Cotler, Joseph, Holtzman, Carly, Dudun, Catherine et al. · Diagnostics (Basel, Switzerland) · 2018 · DOI
This study focused on creating a better way to identify post-exertional malaise (PEM)—the worsening of symptoms that happens after physical or mental activity in ME/CFS patients. Researchers tested whether five additional questions from an existing questionnaire could help doctors confirm PEM in the second step of diagnosis. The test was successful: it correctly identified patients with ME/CFS 82% of the time and rarely misidentified other conditions like multiple sclerosis as ME/CFS.
Standardizing how doctors diagnose post-exertional malaise is critical for ME/CFS patients because PEM is a defining feature of these conditions. Without clear diagnostic tools, patients may be misdiagnosed or have their condition dismissed. This research provides healthcare providers with a practical, evidence-based method to reliably identify PEM and confirm ME/CFS diagnoses.
This study does not prove that these five questions are sufficient for definitive ME/CFS diagnosis on their own—they represent only the second step in a multi-step process. The study also does not establish whether this questionnaire works equally well across all demographic groups or in all healthcare settings. Additionally, the relatively small sample sizes for some comparison groups limit generalizability.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Cotler, Joseph, Holtzman, Carly, Dudun, Catherine, & Jason, Leonard A (2018). A Brief Questionnaire to Assess Post-Exertional Malaise.. Diagnostics (Basel, Switzerland). https://doi.org/10.3390/diagnostics8030066
BibTeX
@article{mecfsatlas-cotler-2018-brief-questionnaire,
author = {Cotler, Joseph and Holtzman, Carly and Dudun, Catherine and Jason, Leonard A},
title = {A Brief Questionnaire to Assess Post-Exertional Malaise.},
journal = {Diagnostics (Basel, Switzerland)},
year = {2018},
doi = {10.3390/diagnostics8030066},
note = {PubMed: 30208578},
url = {https://www.mecfsatlas.com/evidence/cotler-2018-brief-questionnaire},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/cotler-2018-brief-questionnaire
Contribute
Private, reviewed by a human. Not a public comment thread.