Scoring Sheet for the Revised Canadian ME/CES Case Definition
Scoring Sheet: To meet eri
ria, a symptom must have a rating for Frequency and Severity of 2 or more,
Ifa criterion is met, place a check next to the “Yes” question in the ‘scoring column, Dingnosis
Categories Scoring Meets Criterion
tig: Mast mea erierion for
Questions 13,67, and SF-36 Seales
Meets Fatigne Criteria Research
Fatigue: Question 13, 13. Meets frequency and severity of 227 v MEICRS Mees
Yes —~ | categorie 1 1 11,
Lifelong problems with ftigue/eneray: Question 67. | 67, Indicates “No"? IV, V and Vt
Mas answer No” ona that problem with Yes
fatiguelenergy isnot ifelong,
‘Substantial Reduction: Meets eutof¥ ona east two
SF-36 Scales,
Role Physical (R: Score of <0
Vitality (Vp: Score oF 35,
Sorial Functioning ($): Score of <62.8
Substantial Reduction: Meets 2 of 3 SF-36
scales?
Yes
1, Post-Exertional Malaise:
Atleast one symptom from Questions 14 to 18
Indicates frequency and severity of 22 on at
least one symptom from questions 14 to 18?
Yes,
Malaise Criterion
Yes
UL Sleep:
Atleast one symptom from Questions 19 to 24
Indicates frequency and severity of >2.on at
least one symptom from questions 19 to 24
Yes
Meets Sleep Criterion
Yes
1, Pain
At least one symptom from Questions 25 to 31
*To he counted for Question 31 (headaches)
participant must answer “Yes” to Question 68
Indicates frequency and severity of 2 on at
least one symptom from questions 28 to 31?
Yes,
Meets Pain Crit
Yes
V. Neurologial/Cognitive Manifestations:
At Feast two symptoms from Questions 32 to 44
Indicates frequency and severity of 2 on at
least ta sympionts from questions 32 €0 442
Yes
Meets Neurological!
Cognitive
‘Manifestations
Citerion
Yes
VI Other Category
Minimum of one symptom from two of the
following three categories:
1, Autonomic Manifestations: Questions 45 to St
b, Neuroendocrine Manifestations
‘Questions 52 t0 61
«Immune Manifestations: Questions 62 1066
a. Indicates frequency and severity of >2 on at
least one symptom from questions 45 to SI?
Yes
Indicates frequency and severity of 2 on at
least one symptom ffom questions 52 to 61?
Yes,
«Indicates Requeney and severity of 22 on at
least one symptom fFom questions 62 to 66?
Ye
Meets Other Category
Criteria
Yes
for $ of the
6 categories, Also,
for VI oly one
sympiom from one
category is needed,
Category Tis |
require,
Atypical
MEICFS Meets
criteria for 2
categories.
MEICES-
ike Meets eriteria
or all categories but
not fora duration of
six or more months
(see Question 69),
__Remission
Was diagnosed
with ME/CFS at
one time (See
(Question 70) bat is
currently
experiencing 0-1
Criteria categories.
‘Complex Chronic Disease Program
ME DePaul Symptom Questionnaire ~ Appendix B
Page 1of2 Versio
, May 23, 2013