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Severe and very severe ME
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==Comparison== Some scales have a "ceiling effect" that means severe ME can not adequately be distinguished from very severe ME, or from moderate ME, including the [[Chalder fatigue scale]].<ref name="jason2011">{{Cite journal | last= Jason | first = Leonard A. | author-link = Leonard Jason | last2 = Evans | first2 = Meredyth | authorlink2 = Meredyth Evans | last3 = Brown | first3 = Molly | author-link3 = Molly Brown | last4 = Porter | first4 = Nicole | authorlink4 = Nicole Porter | last5 = Brown | first5 = Abigail | authorlink5 = Abigail Brown | last6 = Hunnell | first6 = Jessica | authorlink6 = Jessica Hunnell | last7 = Anderson | first7 = Valerie | authorlink7 = Valerie Anderson | last8 = Lerch | first8 = Athena | authorlink8 = Athena Lurch | date = 2011 | title=Fatigue Scales and Chronic Fatigue Syndrome: Issues of Sensitivity and Specificity|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181109/|journal=Disability studies quarterly : DSQ|volume=31|issue=1|pages=|issn=1041-5718|pmc=3181109|pmid=21966179|quote=|via=}}</ref> Some patients who are severely ill may not have enough concentration to complete a questionnaire, or may be too ill to communicate, these patients may need another person to complete the rating scale instead, for example a carer or health professional. A pilot study of patients with severe CFS/ME in North East England found that even when visiting patients at home, some were unable to complete a questionnaire or to even attempt to stand.<ref name="northeast" /><br style="clear:both;line-height:0;margin:0"> [[File:Naomi Whittingham .png|300px|thumb|left|[[Naomi Whittingham]] lives in the [[United Kingdom|UK]] with a severe case of ME. Naomi became ill at [[Pediatric myalgic encephalomyelitis and chronic fatigue syndrome|age 12]] with a routine virus and never recovered. She advocates for ME by doing interviews, writing the blogย [[A Life Hidden]], and supporting her brother [[Tom Whittingham]]'s marathon fundraising for [[ME Research UK]]]] {{Clear|both}}
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