The CFS Discovery orthostatic intolerance (standing test) protocol is described in detail elsewhere [
10]. Briefly, participants were required to stand, unaided for a maximum of 20 min after a period of repose necessary for baseline (pre-standing) measurements. Heart rate, blood pressure and oxygen saturations were measured at baseline, and subsequently every 2 min during standing. Parameters were measured at the end of the task (either capped at 20 min, or when the participant could no longer continue) and after 3 min of rest following task completion. A difficulty score was also recorded by the nurse, a subjective measure of how difficult the patient found the standing test. A score between 0 and 10 was recorded (0 = no difficulty standing, 10 = support required to stand, pre-syncope). For this study, two further scores were added, with a subjective score of 12 indicating standing difficulty to the point that the standing test was terminated at less than 20 min (but greater than 10 min), and a score of 14 represented the most extreme difficulty where standing was only possible for 10 min, or less.
With the majority of the ME/CFS cohort achieving a standing time of 20 min, comparisons of standing times for ME/CFS and healthy control cohorts were not informative. To weight the standing time in relation to subjective standing difficulty, and produce a single fatigue response variable, the time standing (maximum 20 min, measured at 2 min intervals) and standing difficulty were combined to produce one measure called the “Weighted Standing Time” (WST). The WST (minutes) was calculated by the following equation:
Weighted standing time (WST) = Time standing (mins) x (1-(Difficulty/14)).