFS (AUC p = 0.02). ACTH levels in CFS overlapped with healthy controls at 12 months, but again showed a trend towards a deficiency at 24 months. Conversely, estradiol levels depart significantly from normal at 12 months only to recover at 24 months (AUC p = 0.02). Finally, relative neutrophil count showed a significant departure from normal at 24 months in CFS (AUC p = 0.01). Expression of these markers evolved differently over time between groups. CONCLUSIONS: Preliminary results suggest that serial assessment of stress and sex hormones as well as the relative proportion of innate immune cells measured using standard clinical laboratory tests may support the diagnosis of PI-CFS in adolescents with IM.

Evaluating the Psychometric Properties of a Clinical Vocational Rehabilitation Outcome Measurement: The Assessment of Work Performance (AWP).

This study examined the validity and reliability of the Assessment of Work Performance (AWP) using Rasch analysis. The AWP was administered to 365 clients with a variety of work-related problems. Rasch analysis and principal component analysis were used to examine the appropriateness of the rating scales and unidimensionality of AWP items. The person-response validity, internal consistency, targeting appropriateness, and differential item function were also analyzed. The Rasch analysis confirmed the 4-point rating scale, and the item set met the criteria of unidimensionality. The AWP exhibited satisfactory person-response validity and internal consistency. Among the three subdomains, the targeting of item-difficulty was sufficient in the motor skills and process skills subdomains. Differential item functioning was found across gender and diagnoses. This study presented evidence to support that the AWP functioned as a reliable and valid assessment in assessing work performance. [OTJR: Occupation, Participation and Health 2013;33(3):125-133.].

Danish translation, adaptation and initial validation of the clinical assessment of modes questionnaires.

BACKGROUND: The Clinical Assessment of Modes questionnaires (CAMQs) determine clients' preferential modes for therapy (CAM-C1), clients' perception of modes used by the occupational therapist (OTs) during therapy (CAM-C2), or modes the OTs believed to have used (CAM-T). Access to valid CAMQs for Danish OTs and clients required a rigorous translation and cultural adaptation process. OBJECTIVES: To translate and culturally adapt the CAMQs into Danish, examining face validity in a Danish context. MATERIAL AND METHODS: A 10-step guideline for the process of translating and culturally adapting questionnaires was followed. Steps 1-6 included translation into Danish, steps 7-8 involved cognitive debriefing interviews and validation based on the Content Validity Index (CVI) analyzed using Kappa statistics. Steps 9-10 finalized the process. RESULTS: CAMQs were translated into Danish. Based on cognitive debriefing interviews and CVIs involving 15 clients and 7 OTs, modifications regarding titles, layouts, instructions, wording and response categories were performed in all Danish CAMQs. The Item CVI and the modified kappa revealed that most participants had a high level of agreement on the cultural relevance. CONCLUSIONS AND SIGNIFICANCE: Translated versions of the CAMQs have been culturally adapted into Danish. The current Danish versions seem culturally relevant and useable in Danish occupational therapy.

Introduction of a Novel Sequential Approach to the Ponte Osteotomy to Minimize Spinal Canal Exposure.

Ponte osteotomy is an increasingly popular technique for multiplanar correction of adolescent idiopathic scoliosis. Prior cadaveric studies have suggested that sequential posterior spinal releases increase spinal flexibility. Here we introduce a novel technique involving a sequential approach to the Ponte osteotomy that minimizes spinal canal exposure. One fresh-frozen adult human cadaveric thoracic spine specimen with 4 cm of ribs was divided into three sections (T1-T5, T6-T9, T10-L1) and mounted for biomechanical testing. Each segment was loaded with five Newton meters under four conditions: baseline inferior facetectomy with supra/interspinous ligament release, superior articular process (SAP) osteotomy in situ, spinous process (SP) osteotomy in situ, and complete posterior column osteotomy with SP/SAP excision and ligamentum flavum release (PCO). Compared to baseline, in situ SAP osteotomy alone provided 3.5%, 7.6%, and 7.2% increase in flexion/extension, lateral bending, and axial rotation, respectively. In situ SP osteotomy increased flexion/extension, lateral bending, and axial rotation by 15%, 18%, and 10.3%, respectively. PCO increased flexion/extension, lateral bending, and axial rotation by 19.6%, 28.3%, and 12.2%, respectively. Our report introduces a novel approach where incremental increases in range of motion can be achieved with minimal spinal canal exposure and demonstrates feasibility in a cadaveric model.

Cytokine expression profiles of immune imbalance in post-mononucleosis chronic fatigue.

BACKGROUND: As Chronic Fatigue Syndrome (CFS) has been known to follow Epstein-Bar virus (EBV) and other systemic infections; our objective was to describe differences in immune activation in post-infective CFS (PI-CFS) patients and recovered controls. We studied 301 adolescents prospectively over 24 months following the diagnosis of monospot-positive infectious mononucleosis (IM). We found an incidence of CFS at 6, 12 and 24 months of 13%, 7% and 4% respectively. METHODS: Using chemiluminescent imaging we measured the concentrations of IL-1a, 1b, 2, 4, 5, 6, 8, 10, 12 (p70), 13, 15, 17 and 23, IFN-γ, TNF-α and TNF-ß in duplicate plasma samples available in bio-bank from 9 PI-CFS subjects and 12 recovered controls at 24 months post-infection. RESULTS: Standard comparative analysis indicated significant differences in IL-8 and 23 across subject groups. In constructing a linear classification model IL-6, 8 and 23 were selected by two different statistical approaches as discriminating features, with IL-1a, IL-2 and IFN-γ also selected in one model or the other. This supported an assignment accuracy of better than 80% at a confidence level of 0.95 into PI-CFS versus recovered controls. CONCLUSION: These results suggest that co-expression patterns in as few as 5 cytokines associated with Th17 function may hold promise as a tool for the diagnosis of post-infectious CFS.

Redirecting treatment during neonatal transport.

Neonatal transport teams comprise multidisciplinary health care providers who are skilled in patient care, communication and customer service, and equipment mechanics. They are extensively trained in resuscitation and stabilization, preparing for accelerating care, and their focus is preservation of life. In any situation focused on caring for critically ill patients, ethical issues and questions may arise. For instance, is it compassionate and/or cost-effective to separate mothers and infants when continuing/accelerating care is futile, and when and how should care be redirected from acute and lifesaving care to comfort care and bereavement support for the family? The knowledge and skills required to address such situations and communicate and participate in a redirection of care may not be adequately emphasized in the preparation of the professionals responsible for stabilizing and transporting critically ill newborns. This article raises issues relating to transport and redirecting care such as eligibility for transport, parental request and consent, separation of mothers and infants, palliative and bereavement care, ethical considerations, competitive transport environment, and customer service. A shared mental model is essential. The focus of this article is not to provide answers to all of these issues, but to highlight the complexity of the topic of redirecting treatment during neonatal transport. Redirecting treatment needs to be discussed, and health care professionals should be prepared during their transport team training. Each family and situation must be approached individually, with the acceptance that there will always be more questions than answers.

Psychometric Study of the Occupational Self Assessment with Adolescents After Infectious Mononucleosis.

This study examined the psychometric characteristics of the Occupational Self Assessment (OSA) which measures clients' perceptions of their own competence and the value they assign to occupations. Two hundred and ninety-six adolescents with acute mononucleosis completed the OSA along with the Fatigue Scale, the Checklist of Infectious Symptoms, the Child Health Questionnaire, and the Perceived Stress Scale. Results indicated that OSA items coalesced to capture the intended constructs that the rating scales functioned as intended and that over 90% of adolescents were validly measured. The OSA showed adequate sensitivity and was stable over time. As expected, the OSA measures of competence were moderately associated with infectious symptoms, fatigue severity, health status, and stress while the measure of values was not and both measures were not associated with age, gender, or ethnicity. Finally, as expected, adolescents who had not recovered from mononucleosis after 12 months showed lower measures on the competence scale while still attaching the same value/importance to occupational participation when compared to recovered adolescents.

Danish translation, cultural adaptation and initial validation of the Self-Assessment of modes questionnaire (D-SAMQ).

BACKGROUND: The Self-Assessment of Modes Questionnaire (SAMQ) was developed for occupational therapists (OTs) to identify their therapeutic style when interacting with clients. To provide Danish Occupational Therapists (OTs) with access to the SAMQ, a rigorous translation, cultural adaptation and validation are required. AIM: To describe the process of translating and culturally adapting the SAMQ into Danish (D-SAMQ) and examining initial validation of the SAMQ in terms of relevance and comprehensiveness in a Danish context. MATERIAL AND METHODS: A 10-step process for translation and cultural adaptation was followed: (1) Preparation, (2) Forward translation, (3) Reconciliation, (4) Back translation, (5) Back-translation review, (6) Harmonization, (7) Cognitive debriefing, (8) Review of cognitive debriefing results and finalization, (9) Proofreading and (10) Final report. The cognitive debriefing also involved validation. RESULTS: Seven OTs and one OT student were included in the cognitive debriefing. Adaptations were made in eight of twenty cases, and modifications regarding the choice of words, sentence structure, and rephrasing were performed. The participants suggested more contextual details in the case descriptions. CONCLUSION: The SAMQ was translated into Danish (D-SAMQ) and adapted and validated by Danish OTs. The D-SAMQ may enable OTs to identify their therapeutic style, and thereby improve the client-therapist relationship.

An examination of the psychometric properties of the occupational identity questionnaire for community-living elderly who require care.

INTRODUCTION: Authors created an Occupational Identity Questionnaire Provisional version (OIQ-P) to assess occupational identity for elderly individuals. The purpose of this study was to examine the psychometric properties of the OIQ-P. METHODS: Participants included 135 (42 males) elderly who lived locally and required care or support. OIQ-P was evaluated in terms of structural validity, criterion validity and internal consistency. RESULTS: Based on the results of an exploratory factor analysis and confirmatory factor analysis, an OIQ with a factor structure of 3 factors and 14 items was created. Rasch rating scale model revealed that 14 participants and 1 item did not fit the goodness of fit, nevertheless, the overall result was good. Spearman's rank correlation coefficient indicates that there was a law correlation between OIQ and the occupational identity scale of the Occupational Performance History Interview Version 2. In terms of internal consistency, the person separation index and person separation reliability coefficient were 2.30 and 0.84, respectively. CONCLUSION: This study confirmed the structural validity, criterion validity and internal consistency for the OIQ. To enhance the clinical utility of the OIQ, it is necessary to examine the interpretability and conduct an intervention study using the OIQ.

Long COVID and Post-infective Fatigue Syndrome: A Review.

Fatigue is a dominant feature of both acute and convalescent coronavirus disease 2019 (COVID-19) (sometimes termed "long-COVID"), with up to 46% of patients reporting fatigue that lasts from weeks to months. The investigators of the international Collaborative on Fatigue Following Infection (COFFI) conducted a systematic review of post-COVID fatigue and a narrative review on fatigue after other infections, and made recommendations for clinical and research approaches to assessing fatigue after COVID-19. In the majority of COVID-19 cohort studies, persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16-20 weeks post-symptom onset. Data from the prospective cohort studies in COFFI and others indicate that fatigue is also a prevalent outcome from many acute systemic infections, notably infectious mononucleosis, with a case rate for clinically significant Post-infective fatigue after exclusion of recognized medical and psychiatric causes, ranging from 10%-35% at 6 months. To better characterize post-COVID fatigue, the COFFI investigators recommend the following: application of validated screening questionnaires for case detection; standardized interviews encompassing fatigue, mood, and other symptoms; and investigative approaches to identify end-organ damage and mental health conditions.

Exercise tolerance testing in a prospective cohort of adolescents with chronic fatigue syndrome and recovered controls following infectious mononucleosis.

OBJECTIVE: Six months after acute infectious mononucleosis (IM), 13% of adolescents meet criteria for chronic fatigue syndrome (CFS). We measured exercise tolerance in adolescents with CFS and control subjects 6 months after IM. STUDY DESIGN: Twenty-one adolescents with CFS 6 months after IM and 21 recovered control subjects performed a maximal incremental exercise tolerance test with breath-by-breath gas analysis. Values expressed are mean+/-standard deviation. RESULTS: The adolescents diagnosed with CFS and control subjects did not differ in age, weight, body mass index, or peak work capacity. Lower oxygen consumption peak percent of predicted was seen in adolescents with CFS compared with control subjects (CFS 99.3+/-16.6 vs control subject 110.7+/-19.9, P=.05). Peak oxygen pulse also was lower in adolescents with CFS compared with recovered control subjects (CFS 12.4+/-2.9 vs control subjects 14.9+/-4.3, P=.03). CONCLUSIONS: Adolescents with CFS 6 months after IM have a lower degree of fitness and efficiency of exercise than recovered adolescents. Whether these abnormal exercise findings are a cause or effect of CFS is unknown. IM can lead to both fatigue and measurable changes in exercise testing in a subset of adolescents.