Review: Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management, 2018, Fedorowski

Open access at https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12852

 

I have so far just read through the review once and may be unfair in my comments but two things struck me in an otherwise clear and appearantly well argued review:

1. In relation to 'CFS' the authors say:

however given the limited resources for diagnosis, mentioned by the authors, and the fact that many people with more severe ME do not have adequate access to medical assesment isn't it likely that any research involves under reporting and a potentially skewed sample.

I suspect that POTS in severe ME may be more prevalent, not confined to younger patients and longer lasting than suggested here. Also I am interested in the possibility that the symptom of orthostatic intolerance that may occur in ME in the absence of full blown POTS, though unfortunately this area is so little investigated. Indeed how common is the symptom of orthostatic intolerance outside what would fit the formal diagnostic criteria of POTS?

2. In relation to exercise they say in the abstract:

and in the text they say

however they do not discuss any limitations that perhaps should be placed on exercise in relation to those patients with comorbid ME. Also, though I have not checked their cited studies, because of ME research's unjustified assertions of deconditioning and often totally inadequate evaluation of exercise interventions, I feel wary of taking these assertions at face value.

The current medical belief that exercise is a universal panacea, may 'all things being equal' be a justified assumption, but it should not be allowed to be an excuse for assuming that exercise is always appropriate even when 'all things are not equal'.