Lin, Jin-Mann S, Brimmer, Dana J, Maloney, Elizabeth M et al. · Population health metrics · 2009 · DOI
This study tested whether a 20-question fatigue measurement tool (the MFI-20) works well for people with ME/CFS and other chronic illnesses. Researchers gave the questionnaire to 783 people in Georgia—some with ME/CFS-like illness, some with chronic unwellness, and some who were healthy—and found that the tool reliably distinguished between these groups and accurately measured different types of fatigue.
This is the first rigorous validation of the MFI-20 in ME/CFS and related fatiguing illnesses in a large US population sample. Having a well-validated, reliable fatigue measurement tool is essential for consistent diagnosis, tracking symptom changes over time, and comparing outcomes across ME/CFS research studies and clinical settings.
This study does not establish that the MFI-20 can diagnose ME/CFS on its own—only that it can complement clinical assessment. The cross-sectional design cannot determine whether fatigue causes the observed mood and anxiety changes or vice versa. The study also does not address whether the MFI-20 is sensitive to changes in fatigue severity within individual patients over time (test-retest reliability).
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
Lin, Jin-Mann S, Brimmer, Dana J, Maloney, Elizabeth M, Nyarko, Ernestina, Belue, Rhonda, & Reeves, William C (2009). Further validation of the Multidimensional Fatigue Inventory in a US adult population sample.. Population health metrics. https://doi.org/10.1186/1478-7954-7-18
BibTeX
@article{mecfsatlas-lin-2009-further-validation,
author = {Lin, Jin-Mann S and Brimmer, Dana J and Maloney, Elizabeth M and Nyarko, Ernestina and Belue, Rhonda and Reeves, William C},
title = {Further validation of the Multidimensional Fatigue Inventory in a US adult population sample.},
journal = {Population health metrics},
year = {2009},
doi = {10.1186/1478-7954-7-18},
note = {PubMed: 20003524},
url = {https://www.mecfsatlas.com/evidence/lin-2009-further-validation},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/lin-2009-further-validation
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