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Modified Fatigue Impact Scale
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* Indicates required question
Because of my fatigue in the last 4 weeks, I have been less alert.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue in the last 4 weeks, I have had difficulty paying attention for long periods of time.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue in the last 4 weeks, I have been unable to think clearly.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue in the last 4 weeks, I have been clumsy and uncoordinated.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue in the last 4 weeks, I have been forgetful.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue in the last 4 weeks, I have had to pace myself in my physical activities.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue in the last 4 weeks, I have been less motivated to do anything that requires physical effort.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have been less motivated to participate in social activities.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have been limited in my ability to do things away from home
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have trouble maintaining physical effort for long periods.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have had difficulty making decisions.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have been less motivated to do anything that requires thinking.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, my muscles have felt weak.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have been physically uncomfortable.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have had trouble finishing tasks that require thinking.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have had difficulty organizing my thoughts when doing things at home or at work.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, I have been less able to complete tasks that require physical effort.
*
Never
Rarely
Sometimes
Often
Almost Always
Because of my fatigue during the past 4 weeks, my thinking has been slowed down.
*
Never
Rarely
Sometimes
Often
Almost Always
Because my fatigue during the past 4 weeks, I have had trouble concentrating.
*
Never
Rarely
Sometimes
Often
Almost Always
Because my fatigue during the past 4 weeks, I have limited my physical activities.
*
Never
Rarely
Sometimes
Often
Almost Always
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