HealthMeasures Terms of Use

Approved Version 1.12-2017

Definitions:

• HealthMeasures: a resource encompassing four measurement systems: PROMIS

, NIH

Toolbox®, Neuro-QoL, and ASCQ-ME

• Measurement System: a collection of health measurement instruments under one brand,

such as PROMIS or NIH Toolbox

• Provider: the Department of Medical Social Sciences at Northwestern University Feinberg

School of Medicine

• User: anyone who employs a HealthMeasures Measurement System or Instrument in a

research, clinical, educational, or other setting

• Publicly Available: HealthMeasures Instruments which are available for download at

healthmeasures.net

Thank you for your interest in HealthMeasures. Please read our Terms of Use carefully as we

include information which applies universally to all of our measurement systems as well as

information specific to individual measurement systems.

You understand and agree that the Provider gives access to HealthMeasures Instruments (e.g.,

item banks, short forms, profile measures) subject to these Terms of Use. Provider reserves the

right to update the Terms of Use at any time. Changes to the Terms of Use will apply to new users,

new instruments, and to new projects created by existing users after these changes are posted.

Use of HealthMeasures Measurement Systems, instruments, related materials, and services

requires acceptance of all terms and conditions stated herein. You agree to abide by all of the

HealthMeasures Terms of Use as a condition of using HealthMeasures. No modifications or

additions to these Terms of Use are binding upon Provider unless previously agreed to in writing

by an authorized representative of Provider.

Single Use, Reproducibility, and Distribution

• All HealthMeasures Instruments are copyrighted. All English and Spanish versions of

PROMIS and Neuro-QoL and some NIH Toolbox self- and parent-proxy report instruments

(NIH Toolbox Emotion and select Sensation) are publicly available for use without licensing

or royalty fees for individual research or individual clinical use. Such use of HealthMeasures

Measurement Systems and Instruments is “single use,” meaning solely for User’s research,

clinical, educational, or other application.

• User shall not reproduce HealthMeasures Instruments except as needed to conduct the

authorized single use research, clinical, educational, or other activity. User shall not

distribute, publish, sell, license, or provide HealthMeasures products, by any means

whatsoever, to third parties not involved with the authorized single use as stated above,

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without the prior written agreement of the Provider. Users must request permission to

reprint HealthMeasures Instruments for reasons not included in the single use case.

• Commercial Users must seek permission to use, reproduce, or distribute any

HealthMeasures Measurement Systems and Instruments, regardless of purpose, at all

times.

• Users wishing to integrate instruments into proprietary technological systems, including in

the Single Use case, must seek written approval. Proprietary technological systems include,

but are not limited to, computerized adaptive tests, apps, and web portals used for data

collection. Provider may incur costs in providing the permission to integrate, and those

costs may be passed along to the User.

• Users who secure license agreements to deliver HealthMeasures instruments through

technological systems owned and supported by Provider do not need additional licenses to

use the HealthMeasures instruments provided with the technological system to which User

has been granted license. If the license agreement for the technology owned and

supported by Provider includes reproduction and distribution rights, the license agreement

itself is sufficient permission for reproduction and distribution and covers all requirements

to seek permissions or consent required herein.

• User agrees not to adapt, alter, amend, abridge, modify, condense, make derivative works,

or translate HealthMeasures Instruments without prior written permission from the

Provider. In cases where permission is granted, User will be expected to evaluate the

impact of approved modifications.

• User agrees and undertakes not to sell or incorporate HealthMeasures Measurement

Systems and Instruments into materials that could be sold without prior written consent

from the Provider.

• To inquire about permissions, email help@healthmeasures.net.

Indemnification

• User agrees and undertakes to indemnify and hold Provider harmless against any and all

claims, loss or damage, including fees, penalties or fines and third party claims, and

attorneys’ fees arising from User’s use of any HealthMeasures Measurement System or

Instrument. Further, User shall be obliged to indemnify, defend and/or hold harmless

Provider and its agents, trustees, officers, medical affiliates, employees, and their

respective successors, heirs, and assignees against any liability, damage, loss or expense

incurred in connection with User’s use of any HealthMeasures Measurement System or

Instrument.

• Consent to User’s use of HealthMeasures Measurement System or Instrument is given ‘AS

IS’, without any accompanying services or improvements. Provider does not accept any

liability resulting from User’s use of any HealthMeasures Measurement System or

Instrument. All HealthMeasures Measurement Systems and Instruments are supplied to

User with no warranties or representations of any kind as to the accuracy, currency, or the

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merchantability or fitness of the HealthMeasures Measurement Systems or Instruments for

a particular purpose.

• Neither Provider nor any party involved in creating, producing, or delivering any

HealthMeasures Measurement System or Instrument shall be liable for any damages,

including without limitation, direct, incidental, consequential, indirect, or punitive damages

arising out of access to, use of, alterations of, or inability to use any HealthMeasures

Measurement System or Instrument, or any errors or omissions in the content thereof.

Trademarks

• User will include Provider’s trademark ownership statement on all printed copies of any

HealthMeasures Measurement System or Instrument in the same form as it appears on the

document that User is downloading from this website.

• User agrees and undertakes not to remove the trademark notices which appear on any

printed HealthMeasures Measurement System or Instrument. Use of HealthMeasures

Measurement Systems and Instruments does not and will not create any right, title or

interest thereof for User, other than the right to use HealthMeasures Measurement

Systems and Instruments under these Terms of Use.

Publications and Presentations

• Any publication or presentation created from research, clinical, educational, or other

applicable use of any HealthMeasures Instruments should include a statement that

indicates which instruments (including version number) were used and provide an

appropriate citation.

• For precise copyright citation, see the measurement system of interest below.

Furthering Research

• Use of HealthMeasures Instruments in clinical research is

encouraged, with the

understanding that data collected from that use will contribute to

knowledge about the

validity of HealthMeasures measures. USERS OF HealthMeasures TOOLS ARE

STRONGLY

ENCOURAGED TO SUBMIT A BRIEF REPORT INCLUDING SAMPLE DEMOGRAPHIC

INFORMATION, CLINICAL DATA SUFFICIENT TO characterize THE SAMPLE, AND SCORE

DISTRIBUTIONS (E.G.,

BASELINE MEAN AND STANDARD DEVIATIONS OR CHANGE

SCORES). This brief report should be submitted to

[email protected] for internal

review. None of this submitted information will be

published without the written consent

and participation of the submitter. In addition to the

brief report, clinical researchers are

encouraged to submit de-identified data for

collaborative analysis and reporting. Data

ownership would remain with the submitter. Clinical researchers are strongly encouraged

to collaborate with HealthMeasures investigators when

applying these items and banks to

their research.

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Additional Terms and Conditions of Use for PROMIS

The PROMIS Terms and Conditions contained in this document serve as an agreement between

Provider and Users of any and all aspects or components of PROMIS.

PROMIS tests, test protocols, test items, norms, norms tables, scoring programs, scoring keys

(including scoring algorithms, scale definitions, scale membership, and scoring directions),

Organization or other individuals/entities that

have contributed information and materials, and

are being

used with the permission of the copyright holders. For a table of PROMIS copyright

holders and the copyrighted information and materials employed by the copyright holders, see

Appendix A.

Additional Terms and Conditions of Use for NIH Toolbox

NIH Toolbox Terms and Conditions

The NIH Toolbox Terms and Conditions contained in this document (hereinafter referred to as

“NTAC”) serve as an agreement between Provider and Users of any and all aspects or

components of the NIH Toolbox.

NIH Toolbox tests, test protocols, test items, norms, norms tables, scoring programs, scoring keys

(including scoring algorithms, scale definitions, scale membership, and scoring directions), score

and the National Institutes of Health. Information and materials contributed to the NIH Toolbox

by other individuals/entities are being used with the permission of the copyright holders.

CONFIDENTIALITY.

User acknowledges and agrees that the contents of the NIH Toolbox may constitute trade secrets,

which include confidential and proprietary material, information, and procedures. User will not

resell or otherwise distribute materials, or authorize or allow disclosure of the contents of a test

instrument protocol, including test questions and answers, or normative data, except under the

limited circumstances described in the section titled, "Maintenance of Test Security and Test Use,"

or as otherwise contemplated in the published manual associated with the test. User

acknowledges and agrees that the use or disclosure of trade secrets in a manner inconsistent with

the provisions of this Agreement may cause Provider irreparable damage, for which remedies

other than injunctive relief may be inadequate. Accordingly, User agrees that in any request by

Provider to a court of competent jurisdiction for injunctive or other equitable relief seeking to

restrain such use or disclosure, User will not maintain that such remedy is not appropriate under

the circumstances.

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PERMISSIONS AND LICENSING POLICY

Reproduction of any NIH Toolbox materials, except for authorized single use of publicly available

NIH Toolbox measures, requires the prior written consent of Provider. Questions and answers,

including practice questions and answers, may not be reproduced without written permission,

regardless of the number of lines or items involved. Test copies may not be bound in theses or

reports placed in libraries, generally circulated, or accessible to the public, or in any article or text

of any kind.

PERMISSION TO USE COPYRIGHTED TEST NORMS

Provider has the sole right to authorize reproductions of any portion of their published tests,

including test norms. Copying of test norms without authorization is a violation of federal

into a computer's memory for purposes of test processing, scoring, or reporting. Any person or

organization wanting to use NIH Toolbox test norms outside of official NIH Toolbox software must

submit a written request to help@healthmeasures.net. If permission is granted, a fee may be

charged. For the avoidance of doubt, permission from Provider for use of test norms does not

imply endorsement of, or responsibility for, the accuracy or adequacy of any test processing,

scoring, or reporting service.

MODIFICATION OF NIH TOOLBOX COMPONENTS

Provider recognizes the importance of continued scientific development of the NIH Toolbox

measures to meet the needs of researchers, but emphasizes the importance of maintaining

rigorous measurement standards. Therefore, User may make modifications to NIH Toolbox

Cognition, Motor, Emotion and Sensation tests and test items if, and only if, the following

conditions are met:

1. Specific modification plans must be enumerated and submitted in writing to Provider for

approval. This request must include the specific changes to be made and the rationale for the

changes. This written request must be signed by the lead researcher.

2. User may not make modifications to any component of NIH Toolbox without written

consent of Provider.

3. All modifications should be fully validated against the existing NIH Toolbox measure(s) on

which they were based. Plans for a concurrent validation study should be included in the written

request for modifications. If no validation study is planned, this must be noted in the written

request, along with an explanation.

4. User must send validation study results to Provider for review prior to publication citing

any results of said study or any results citing use of NIH Toolbox.

5. Provider will review validation study data and will inform User if modification to NIH Toolbox

measure(s) constitute an “Approved Adaptation” or a “Non-Validated Adaptation” of NIH

Toolbox. Provider will update HealthMeasures.net accordingly to inform other users and

prospective users of these modifications, along with contact information for the lead researcher.

6. User must cite NIH Toolbox in any and all presentations, publications, or other third-party

sharing of research data, indicating whether any measures used constitute Approved

Adaptations or Non-Validated Adaptations.

7. Provider maintains all rights to Approved Adaptations as well as Non-Validated Adaptations

of NIH Toolbox tests and test items made by User. User may under no circumstances license,

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distribute, or share any components of NIH Toolbox with third parties, regardless of the extent

of modifications, without official, written consent of PROVIDER. User is entitled to no

ownership claim of intellectual property as a result of making any NIH Toolbox modifications,

and is hereby enjoined from communicating or stating any such claims.

MAINTENANCE OF NIH TOOLBOX TEST SECURITY AND TEST USE

• Each person or institution using the NIH Toolbox Measures must agree to comply with

these basic principles of test security.

• Test takers must not receive test answers before beginning the test. Test questions are

not to be reproduced or paraphrased in any way.

• Access to test materials must be limited to qualified persons with a responsible,

professional interest who agree to safeguard their use.

• Test materials and scores may be released only to persons qualified to interpret and use

them properly.

• If a test taker or the parent of a child who has taken a test wishes to examine test

responses or results, the parent or test taker may be permitted to review the test and the

test answers in the presence of a representative of the school, college, or institution that

administered the test. Such review should not be permitted in those jurisdictions where

applicable laws require the institution to provide a photocopy of the test subsequent to

review. If User is not certain of the effect of the laws in User’s jurisdiction, the User should

contact their jurisdiction's professional organization.

USER QUALIFICATIONS

Test users must have the appropriate knowledge, skills, training and experience to responsibly

use NIH Toolbox measures. “Test users” are those persons responsible for the selection,

administration, scoring and interpretation of tests and the communication of results. Provider

reserves the right to ask individuals requesting access to NIH Toolbox Cognition measures to

provide documentation that they have the experience and training necessary to use those

measures, or are working under the supervision of someone qualified to use those measures.

NIH Toolbox Cognition measures are classified as “C-Level.” C-Level tests require a high degree of

expertise in test interpretation, and thus can only be requested by a User with state licensure or

certification to practice in a field related to the request, or a doctorate degree in psychology,

education, or a closely related field, with formal training in the ethical administration, scoring,

and interpretation of clinical assessments related to the intended use of the assessment. Any

users of C-Level assessments must be supervised by one or more users with C-Level

qualifications, which must have been provided in advance to Provider per this process.

RULES GOVERNING USE OF THE NIH TOOLBOX BY VARIOUS CATEGORIES OF USERS

Universities, schools, organizations, businesses, clinics, and hospitals are subject to the

guidelines set forth above and must have appropriately qualified individuals on staff in order to

use the NIH Toolbox tests.

PROTECTIVE ORDERS. User agrees to seek a protective order safeguarding the confidentiality of

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test materials classified by Provider as “C-level” assessments if User is required to produce such

materials in court or administrative proceedings.

NO WARRANTY. Provider makes no warranties, expressed or implied, including warranties of

merchantability or fitness for a particular purpose. Provider will not, under any circumstances,

be liable for User's expense for delays, for costs of substitute materials, or for possible lost

income, grants, profits, or any other special or consequential damages that may result from

using the NIH Toolbox.

Additional Terms and Conditions of Use for Neuro-QoL

People using Neuro-QoL should include the following copyright notice.

National Institute for Neurological Disorders and

Stroke (NINDS). Some content used with permission of the PROMIS Health Organization.

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Appendix A

PROMIS Copyright Holders and Their Copyrighted Information and Materials

The table set forth below identifies individuals and entities who have contributed items in

support of building PROMIS item banks and the copyrighted information and materials

employed by such persons. As a user of PROMIS you are entirely responsible for respecting

the

proprietary rights of such persons, and for complying strictly with the requirements set

forth

herein. If you have questions about these requirements and your legal obligations, you

may

wish to consult an attorney.

Thomas M. Achenbach, PhD

Child Behavior Checklist for Youth

Torbjörn Åkerstedt

Karolinska Sleep Diary

Stanley E. Althof

Center for Marital and Sexual Health Sexual Functioning Questionnaire

Julie Barroso, PhD

HIV-Related Fatigue Scale

Dorcas Beaton

Disabilities of the Arm, Shoulder and Hand (DASH)

Basia Belza

Multidimensional Assessment of Fatigue

Smita Bhatia

Minneapolis-Manchester Quality of Life Instrument – Adolescent Version

Jill Binkley, PT

Lower Extremity Functional Scale

Thomas Borkovec

Penn State Worry Questionnaire

Ron Borland

Perceived dependence items from International Tobacco Control Policy Evaluation Study (ITC)

Lynn Breau

Non-communicating Children's Pain Checklist

Bengt Brorsson

Swedish Health Related Quality of Life Survey

Richard Brown, PhD

Parkinson Fatigue Scale

Elly Budiman-Mak, MD

Foot Function Scale

Arnold Buss

Buss-Durkee Hostility Inventory

Daniel J. Buysse

Pittsburgh Sleep Quality Index

Andrei Calin, MD

Bath Ankylosing Spondylitis Function Index (BASFI)

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David Cella, PhD

Functional Assessment of Chronic Illness Therapy (FACIT)

Center on Outcomes, Research, and Education Item Banks

Larry Chambers, PhD

McMaster Health Index Questionnaire

Trudie Chadler

14-Item fatigue scale

Amy Copeland

Smoking Consequences Questionnaire

Ann Coscarelli

Cancer Rehabilitation Evaluation System (CARES)

Kimberly A. Cote

Brock Sleep and Insomnia Questionnaire

Laura Creti

Sexual History Form

Peter Dent, MD

Juvenile Arthritis Self-Report Index (JASI)

Ed Diener

Satisfaction with Life Scale

Joe DiFranza

Autonomy over smoking scale

Dr. Colleen Dilorio

Epilepsy Self-Efficacy Scale

George Domino

Assessment of Sleep

Sleep Questionnaire

Maxime Dougados, MD

Dougados Functional Index (DFI)

Alan B. Douglass

Sleep Disorders Questionnaire

David Drobes

Questionnaire of Smoking Urges - Long Form

M Tuncay Duruoz, MD

Duruoz Hand Index

Jack D. Edinger, Professional Resource Exchange

Edinger’s Sleep History Questionnaire

Colin A. Espie

Beliefs and Attitudes about Sleep Scale

Dysfunctional Beliefs and Attitudes about Sleep Scale - 10

Glasgow Content of Thoughts Inventory

Insomnia Impact Scale

Sleep Disturbance Questionnaire

JF Etter

The Cigarette Dependence Scale, English-language version

Sydney Ey

Youth Life Orientation Test

Approved Version 1.12-2017

Jeremy Fairbank, MD

Oswestry Low Back Pain Disability Questionnaire (OLBPDQ)

Catherine S. Fichten

Sleep Diary

Sleep Questionnaire

Robert Ficke

Performance Outcomes Measures Project

J.D. Fisk

Fatigue Impact Scale

Ross Flett

Affectometer-2

James F Fries, MD

Health Assessment Questionnaire (HAQ)

Marie Gage

Self-Efficacy Gauge (SEG)

Richard Gracely

Descriptor Differential Scale of Pain Affect (DDS - Pain Affect item)

Johanna CJM de Haes, PhD

Rotterdam Symptom Checklist

Stephen Haley, PhD

Late Life Function and Disability Instrument: Function Component

Danete Hann, PhD and Paul Jacobsen, PhD

Fatigue Symptom Inventory

Todd Heatherton

Fagerstrom Test for Nicotine Dependence

Vicki Helgeson

Benefit Finding Scale

Philip S Helliwell, MD, PhD

Revised Leeds Disability Questionnaire

Sarah Hewlett MD

Rheumatoid Arthritis Self-Efficacy Scale (RASE)

Ian Hindmarch

Quality of Life of Insomniacs

Leeds Sleep Evaluation Questionnaire (LESQ)

Mark Hlatky, MD

Duke Activity Status Index (DASI)

Timothy J. Hoelscher

Insomnia Impact Scale

William L. Holzemer

PPBL

E. Scott Huebner, PhD

Multidimensional Students’ Life Satisfaction Scale (MSLSS)

Student’s Life Satisfaction Scale

Paul Jacobsen

Fatigue Symptom Inventory

Alan Jette

AMPAC

Approved Version 1.12-2017

Jeffrey G. Johnson, PhD

Patient Health Questionnaire for Adolescents (PHQ-A)

Robert Kerns

WHYMOI

Dinesh Khanna

UCLA Scleroderma Clinical Trials Consortium Gastrointestinal Tract (SCTC GIT) 2.0

Dr Sunil Kripalani

Self-efficacy for Appropriate Medication Adherence Scale (SEAMS)

Lauren Krupp

Fatigue Severity Scale

Sleep Symptom Questionnaire

Jin-Shei Lai, PhD

Pediatric Fatigue Item Bank

Kathryn A. Lee

Numerical Rating Scale for Fatigue

Stephen J. Lepore

Social Constraint Scale

Debra Lerner, PhD

Work Limitations Questionnaire

Kenneth Lichstein

Sleep Questionnaire

Mark S. Litwin

UCLA Prostate Cancer Index

Daniel Lovell, MD

Juvenile Arthritis Functional Assessment Scale

Juvenile Arthritis Functional Assessment Report for Children (JAFAR-C)

Anne Lynch-Jordan (S. Kashikar-Zuck, & K. Goldschneider)

Adolescent Pain Behavior Questionnaire

Ayala Malach-Pines

Burnout Measure

Ralph Marino, MD

Capabilities of Upper Extremity (CUE)

Sherry McKee

The 39-Item Perceived Risk and Benefits Questionnaire

John Mayer

Brief Mood Introspection Scale

Robert Meenan, MD

Arthritis Impact Measurement Scales 2 (AIMS2)

Tito Mendoza, Charles Cleeland

MD Anderson Symptom Inventory

Charles M. Morin

Insomnia Interview Schedule

Sleep Diary

Douglas E. Moul

Pittsburgh Insomnia Rating Scale

Nikolaus Netzer

Berlin Questionnaire

Approved Version 1.12-2017

Olugbenga Ogedegbe

Medication Adherence Self-Efficacy Scale

Geraldine Padilla

Quality of Life Scale – Cancer

Tonya M. Palermo, PhD

Child Activity Limitations Interview (CALI)

George Parkerson, MD

Duke Health Profile

Donald Patrick, PhD

WHOQOL-100 US Version

Pfizer, Inc.

International Index of Erectile Function, Erection Harness Scale

Megan Piper

Wisconsin Inventory of Smoking Dependence Motives

Ovide Pomerleau

Michigan Nicotine Reinforcement Questionnaire

Arnold L. Potosky

Prostate Cancer Outcomes Study

Quentin R. Regestein

Hyperarousal Scale

Graham J. Reid (C. Gilbert, & P. McGrath)

Pain Coping Questionnaire

Gary T. Reker

Life Attitude Profile-Revised (LAP-R)

Dennis Revicki

PROMIS Adult Pain Behavior Bank

Robin Richards, MD

American Shoulder and Elbow Surgeons Shoulder Form (ASES)

J. Scott Richards

UAB Pain Behavior Scale

Tracey Riseborough

Hospital Anxiety and Depression Scale (HADS)

Kathryn Roach, PhD

Shoulder Pain and Disability Index

Damaris J. Rohsenow

Smoking Effects Questionnaire

Martin Roland, MA, MRCP

Roland-Morris Low Back Pain and Disability Questionnaire

Raymond Rosen and Jules Mitchell

Brief Index of Sexual Functioning for Women

Female Sexual Function Index

Thomas Roth

Global Sleep Assessment Questionnaire

Daniel W. Russell

UCLA Loneliness Scale

Michael F. Scheier

Life Engagement Test

Approved Version 1.12-2017

Raf Schwarzer

General Self-Efficacy Scale

Debra Sciabarrasi

Barthel Index

William G. Shadel, PhD

Smoker Self-concept and Abstainer Self-concept scales

Cathy Sherbourne, Robert Brook, Brent Bradley

Rand-36 Index of Vitality

Saul Shiffman

Nicotine Dependence Syndrome Scale

Judith Siegel, PhD

Multidimensional Anger Inventory

Ann Skinner

Sickness Impact Profile (SIP)

C. R. Snyder (by B. Hoza)

Children’s Hope Scale

John Spertus, MD, MPH

Seattle Angina Questionnaire

Charles D. Spielberger, PhD

State-Trait Anger Expression Inventory (STAXI)

Barbara Starfield, MD, MPH

Child Health and Illness Profile – Adolescent Edition (CHIP-AE)

Michael Steger

Meaning in Life Questionnaire – Expanded Version (MLQ-X)

Kevin Stein

Multidimensional Fatigue Symptom Inventory

Mark Sullivan MD

Cardiac Self-Efficacy Scale

K.L. Syrjala

Sexual Function Questionnaire

Peter Tugwell, MD

McMaster Toronto Arthritis

David Tulsky, PhD

SCI-QOL

TBI-QOL

James W. Varni, PhD

PedsQL™ Arthritis Module Version 3.0 Child Report (ages 8-12)

PedsQL™ Asthma Module Version 3.0 Child Report (ages 8-12)

PedsQL™ Cerebral Palsy Module Version 3.0 Child Report (ages 8-12)

PedsQL™ Multidimensional Fatigue Scale Standard Version Child Report (ages 8-12)

PedsQL™ Pediatric Quality of Life Inventory Version 4.0 Child Report (ages 8-12)

Wayne Velicer and James Prochaska

The Self-Efficacy/Temptations Scale-Long Form

Smoking: Decisional Balance Scale

Transtheoretical Model Assessment

Johan W. S. Vlaeyen

Checklist for Interpersonal Pain Behavior

Lynn S. Walker

Pain Response Inventory for Children

John Ware, PhD

PIQ-6

SF-36 v2

Medical Outcomes Study Sexual Functioning Scale

David Watson

Positive and Negative Affect Scale-Expanded form (PANAS-X)

Terri E. Weaver

Functional Outcomes of Sleep Questionnaire

Wilse B. Webb

Post-Sleep Inventory

Nadine Weisscher

AMC Linear Disability Score (ALDS)

Nick Wetton

Crown-Crisp Experiential Index

Horng-Shiuann Wu, PhD

Cancer-Related Fatigue Instrument