Development and validation of the rest experience scale for adults with chronically fatiguing conditions, 2026, Ackah, Deary et al

[Dolphin]

Development and validation of the rest experience scale for adults with chronically fatiguing conditions

Introduction Rest is a key component of rehabilitation but remains understudied and underspecified in research and practice, partly due to limited conceptual understanding and comprehensive assessment tools. This gap may hinder the integration of rest advice into physical activity and fatigue...

journals.plos.org

RESEARCH ARTICLE

Development and validation of the rest experience scale for adults with chronically fatiguing conditions

Martin Ackah1, Ulric S. Abonie 1, Florentina Johanna Hettinga1,2, Katie L. Hackett3, Vincent Deary 4*

1 Department of Sport Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom, 2 Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, 3 Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom, 4 Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom * vincent.deary@northumbria.ac.uk

Abstract

Introduction

Rest is a key component of rehabilitation but remains understudied and underspecified in research and practice, partly due to limited conceptual understanding and comprehensive assessment tools. This gap may hinder the integration of rest advice into physical activity and fatigue management protocols. This study aimed to develop and validate the Multidimensional Rest Experience Scale (MRES) for adults with Chronically Fatiguing Conditions (CFC).

Methods

Conducted in three phases, Phase 1 involved MRES development via a modified Delphi method to ensure content validity. Phase 2 included preliminary validation by administering the MRES to a representative sample of adults with CFC to assess construct validity and factor structure. Phase 3 evaluated reliability, examining internal consistency and test-retest reliability. Descriptive and inferential analyses were performed.

Results

The Delphi process reached consensus on 25 items. Exploratory factor analysis refined the scale to 22 items with six factors: resting activity, restorative rest, planning and prioritising rest, physical and psychological barriers to rest, emotional response to rest, and risk of under-resting. Resting Activity showed significant positive correlations with Chronic Pain Coping Inventory (CPCI) Rest subscale (r = 0.572, p < 0.001) and Pacing Engagement (r = 0.332, p < 0.001). Planning and Prioritising Rest correlated with CPCI-Rest (r = 0.532, p < 0.001) and Pacing Engagement (r = 0.681, p < 0.0001). Under-resting risk correlated with Over-Activity risk (r = 0.504, p < 0.001). Discriminant validity for the MRES-22 subscales was established, with Heterotrait- Monotrait (HTMT) ratios ≤ 0.85. Internal consistency was acceptable to good (Cronbach’s α = 0.773–0.829, CR = 0.752–0.830), and test-retest reliability was good to excellent (ICC = 0.816–0.943).

Conclusion

The MRES-22 is a valid and reliable tool for capturing the multidimensional components of rest experience, which are often overlooked in fatigue management protocols. This finding supports the use of the MRES-22 in both clinical and research settings to enhance understanding of rest in relation to key health outcomes and to optimise fatigue interventions in rehabilitation.

Citation: Ackah M, Abonie US, Hettinga FJ, Hackett KL, Deary V (2026) Development and validation of the rest experience scale for adults with chronically fatiguing conditions. PLoS One 21(9): e0355730. https://doi.org/10.1371/journal.pone.0355730

 

[Hutan]

Do they really not have anything better to do with their time? Vincent Deary has been at this for a long time now, surely it is time to go scuba diving or something.

The Delphi process reached consensus on 25 items. Exploratory factor analysis refined the scale to 22 items with six factors: resting activity, restorative rest, planning and prioritising rest, physical and psychological barriers to rest, emotional response to rest, and risk of under-resting.

Silly me, I would have thought a chat with someone was fine for exploring issues with rest and adjusting the approach where that might be required. But, the rehabilitationists want to put a number on it, and presumably quantify it down to sub scales. I imagine that is so they can record in the person's medical history that they are not planning rest right, or their emotional response to rest is wrong, or they are resting too much or not enough. And then, later, what a difference the health professional's wise advice has made!

Thank goodness we have Deary and his friends to tell us precisely how we are resting wrong.

Resting Activity showed significant positive correlations with Chronic Pain Coping Inventory (CPCI) Rest subscale (r = 0.572, p < 0.001) and Pacing Engagement (r = 0.332, p < 0.001). Planning and Prioritising Rest correlated with CPCI-Rest (r = 0.532, p < 0.001) and Pacing Engagement (r = 0.681, p < 0.0001). Under-resting risk correlated with Over-Activity risk (r = 0.504, p < 0.001). Discriminant validity for the MRES-22 subscales was established, with Heterotrait- Monotrait (HTMT) ratios ≤ 0.85. Internal consistency was acceptable to good (Cronbach’s α = 0.773–0.829, CR = 0.752–0.830), and test-retest reliability was good to excellent (ICC = 0.816–0.943).

Ah, the test-retest reliability was good to excellent, and look at those p-values. This must be science.

Under-resting risk correlated with Over-Activity risk (r = 0.504, p < 0.001).

 

[shak8]

File under "advice you don't need" from four disciplines.

 

[rvallee]

I have numerology in mind, there is another more appropriate term for putting up fake numbers to hide ignorance, but frankly it adds up to the same. Turning concepts, especially vague ones, into ordinal numbers does not make them more scientific. It's really beyond time that the principle of "if you're not measuring, you're not doing science" comes back in force. You can't do quantitative math on qualitative data and call it science.

It's always so odd to see people who clearly don't understand the concepts try to teach people about what they mean and how to apply them.

Exploratory factor analysis refined the scale to 22 items with six factors: resting activity, restorative rest, planning and prioritising rest, physical and psychological barriers to rest, emotional response to rest, and risk of under-resting.

Anyway, like I was sayin', shrimp is the fruit of the sea. You can barbecue it, boil it, broil it, bake it, saute it. Dey's uh, shrimp-kabobs, shrimp creole, shrimp gumbo. Pan fried, deep fried, stir-fried. There's pineapple shrimp, lemon shrimp, coconut shrimp, pepper shrimp, shrimp soup, shrimp stew, shrimp salad, shrimp and potatoes, shrimp burger, shrimp sandwich. That- that's about it.

 

[Trish]

I wondered why salute a shrimp.
Saute.
I should learn to read.

 

[Hutan]

why salute a shrimp

Why not? It's probably only slightly less useful when it comes to trying to

optimise fatigue interventions in rehabilitation

by determining a client's summed result on the Multidimensional Rest Experience Scale-22.

It occurs to me that perhaps somebody has realised that promoting exercise is not the answer to all ills. And so, to remain relevant, the rehabilitationists find it necessary to also see themselves as experts in rest. And for that they need a scale with an acronym name and a published paper that reports that the 'internal consistency is acceptable to good'.

 

[NelliePledge]

Multidimensional rest experience scale is giving me hitchhikers guide to the galaxy vibes so I reckon it probably should be 42 not 22

 

[Utsikt]

Multidimensional rest experience scale is giving me hitchhikers guide to the galaxy vibes so I reckon it probably should be 42 not 22

I’d prefer to say so long, and thanks for all the fish(y research) to the rehabbers.

 

[Trish]

Scales and subscales add to the fishy vibe.
They don't make the whole exercise any more scientific or useful.

Maybe they need to think more about this from a patient's perspective instead of their own prespective as therapists.

Why would we want another useless scale to fill in that adds up to a meaningless number? It feels like it's getting to the stage where a large pile of questionnaires replaces any human interaction. They are a barrier to communication, not a help.

We're perilously close to the whole of ME/CFS services in the NHS being an app with dozens of questionnaires to be filled in and scores calculated every 3 months, or maybe every day - who knows, a set of links to MEA leaflets, and AI generated 'personal guidance'. Probably also AI generated reports to go to our GP, school, employer, benefits agency telling them whether we are conforming and trying hard.. No need for any actual human helping us at all.

 

[Eleanor]

This finding supports the use of the MRES-22 in both clinical and research settings to enhance understanding of rest in relation to key health outcomes and to optimise fatigue interventions in rehabilitation.

You do interviews with twenty-odd people, who you acknowledge aren't representative of the general population. You have no idea whether the correlations in their questionnaire answers reflect anything real in the way they manage their health conditions. You think this qualifies as evidence for therapists to tell other people to change the way they manage their health conditions.

Absolute money for jam.

 

[MrMagoo]

It’s good to know it integrates with the chronic pain coping inventory. What with chronic pain not being the biggest issue in fatigue.