Development and Primary Validation of the Vienna Post-Exertional Malaise Assessment Questionnaire
Abstract
Background: Post-exertional malaise (PEM) is increasingly understood as a multidimensional deterioration process involving diverse triggers, functional loss, and prolonged recovery. This study developed and initially validated the Vienna Post-Exertional Malaise Assessment Questionnaire (VPEM-AQ), a patient-reported outcome measure assessing PEM manifestations and functional consequences in ME/CFS.
Methods: We conducted a primary psychometric validation study in adults with ME/CFS. The VPEM-AQ assessed crash frequency, exertion thresholds across physical, cognitive, sensory, emotional-social, and orthostatic domains, crash severity, recovery duration, new or additional crash-related symptoms, and pacing behaviour. Analyses included descriptive statistics, floor and ceiling effects, factor analyses, internal consistency, convergent validity with DSQ-PEM and FUNCAP-27, and known-groups validity.
Results: The VPEM-AQ was completed by 1,108 adults; 83.0% female, median age was 46 years (IQR 36–54). The score showed no relevant floor or ceiling effects. Internal consistency was good for the 7-item score (Cronbach’s α = 0.82) and improved in the 6-item version excluding the weaker new-symptoms item (α = 0.87). Confirmatory factor analysis showed mixed fit, indicating that the VPEM-AQ should not be interpreted as a fully homogeneous one-dimensional scale. Convergent validity was supported by correlations with DSQ-PEM (ρ = 0.475; 95% CI 0.425–0.522) and FUNCAP-27 (ρ = −0.680; 95% CI − 0.713 to − 0.643). Known-groups validity was supported across DSQ-PEM quartiles (H = 313.3, p < 0.001) and FUNCAP-27 quartiles (H = 412.5, p < 0.001), although discrimination between the two highest DSQ-PEM quartiles was limited.
Conclusions: The VPEM-AQ showed promising but not definitive initial psychometric properties, particularly for multidomain exertion thresholds. Crash severity and recovery duration remain clinically important but require simpler or diary-based formats before scoring.
Key messages: • The VPEM-AQ is a promising new patient-reported tool to assess multidimensional post-exertional malaise in ME/CFS.
• The VPEM-AQ captures the wide variation of post-exertional malaise in ME/CFS, reflecting differences in triggers, severity, recovery, and functional impact.
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BibTeX
@article{brandl2026development,
title = {{Development and Primary Validation of the Vienna Post-Exertional Malaise Assessment Questionnaire}},
author = {T Brandl and T Pimminger and A Schwabe and T Waldhoer and A Kapan},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1100},
url = {https://doi.org/10.1093/eurpub/ckag169.1100},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Development and Primary Validation of the Vienna Post-Exertional Malaise Assessment Questionnaire
AU - T Brandl
AU - T Pimminger
AU - A Schwabe
AU - T Waldhoer
AU - A Kapan
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1100
UR - https://doi.org/10.1093/eurpub/ckag169.1100
AB - Background: Post-exertional malaise (PEM) is increasingly understood as a multidimensional deterioration process involving diverse triggers, functional loss, and prolonged recovery. This study developed and initially validated the Vienna Post-Exertional Malaise Assessment Questionnaire (VPEM-AQ), a patient-reported outcome measure assessing PEM manifestations and functional consequences in ME/CFS. Methods: We conducted a primary psychometric validation study in adults with ME/CFS. The VPEM-AQ assessed crash frequency, exertion thresholds across physical, cognitive, sensory, emotional-social, and orthostatic domains, crash severity, recovery duration, new or additional crash-related symptoms, and pacing behaviour. Analyses included descriptive statistics, floor and ceiling effects, factor analyses, internal consistency, convergent validity with DSQ-PEM and FUNCAP-27, and known-groups validity. Results: The VPEM-AQ was completed by 1,108 adults; 83.0% female, median age was 46 years (IQR 36–54). The score showed no relevant floor or ceiling effects. Internal consistency was good for the 7-item score (Cronbach’s α = 0.82) and improved in the 6-item version excluding the weaker new-symptoms item (α = 0.87). Confirmatory factor analysis showed mixed fit, indicating that the VPEM-AQ should not be interpreted as a fully homogeneous one-dimensional scale. Convergent validity was supported by correlations with DSQ-PEM (ρ = 0.475; 95% CI 0.425–0.522) and FUNCAP-27 (ρ = −0.680; 95% CI − 0.713 to − 0.643). Known-groups validity was supported across DSQ-PEM quartiles (H = 313.3, p < 0.001) and FUNCAP-27 quartiles (H = 412.5, p < 0.001), although discrimination between the two highest DSQ-PEM quartiles was limited. Conclusions: The VPEM-AQ showed promising but not definitive initial psychometric properties, particularly for multidomain exertion thresholds. Crash severity and recovery duration remain clinically important but require simpler or diary-based formats before scoring. Key messages: • The VPEM-AQ is a promising new patient-reported tool to assess multidimensional post-exertional malaise in ME/CFS. • The VPEM-AQ captures the wide variation of post-exertional malaise in ME/CFS, reflecting differences in triggers, severity, recovery, and functional impact.
SN - 1101-1262
SN - 1464-360X
ER -