I'm just floating ideas here, and would appreciate some feedback. I have been thinking about the difficulties that ME centres have in measuring effectiveness. It doesn't seem appropriate to put patients through a set of demanding objective assessments, and yet responses to subjective assessments are so easily manipulated. So here's my take on it so far: three areas need looking at – activity levels, knowledge and "feelings" about the condition, and cognitive abilities. I don't think it is appropriate to try and produce a lengthy, finely-scored set of questionnaires. I'm not interested in a treatment that may bump up my Chalder Fatigue score by 2 points - I vary by more than that from week to week. So, one questionnaire simply asking a series of graded questions (graded question therapy?) about what the patient did on the previous day, starting with "Did you wash and dress yourself?" up to "Did you spend more than 4 hours in paid employment?". One questionnaire asking a very limited number of questions such as "Do you think you have ME?", "Do you understand the principles of pacing" etc. The idea here is to cover one of the main benefits of the specialist centres – confirmation of diagnosis and an introduction to pacing, possible sleep techniques etc. And one short computer controlled cognitive test, where perhaps you have the words RED, BLUE, GREEN, and YELLOW, in the right colours, apart from one which you have to spot, then the converse, or something along those lines. I gather 5 minutes is enough to slow us down. With PACE, almost all assessments showed the greatest improvement between baseline and the next assessment. I'm not surprised – the effort involved in getting to the first session, meeting new people and adjusting to the system is exhausting. I would propose that copies of these assessments were sent to the patients, together with a link to the computer test, so that they can look through what they will be required to do, and soften the shock. Finally, while at home, patients could be asked to complete a "clock scale" for two weekdays, just shading in blue the hours spent in bed or at rest, and those spent in higher energy requirements (like driving) in red: unshaded areas would be assumed to be low energy requirements such as eating, watching TV etc. (I'm talking in terms of healthy people's perception of energy levels here). Obviously there would need to be a good list of useful examples of each. My thoughts would be to produce a set of ME-patient approved assessments for centres to use to measure any effectiveness. They need to be able to be coded and analysed in bulk. I certainly do not think that the present ones that they use are appropriate.