What is the Orthostatic Grading Scale?

The Orthostatic Grading Scale (OGS) is a five-item self-report questionnaire developed at the Mayo Clinic and published in 2005. It grades the frequency and severity of orthostatic symptoms, the conditions that bring them on, their interference with daily activities, and how long you can stand before symptoms start. Each item scores 0 to 4, giving a total from 0 to 20.

What is a high Orthostatic Grading Scale score?

Published bands are mild (below 4), moderate (4 to 9), and severe (above 9). In the original Mayo study a score of 9 or more best matched laboratory evidence of adrenergic autonomic failure. Healthy controls typically score 0 to 3; UK POTS patients have averaged about 13, ME/CFS cohorts 8 to 13, and hypermobile EDS patients about 10.

Does the Orthostatic Grading Scale diagnose POTS?

No. It measures the burden of orthostatic symptoms, whatever their cause. POTS and orthostatic hypotension are diagnosed from heart rate and blood pressure responses to standing or tilt. A high OGS score is a reason to ask for that testing, and the scale is useful for tracking symptoms over time.

Orthostatic Grading Scale (OGS): free online orthostatic intolerance questionnaire

For each of the five areas, choose the one statement that best describes your usual experience.

1. Frequency of orthostatic symptoms

0 I never or rarely experience orthostatic symptoms when I stand up1 I sometimes experience orthostatic symptoms when I stand up2 I often experience orthostatic symptoms when I stand up3 I usually experience orthostatic symptoms when I stand up4 I always experience orthostatic symptoms when I stand up

2. Severity of orthostatic symptoms

0 I do not experience orthostatic symptoms when I stand up1 I experience mild orthostatic symptoms when I stand up2 I experience moderate orthostatic symptoms when I stand up and sometimes have to sit back down for relief3 I experience severe orthostatic symptoms when I stand up and frequently have to sit back down for relief4 I experience severe orthostatic symptoms when I stand up and regularly faint if I do not sit back down

3. Conditions under which orthostatic symptoms occur

0 I never or rarely experience orthostatic symptoms under any circumstances1 I sometimes experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g. walking), or when exposed to heat (e.g. a hot day, hot bath, or hot shower)2 I often experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g. walking), or when exposed to heat (e.g. a hot day, hot bath, or hot shower)3 I usually experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g. walking), or when exposed to heat (e.g. a hot day, hot bath, or hot shower)4 I always experience orthostatic symptoms when I stand up; the specific conditions do not matter

4. Activities of daily living

0 My orthostatic symptoms do not interfere with activities of daily living (e.g. work, chores, dressing, bathing)1 My orthostatic symptoms mildly interfere with activities of daily living2 My orthostatic symptoms moderately interfere with activities of daily living3 My orthostatic symptoms severely interfere with activities of daily living4 My orthostatic symptoms severely interfere with activities of daily living; I am bedridden or wheelchair-bound because of my symptoms

5. Standing time

0 On most occasions, I can stand as long as necessary without experiencing orthostatic symptoms1 On most occasions, I can stand more than 15 minutes before experiencing orthostatic symptoms2 On most occasions, I can stand 5–14 minutes before experiencing orthostatic symptoms3 On most occasions, I can stand 1–4 minutes before experiencing orthostatic symptoms4 On most occasions, I can stand less than 1 minute before experiencing orthostatic symptoms

Your Orthostatic Grading Scale score

— out of 20

Item breakdown

Reference values

Understanding your score

The bands most often quoted are mild (below 4), moderate (4–9), and severe (above 9), from Frith and Newton's work on orthostatic symptoms. In the original Mayo data a score of 9 or more was the best match for laboratory evidence of adrenergic failure, with modest accuracy (66% sensitivity, 69% specificity), which is a reminder that symptom burden and measured autonomic function only partly overlap.

Published averages: healthy controls 0.6–3; UK POTS patients about 13 (SD 4); ME/CFS cohorts 8–13; hypermobile EDS about 10; post-COVID condition about 11. A 2023 UK study of people referred with suspected POTS found the five items behave as a single dimension and correlate with heart-rate responses on standing.

Because the OGS asks about your usual pattern rather than a single week, it changes slowly. Repeating it monthly, or before and after a treatment change, is enough. Record it with your stand test results so the symptom score and the heart-rate response sit together.

This is not a diagnosis. Discuss your results with your doctor or specialist.