| GRADE score | |||||
| 2 | 1 | 0 | -1 | -2 | |
| Balance between desirable and undesirable consequences of inclusion as a core or required symptom | Desirable clearly outweigh undesirable | Desirable probably outweigh undesirable | Trade-offs equally balanced or uncertain | Undesirable probably outweigh desirable | Undesirable clearly outweigh desirable |
| Assessment of quality of evidence | Strong: “definitely include as required” | Weak: “probably include as required” | No specific recommendation | Weak: “probably don’t include as required” | Strong: “definitely don’t include as required” |
| For each symptom or category of symptoms below, please mark with an “X” the cell that best corresponds to your assessment of the available evidence, in terms of benefits versus disadvantages for inclusion as a core or required symptom. | |||||
| Post-exertional malaise (exacerbation of symptoms or fatigue triggered by physical or mental exertion and lasting > 24 hours after exercise) |
|||||
| Sleep (unrefreshing sleep, sleep disturbance/dysfunction) |
|||||
| Neurocognitive manifestations (mental fatigue, memory impairment, concentration difficulties, confusion) |
|||||
| Autonomic manifestations (orthostatic intolerance, cardiovascular irregularities, gastrointestinal impairments, genitourinary impairments) |
|||||
| Immune manifestations (sore throat, tender lymph nodes) |
|||||
| Neuroendocrine manifestations (loss of thermostatic stability, sweating episodes, intolerance of temperature extremes) |
|||||
| Pain (headaches, muscle pain, joint pain) |
|||||
Balance between desirable and undesirable effects of inclusion as a required or core symptom or symptom category
Desirable consequence: The specific symptom or symptom category is present in a majority of ME/CFS patients, and its inclusion as a required symptom could prevent incorrect diagnoses of ME/CFS in those that do not have it.
Undesirable consequence: The specific symptom or symptom category is not present in a majority of ME/CFS patients, and its requirement could thus exclude patients with ME/CFS from diagnosis.
The larger the difference between the desirable and undesirable effects, the more likely a strong recommendation is warranted. The narrower the gradient, the more likely a weak recommendation is warranted.
Quality of evidence: The higher the quality of evidence, the more likely a strong recommendation is warranted.
