Fatigue Impact Scale Questionnaire Form
Please complete the following questions to help assess how fatigue affects your daily activities. Answer each item based on your recent experience.
In the past week, how often did fatigue limit your ability to carry out physical activities (e.g., walking, climbing stairs)?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
How much has fatigue interfered with your ability to concentrate or think clearly?
*
Not at all
1
2
3
4
Extremely
5
1 is Not at all, 5 is Extremely
How often did you feel too tired to participate in social or family activities?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
How much has fatigue affected your motivation to start new tasks?
*
Not at all
1
2
3
4
Extremely
5
1 is Not at all, 5 is Extremely
How often did you need to rest during the day because of fatigue?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
How much has fatigue impacted your ability to complete work or household responsibilities?
*
Not at all
1
2
3
4
Extremely
5
1 is Not at all, 5 is Extremely
How often did you feel frustrated because of your fatigue?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
How much has fatigue affected your enjoyment of daily activities?
*
Not at all
1
2
3
4
Extremely
5
1 is Not at all, 5 is Extremely
How often did you feel you lacked energy to do things you wanted?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Please share any additional comments about how fatigue has affected you.
Submit Questionnaire
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