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ExerciseNov 1, 2021

Physios for ME says all students and physios need specialist training in wake of NICE guideline

A group of specialist physiotherapists has criticised aspects of a recently issued national guideline on treating people with a diagnosis of myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).

When the guideline was released by the National Institute for Health and Care Excellence (NICE) at the end of last month it was welcomed in a statement by the Forward-ME coalition. The physiotherapy group Physios for ME is one of nine organisations in the field that make up the coalition.

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Physios must be able to identify and manage post-exertional malaise, says Physios for ME

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In a separate statement, issued shortly after Forward-ME responded to the NICE guideline's publication, Physios for ME thanked members of the NICE team for their efforts in drawing up the guideline. ‘The guidelines are in line with our own recommendations and reflects the known adverse physiological effects of exertion,’ it noted.

But the Physios for ME statement also criticised a key section of the guideline dealing with exercise programmes and the role of physiotherapists. In this section, NICE argued that only physios working in ME/CFS specialist teams should be able to oversee physical activity or exercise programmes that have been offered to patients.

'Too restrictive'

Describing this recommendation as ‘too restrictive’, Physios for ME noted: ‘People with ME may see a physiotherapist outside of a specialist ME service for other problems, such as musculoskeletal [MSK], pain or rheumatology conditions.

‘Under these guidelines, how should an MSK practitioner manage a shoulder injury in a person with ME? Or an orthopaedic physiotherapist provide rehabilitation to a person with ME who has just had a hip replacement?

Physios for ME added: ‘We feel that education for all physiotherapists needs to be improved regarding ME, in particular the ability to identify and manage post exertional malaise, so that all physiotherapy interventions can be adapted and made suitable for a person with ME.’

Do not offer people with ME/CFS physical activity or exercise programmes that use fixed incremental increases, based on deconditioning and exercise avoidance theories as perpetuating ME/CFS [Physios for ME]

What is Physios for ME’s 'over-riding message for physiotherapists'?

‘Do not offer people with ME/CFS physical activity or exercise programmes that use fixed incremental increases, based on deconditioning and exercise avoidance theories as perpetuating ME/CFS.

Physios for ME also stated that:

all undergraduate physiotherapy programmes should cover ME topics ‘as standard’

all physiotherapists – regardless of their speciality – need training updates based on the most recent biomedical evidence

individual practitioners are responsible for ensuring their continuing professional development is up to scratch 

To see the Physios for ME statement, visit: https://www.physiosforme.com/post/nice-publish-new-guidelines

To see PhysioUpdate’s original article on the NICE guideline, visit: https://www.physioupdate.co.uk/news/coalition-including-specialist-me-physios-welcomes-nice-guidelines-break-from-the-past-/

Author: Ian A McMillan
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