Table 5.

Scored item sets for (a) the FSIQ-RMS and (b) the NFI-MS

(a)
PRO	Fatigue symptoms and impact questionnaire relapsing multiple sclerosis (FSIQ-RMS)
Section	SYMPTOMS (Sect. 1)	IMPACTS (Sect. 2)
SCORE	SYMPTOMS scale	Impacts scale	Physical Impacts subscale	Cognitive/Emotional Impacts subscale	Coping Impacts subscale
No. of items	7	13a	5	5	5
Author’s fatigue definition	Often described as a feeling of extreme mental or physical exhaustion, MS-related fatigue has far-reaching effects on quality of life, employment, and productivity, imposing limitations independently of MS-related physical disability and depression
FSIQ-RMS item	How physically tired did you feel? (S1, 1b)	Difficulty running errands (S2, 1)	Difficulty running errands (S2, 1)	Difficulties communicating clearly (S2, 2)	Difficulties motivating yourself to do routine daily activities (S2, 4)
	How mentally tired did you feel? (S1, 2)	Difficulties communicating clearly (S2, 2)	Difficulty doing indoor household chores (S2, 5)	Difficulties thinking clearly (S2, 3)	Difficulty taking part in social activities (S2, 8)c
	How physically weak did you feel? (S1, 3)	Difficulties thinking clearly (S2, 3)	Difficulty walking (S2, 6)	Difficulty maintaining relationships with people close to you (S2, 7)	Frequency of taking a nap (S2, 11)
	Rate your energy level (S1, 4)	Difficulties motivating yourself to do routine daily activities (S2, 4)	Difficulty taking part in social activitiesc (S2, 8)	How frustrated (S2, 9)	Frequency of needing to take a break (S2, 12)
	How worn out did you feel? (S1, 5)	Difficulty doing …indoor household chores (S2, 5)	Frequency of rearranging plans (S2, 13)c	How often forgetful (S2, 10)	Frequency of rearranging plans (S2, 13)c
	How sleepy did you feel? (S1, 6)	Difficulty walking (S2, 6)
	How worn out did you feel at rest? (S1, 7)	Difficulty maintaining relationships with people close to you (S2, 7)
		Difficulty taking part in social activitiesc (S2, 8)
		How frustrated (S2, 9)
		How often forgetful (S2, 10)
		Frequency of taking a nap (S2, 11)
		Frequency of needing to take a break (S2, 12)
		Frequency of rearranging plans (S2, 13)c

(b)
PRO	Neurological fatigue index multiple sclerosis (NFI-MS)
Score	Summary subscaled	Physical subscale	Cognitive subscale	Relief by Diurnal Sleep or Rest subscale	Abnormal Nocturnal Sleep or Sleepiness subscale
No. of items	10	8	4	6	5
Author’s fatigue definition	Fatigue has been defined, as a result of qualitative analysis, as a: ‘reversible motor and cognitive impairment with reduced motivation, and a desire to rest, either appearing spontaneously or brought on separately by mental or physical activity, humidity, acute infection and food ingestion. It was relieved by daytime sleep or rest without sleep. It could occur at any time but was usually worse in the afternoon’. In MS, fatigue could be daily, had usually been present for years and had greater severity than any pre-morbid fatigue
NFI-MS item	I can become tired easily [1]	I can become tired easily [1]	Sometimes I really have to concentrate on what are usually simple things [9]	I need to rest in the day [13]	I get a feeling as if I have not slept for a couple of nights [19]
	Sometimes I lose my body strength [2]	Sometimes I lose my body strength [2]	I have problems with my speech when I’m tired [10]	I need to sleep in the day [14]	I yawn a lot [20]
	My limbs can become very heavy [3]	My limbs can become very heavy [3]	My coordination gets worse as the day goes on [11]	Sleep in the day can really help me [15]	I sometimes wake in the night for no reason [21]
	My body can’t keep up with what I want to do [4]	My body can’t keep up with what I want to do [4]	Mental effort really takes it out of me 12]	Resting allows me to carry on [16]	When I awake in the morning I feel unrefreshed [22]
	The longer I do something the more difficult it becomes [5]	The longer I do something the more difficult it becomes [5]		I try to get everything done in the morning [17]	Often in the morning, I don’t feel like getting out of bed [23]
	Sometimes I have no option but to simply stop what I’ve been doing [6]	Sometimes I have no option but to simply stop what I’ve been doing [6]		I try to rest or sleep beforehand, if I know I’ve got to do something that requires a lot of effort [18]
	I usually get tired on most days [7]	I usually get tired on most days [7]
	Sometimes I really have to concentrate on what are usually simple things [8]	I can become weak even if I’ve not been doing anything [8]
	My coordination gets worse as the day goes on [11]
	Mental effort really takes it out of me [12]

^aThere are k = 13 impacts items, and three k = 5 impacts subscales because k = 2 items are scored in two subscales

^bIn parentheses: S = Sect. 1 or 2, number = item number in sequence order

^cItem that is scored in 2 different subscales

^dNFI-MS has k = 23 items, the Summary subscale is a selection of 10 of these items