The evidence base for physiotherapy in myalgic encephalomyelitis/chronic fatigue syndrome when considering post-exertional malaise: a systematic review and  narrative synthesis.

Abstract

BACKGROUND: Due to the inconsistent use of diagnostic criteria in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), it is unsure whether  physiotherapeutic management regarded effective in ME/CFS is appropriate for  patients diagnosed with criteria that consider post-exertional malaise (PEM) as a  hallmark feature. PURPOSE: To appraise current evidence of the effects of  physiotherapy on symptoms and functioning in ME/CFS patients in view of the  significance of PEM in the applied diagnostic criteria for inclusion. METHODS: A  systematic review of randomized controlled trials published over the last two  decades was conducted. Studies evaluating physiotherapeutic interventions for  adult ME/CFS patients were included. The diagnostic criteria sets were classified  into three groups according to the extent to which the importance of PEM was  emphasized: chronic fatigue (CF; PEM not mentioned as a criterion), CFS (PEM  included as an optional or minor criterion) or ME (PEM is a required symptom).  The main results of included studies were synthesized in relation to the  classification of the applied diagnostic criteria. In addition, special attention  was given to the tolerability of the interventions. RESULTS: Eighteen RCTs were  included in the systematic review: three RCTs with CF patients, 14 RCTs with CFS  patients and one RCT covering ME patients with PEM. Intervention effects, if any,  seemed to disappear with more narrow case definitions, increasing objectivity of  the outcome measures and longer follow-up. CONCLUSION: Currently, there is no  scientific evidence when it comes to effective physiotherapy for ME patients.  Applying treatment that seems effective for CF or CFS patients may have adverse  consequences for ME patients and should be avoided.