Fatigue Severity Scale


Original Editor - Sinead Greenan

Top Contributors - Sinead Greenan, Kim Jackson, Lauren Lopez, Laura Ritchie and Evan Thomas


The Fatigue Severity Scale is a 9-item scale which measures the severity of fatigue and its effect on a person's activities and lifestyle in patients with a variety of disorders. It was originally devised for people with Multiple Sclerosis or systemic lupus erythematosus[1].


Intended Population

Those with a variety of diagnoses including arthritis, fibromyalgia, Multiple sclerosis, Parkinson’s disease and stroke.

Method of Use

A self-report scale of nine items about fatigue, its severity and how it affects certain activities. Answers are scored on a seven point scale where 1 = strongly disagree and 7 = strongly agree. This means the minimum score possible is nine and the highest is 63. The higher the score, the more severe the fatigue is and the more it affects the person's activities. It is simple to understand and takes an average of eight minutes to answer[3].



Test-retest Reliability

One study reported excellent test-retest reliability (ICC = 0.91) in a Brazilian-Portuguese version for people with Parkinson's (n = 30, mean age = 62 (11) years, mean time post- Parkinson's = 7.6 (6.5) years)[4]. Similar results were found in a study of cirrhotic patients[3].


Able to discriminate between groups (with and without fatigue) in a study of people with cirrhosis[3].

Correlates with depressive symptomology (Beck Depression Inventory) and quality of life (SF-36)[3].

Parkinson’s Disease

  • Excellent (r = -0.77) negative correlation with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale[5]
  • Excellent (r = 0.62) correlation with Nottingham Health Profile (NHP-EN) scale[5]
  • Excellent (r = 0.84) correlation with Parkinson’s Fatigue (PFS) scale [6]
  • Poor-adequate (r = 0.22-0.47) correlation with Parkinson’s Disease Questionnaire-39 (PDQ-39) scale; n = 66, mean age = 70.8 (9.9) years, time since Parkinson's = 70.2 (56.1) months) [7]


No significant changes observed with the scale pre and post liver transplant[3].

The FSS has been reported to have low floor and moderate ceiling effects[8].





  1. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. Arch Neurol. 1989 Oct;46(10):1121-3. The Fatigue Severity Scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121-3. Accessed 27 June 2019.
  2. Mometrix Academy. Fatigue severity scale. Available from: https://www.youtube.com/watch?v=XAwDgczNCO0 )last accessed 3.3.2019)
  3. 3.0 3.1 3.2 3.3 3.4 Rossi D, Galant LH, Marroni CA. Psychometric property of fatigue severity scale and correlation with depression and quality of life in cirrhotics. Arq Gastroenterol. 2017. 54; 4: 344-348. Accessed 27 June 2019.
  4. 4.0 4.1 Valderramas, S., Feres, A. C., et al. "Reliability and validity study of a Brazilian-Portuguese version of the fatigue severity scale in Parkinson's patients." Arq Neuropsiquiatr 2012 70(7): 497-500
  5. 5.0 5.1 Hagell, P., Hoglund, A., et al. "Measuring fatigue in Parkinson's: a psychometric study of two brief generic fatigue questionnaires." J Pain Symptom Manage 2006 32(5): 420-432
  6. Grace, J., Mendelsohn, A., et al. "A comparison of fatigue measures in Parkinson's." Parkinsonism Relat Disord 2007 13(7): 443-445
  7. Herlofson, K. and Larsen, J. P. "The influence of fatigue on health-related quality of life in patients with Parkinson's." Acta Neurol Scand 2003 107(1): 1-6
  8. Amtmann D, Bamer AM, Noonan V, Lang N, Kim J,  Cook KF. Comparison of the psychometric properties of two fatigue scales in multiple sclerosis. Rehabil Psychol. 2012. 57; 2: 159–166. Accessed 27 June 2019.
  9. Rosti‐Otajärvi E, Hämäläinen P, Wiksten A, Hakkarainen T, Ruutiainen J. Validity and reliability of the Fatigue Severity Scale in Finnish multiple sclerosis patients. Brain and Behaviour. 2017. Volume7; Issue7 : e00743. Accessed 27 June 2019.