Fatigue-Severity-Scale

Fatigue-Severity-Scale

Choose a number from 1 to 7 that indicates your degree of agreement with the following statements where 1 indicates strongly disagree and 7 indicates strongly agree. Please answer the questions with reference to how you have been feeling on average over the last week.
Name

First NameLast Name
Email
example@example.com
Treatment Status

Pre-TreatmentPost-Treatment
Number of weeks on treatment: blanks
1. My Motivation is lower when I am fatigued

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
2. Exercise brings on my fatigue

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
3. I am easily fatigue

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
4. Fatigue interferes with my physical functioning

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
5. Fatigue causes frequent problems for me

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
6. My fatigue prevents sustained physical functioning

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
7. Fatigue interferes with carrying out certain duties and responsibilities

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
8. Fatigue is among my three most disabling symptoms

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
9. Fatigue interferes wih my work, family or social life

1

2

3

4

5

6

7

1 is Strongly disagree, 7 is Strongly agree
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