Stussman, Barbara, Calco, Brice, Norato, Gina et al. · medRxiv : the preprint server for health sciences · 2023 · DOI
This study looked at how to better measure post-exertional malaise (PEM)—the symptom flare-up that happens after activity in ME/CFS patients. Researchers asked 10 ME/CFS patients and 9 healthy people to do an exercise test, then tracked their symptoms over 72 hours using both rating scales and detailed interviews. They found that combining interviews with rating scales captured PEM patterns much better than rating scales alone, especially because rating scales sometimes hit their limits and couldn't show the full picture of symptom changes.
Accurate measurement of PEM is crucial for both clinical care and research, as PEM is a defining feature of ME/CFS. This study demonstrates that current standard rating scales may fail to capture the true pattern and severity of PEM in individual patients, suggesting that better measurement tools could improve diagnosis, treatment monitoring, and research validity. The finding that personalized symptom assessment outperforms generic scales has direct implications for how clinicians and researchers should evaluate treatment responses.
This study does not prove that the mixed-methods approach is superior in other patient populations, clinical settings, or with different exercise protocols. It does not establish causation or biological mechanisms underlying PEM phenotype variation. The small sample size and preprint status mean findings require independent replication before implementation as clinical standard.
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
Stussman, Barbara, Calco, Brice, Norato, Gina, Gavin, Angelique, Chigurupati, Snigdha, Nath, Avindra, et al. (2023). A Mixed Methods System for the Assessment of Post Exertional Malaise in Encephalomyelitis/Chronic Fatigue Syndrome.. medRxiv : the preprint server for health sciences. https://doi.org/10.1101/2023.04.24.23288821
BibTeX
@article{mecfsatlas-stussman-2023-mixed-methods,
author = {Stussman, Barbara and Calco, Brice and Norato, Gina and Gavin, Angelique and Chigurupati, Snigdha and Nath, Avindra and Walitt, Brian},
title = {A Mixed Methods System for the Assessment of Post Exertional Malaise in Encephalomyelitis/Chronic Fatigue Syndrome.},
journal = {medRxiv : the preprint server for health sciences},
year = {2023},
doi = {10.1101/2023.04.24.23288821},
note = {PubMed: 37205352},
url = {https://www.mecfsatlas.com/evidence/stussman-2023-mixed-methods},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/stussman-2023-mixed-methods
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