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Composite Autonomic Symptom Scale
Please email the author for information about obtaining the instrument: low@mayo.edu
Supplemental Highly-Recommended: Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS)
Supplemental: Parkinson’s Disease (PD)
Short Description of Instrument
The COMPASS-31 is an improved, shortened self-assessment of autonomic symptoms, based on the Autonomic Symptom Profile, which examines 6 clinically relevant domains (Orthostatic intolerance, Vasomotor, Secretomotor, Pupillomotor, GI and Bladder).  
COMPASS-31 total scores demonstrate good internal validity (Cronbach's α = 0.919), test-retest reliability (r(s) = 0.886; P < 0.001) and good convergent validity (r(s) = 0.474; P < 0.001).
The instrument may be used for individuals ages 8-79. It takes approximately 20 minutes or less to complete this assessment. The participant should complete this assessment.
While the COMPASS 31 questionnaire has been validated and used in ME/CFS studies, it has a limited range of questions regarding orthostatic intolerance. It asks respondents to answer only 4 questions about "feeling faint, dizzy, goofy, or having difficulty thinking soon after standing up from a sitting or lying position." In contrast, it asks 12 questions about gastrointestinal symptoms. The presence or absence of lightheadedness is not ascertained, and there are no questions that address how long the respondent can stand without developing symptoms.
Higher scores indicate worse or more symptoms. Scores are weighted for each domain and can range from 0 – 100.
Yes/No or Present/Absent questions are scored 0 or 1. Frequency, Severity and Time Course questions are scored on a 0 – 3 Likert scale.
Suarez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O’Brien PC, Low PA. The Autonomic Symptom Profile: A new instrument to assess autonomic symptoms. Neurology. 1999;52:523–528.
Newton JL, et al. Symptoms of autonomic dysfunction in chronic fatigue syndrome. QJM. 2007;100(8):519–526.
Rizzi M, Atzeni F, Airoldi A, Masala IF, Frassanito F, Salaffi F, Macaluso C, Sarzi-Puttini P. Impaired lung transfer factor in fibromyalgia syndrome. Clin Exp Rheumatol. 2016;34(2 Suppl 96): S114–S119.
Treister R, O'Neil K, Downs HM, Oaklander AL. Validation of the composite autonomic symptom scale 31 (COMPASS-31) in patients with and without small fiber polyneuropathy. Eur J Neurol. 2015;22(7):1124–1130.
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