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Retraining body parts is overcoming deconditioning as far as I am concerned. And it is not an evidence based treatment so has no legitimacy.

Has she? Her answer to Khan does not look much of an improvement. The important distinction is between ME/CFS type problems - which no doubt can be severe - and specific cardiorespiratory pathology high I very much doubt needs any steroids, antivirals or anticoagulants in the 'Long' situation.

I thought GRADE was led by Guyatt of McMaster?

That is as bad, though. It is the implication of cause and effect that is the problem. The broader text of the guideline gives a clear idea how the detailed text should be read. The de-recommendation of protocols for which there is no evidence provides a clear context too. Any slight shifting...

The other thing is that the guideline is saying IF the patient wants to take up an offer of an exercise programme which as far as I know is not being recommended but might be reasonable to offer to someone wanting to know how to increase their activity safely then they should be helped to...

making flexible adjustments to their physical activity (up or down as needed) to help them gradually improve their physical abilities while staying within their energy limits There is a crucial but subtle difference there. I admit that I think the guideline gets muddled here but the objective...

Absolutely, @Trish. The therapist community need to wake up to the reality that e have no reliable evidence that their management increases the physical abilities of PWME. My understanding of the guideline is that it recognises that it is sensible to help people balance their activities, and do...

OK but that is not good enough. Individualised approach could mean absolutely anything. If it is designed to 'improve physical abilities' there is a claim of some therapeutic efficacy, which we do not have. The problem is that we know that service units who are presenting their policy in this...

My understanding is that this is not consistent with NICE guidelines. The guidelines make it clear that exercise is not to be used as a way of improving physical abilities -since this implies the assumption that it is overcoming deconditioning.

So, in the face of not even having a functioning GP service that can cope with routine medical care why add a completely un-evidenced workload like this? This is what frightened me at the NICE roundtable - my colleagues seem only interested in selling their business - in this case rehab...

I find this tedious. It isn't. Clinical evidence comes primarily from the subjective evidence from the patient - the history - and always has. Using that evidence to build understanding of disease is then something that requires scientific rigour rather than social memes. I am not sure Long...

Maybe what I mean is that she doesn't understand that the concept of Long Covid that she has invented makes no sense. Fat embolism in the lung, Sudeck's atrophy and a limp are all long term sequelae of a fracture. But we don't lump them together as 'Long Fracture' disease. Getting people to...

Isn't this paper an example of what Freud conceived as an obsession with the contents of one's potty - in this case the initials BPS formed by the shape of the contents?

I don't think she understands that Long Covid is used to cover both the organ damage problems linked to stroke and heart failure and the ME/CFS type problems that are unlikely to have any more to do with organ damage than ordinary ME/CFS. The people who shout loudest are very rarely the ones...

To be fair, I think they sat at the same table or at least videoconference.

Not to me I am afraid. None of it is new.

And what about this quote: So when we are faced with a client who is apprehensive about exercise physiology, we know that it is just another barrier that we need to knock down before we can get the ball rolling and start to reap some of those benefits!

It is interesting to look round the site. The post on NICE that was originally flagged up looks quite enlightened. On the other hand there is a poss about 'your claimant'. The paying customer for this outfit is clearly an insurance company, not a patient. This is a quote Carmyn challenged...

Indeed, although it may be more shooting themselves somewhere even more uncomfortable. I already have a paragraph or two on this; I could easily add few more names. Perhaps we should ask for an official Cochrane view of the NICE guidelines. Do they support the constant Garner and Mrs Floptop...

If we're going to be nautical - walk the plank?