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Viral link does not negate need for physio

New research indicating a viral link to chronic fatigue syndrome/ME does not change the need for physiotherapists to follow existing published guidance recommending graded exercise therapy, says a leading NICE advisor.

A study published in the journal Science found a retrovirus already linked to prostate cancer was also present in most patients who suffered from CFS/Myalgic Encephalomyelitis.

Although it did not say the virus caused the syndrome, the study has raised hopes that combination drugs, like those for AIDS, might eventually be developed for CFS/ME.

One patient campaign group said the latest ‘groundbreaking’ study supported their view that current therapy-led interventions were misguided and may even cause harm. Cath Ross, a patient with CFS/ME who supports MEActionUK, told Frontline: ‘If it turns out we have something as serious as AIDS then treating it with exercise is going to look foolish.’

However, a leading physiotherapist who helped the National Institute for Health and Clinical Exercise draw up guidelines for CFS/ME rejected the claim. Jessica Bavinton said although the new study was of interest and may trigger new developments in future it did not invalidate current treatment.

In 2007 NICE guidance recommended people with mild or moderate CFS/ME be offered cognitive behaviour therapy (CBT) and/or graded exercise therapy (GET) as the interventions for which there is the ‘clearest evidence of benefit’.

Commenting on the Science study, Jessica Bavinton told Frontline: ‘Physios should continue to follow the NICE guidelines and work within the evidence base for the condition. It’s important that we follow what is our current best practice.’

Physios are involved in delivering GET programmes, which is designed to allow patients to do more exercise gradually, in a network of clinical centres.

Jessica Bavinton said there was no evidence at all that GET could cause harm.

She said some people had confused GET, a very specific and beneficial treatment, with exercise generally which could cause problems for some people with CFS/ME if not carefully graded and inappropriately carried out.

She said she was saddened that some people had been put off accessing GET because of misunderstanding of the treatment.

Sarah Adelakun, a specialist physiotherapist for West Sussex primary care trust, who delivers GET, said the concept of exercise in patients with a debilitating condition could seem contradictory.

She added: ‘We work very closely with patients over several months to stabilise their activity levels before we even discuss talking about starting to do more. It’s a very collaborative process and the patient and therapist must be in agreement that activity levels are stable before trying to up the activity every so slightly.’


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