Tools

Orthostatic Grading Scale (OGS)

Five questions grading how much standing up costs you, scored 0–20

The Orthostatic Grading Scale was developed at the Mayo Clinic's autonomic laboratory by Schrezenmaier, Low, Sandroni and colleagues and published in 2005. It was designed to put a number on orthostatic intolerance in the way a clinician would take a history: how often symptoms happen on standing, how severe they are, what conditions bring them on, how much they interfere with daily activities, and how long you can stand before they start. Each of the five items scores 0–4, for a total of 0–20.

In the original study of 145 patients the scale was internally consistent (alpha 0.91) and tracked laboratory measures of adrenergic autonomic function. It has since been used in UK POTS research, ME/CFS studies, the CDC's multi-site ME/CFS study, and post-COVID cohorts. "Orthostatic symptoms" here means the symptoms you get on standing: lightheadedness, dizziness, blurred vision, weakness, fatigue, brain fog, palpitations, nausea, or feeling faint.

The OGS describes your usual pattern, which makes it a good baseline and monthly tracking measure. The Vanderbilt Orthostatic Symptom Score is the complementary snapshot rated while standing, the Malmö POTS score covers the past week, and the NASA lean test records the heart-rate data that a POTS or orthostatic hypotension diagnosis actually needs.

This is not a diagnostic tool. The scale measures the burden of orthostatic symptoms regardless of cause. It cannot distinguish POTS from orthostatic hypotension, deconditioning, medication effects, or other conditions. Discuss your results with your doctor. Based on: Schrezenmaier C, Gehrking JA, Hines SM, Low PA, Benrud-Larson LM, Sandroni P. Evaluation of orthostatic hypotension: relationship of a new self-report instrument to laboratory-based measures. Mayo Clin Proc. 2005;80(3):330–334. The scale is the work of its authors at the Mayo Clinic; this page is an interactive scoring aid for personal, non-commercial use.

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

1. Frequency of orthostatic symptoms

2. Severity of orthostatic symptoms

3. Conditions under which orthostatic symptoms occur

4. Activities of daily living

5. Standing time

Understanding your OGS score

What the score measures

The Orthostatic Grading Scale (OGS) is a five-question self-report scale from the Mayo Clinic, published in 2005. It asks how often you get symptoms on standing, how severe they are, what brings them on, how much they interfere with daily life and how long you can stand. Each question scores 0 to 4, giving a total from 0 to 20. Higher means more orthostatic symptoms.

In the original study of 145 people tested in the Mayo autonomic laboratory, the five questions hung together well (alpha 0.91), and scores tracked laboratory measures of autonomic function, most closely the adrenergic (blood pressure control) part (Schrezenmaier et al. 2005).

Yes. It was designed for symptoms of low blood pressure on standing, but a 2023 study of 149 people being investigated for POTS found that its five questions measure a single underlying problem and that scores rose modestly with heart rate on standing. UK POTS patients have averaged 13. (Knoop et al. 2023)

Score bands

Studies using the OGS treat 4 or more as consistent with orthostatic intolerance and 9 or more as consistent with orthostatic hypotension, citing the original Mayo paper. Neither threshold is a diagnosis. For comparison, published averages are 0.6 in healthy controls, 8.3 in ME/CFS and 13 in POTS.

The thresholds of 4 and 9 are as stated by Słomko et al. 2020; we could not check them against the full text of the original paper. Mild, moderate and severe labels sometimes quoted for the OGS have no published thresholds we could verify, so they are not used here.

Average OGS totals in published studies
GroupPeopleAverageSource
Healthy controls (US)1410.6Issa et al. 2025
Hypermobility spectrum disorder (Australia)156.8Peebles et al. 2022
ME/CFS (US)3018.3Issa et al. 2025
Hypermobile EDS (Australia)1410.4Peebles et al. 2022
Long COVID (Spain)2310.6Domingo et al. 2024
ME/CFS (Spain)3112.8Domingo et al. 2024
POTS (UK)13613McDonald et al. 2014

What a change in score means

No minimal important change has been published. The OGS asks about your usual pattern rather than one day, so it changes slowly. Repeat it monthly or around a treatment change; a shift that holds over several results is more likely to be real than a one-off difference.

Your saved results above keep the history on this device; keep your stand test readings alongside.

What it does not measure

No. It measures the burden of symptoms on standing, whatever the cause. POTS and orthostatic hypotension are diagnosed from heart rate and blood pressure measured lying and then standing or tilted. A high score is a reason to ask for that testing.

The NASA lean test records those readings at home, and the 30 bpm threshold explainer covers what they mean. The Malmö POTS score covers a wider set of symptoms over the past week.

Taking this to your GP or consultant

Bring your total, the date, your answer to the standing-time question and, if you have it, the trend from your saved results. Describe the OGS as a five-question Mayo Clinic scale for symptoms on standing, used in POTS and ME/CFS research. A score of 9 or more, with symptoms on standing, supports asking for a lying and standing blood pressure and heart rate check. It does not show what is causing the symptoms. See preparing for a GP appointment.

Sources