Post-exertional malaise questionnaire
DSQ-PEM: the DePaul post-exertional malaise short form
Post-exertional malaise (PEM) is a disproportionate worsening of symptoms after physical or mental effort. It is often delayed by hours or a day, and it lasts far longer than ordinary tiredness. PEM is the hallmark feature of ME/CFS and is common in long COVID.
It also matters practically. If PEM is present, pushing through or steadily increasing activity can make things worse. Spotting it early changes how you approach recovery.
The DSQ-PEM is a 10-question short form of the DePaul Symptom Questionnaire, published by Cotler and colleagues in 2018. Five symptoms are rated for how often and how severely they occurred over the past six months. Five more questions ask about triggers and recovery time. In the validation study, the five core items identified 97% of patients with ME/CFS. It takes about 3 minutes.
This tool sits between the 4-question DSQ-Brief (a general ME/CFS screen) and the full DSQ-2 (a complete symptom assessment). If you want to check whether your post-activity pattern looks like PEM, this is the one to take.
Your DSQ-PEM result
Symptom breakdown
| Symptom | Frequency | Severity | Threshold met? |
|---|
Recovery and trigger pattern
Understanding your result
A symptom counts as present when it occurs at least half the time and is at least moderate. This is the standard 2/2 threshold used across the DePaul questionnaires. PEM is indicated when at least one of the five core symptoms meets it.
The supplementary questions describe the character of your PEM. In the research literature, worsening after minimal physical or mental effort together with a recovery time of 14 hours or more is the pattern most consistent with ME/CFS-type PEM, as distinct from ordinary post-exercise fatigue, which resolves within a few hours.
If PEM is indicated, the most practically useful next steps are usually: learning about pacing before attempting any structured increase in activity, and taking these results to your GP or specialist. The full DSQ-2 gives a complete symptom profile with screening against the ME/CFS case definitions, and the FUNCAP questionnaire documents what activity currently costs you.
Your headline result is saved on this device only, never sent anywhere, so that the exercise readiness screen can pick it up automatically.
This is not a diagnosis. It reflects the symptom pattern you have reported. Discuss your results with your doctor or specialist.