Barr, Julia, Marsden, Lowri, Dassanayake, Theshan et al. · Journal of clinical medicine · 2026 · DOI
This observational study tested whether a personalised 8-week management plan (involving increased fluid and salt intake, pacing strategies, and calf exercises) was feasible and associated with symptom changes in 22 people with ME/CFS or Long COVID who experienced orthostatic intolerance. Reported improvements were modest: autonomic symptom scores improved by 7.7 points, and heart rate response during a standing test decreased slightly; however, adherence was highly variable, and the authors note that statistical improvements may not reflect clinically meaningful symptom relief. The study remains preliminary and cannot establish whether this protocol is an effective treatment.
Dysautonomia (including orthostatic intolerance and PoTS-like features) is reported in a substantial proportion of people with ME/CFS and Long COVID, yet conservative first-line treatments lack robust evidence. By analogy, understanding whether structured management of dysautonomia may be associated with symptom or autonomic function changes is relevant to ME/CFS care pathways, even though this study enrolled a mixed ME/CFS and Long COVID population and observed only modest associations.
This observational design with no control group does not establish that the DMP causes symptom improvement or that any particular intervention component was responsible for the observed associations. The heterogeneous cohort (ME/CFS and Long COVID combined), high drop-out rate (28%), variable adherence, and small final sample (n=16) limit generalisation. The study does not demonstrate that the protocol is an effective treatment, only that modest changes in some measures were observed during the 8-week period.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Barr, Julia, Marsden, Lowri, Dassanayake, Theshan, Almutairi, Norah, McKeever, Vikki, Gaber, Tarek, et al. (2026). Testing a Personalised Dysautonomia Management Protocol in Patients with Orthostatic Intolerance and a Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome or Long COVID.. Journal of clinical medicine. https://doi.org/10.3390/jcm15072510
BibTeX
@article{mecfsatlas-barr-2026-testing-personalised,
author = {Barr, Julia and Marsden, Lowri and Dassanayake, Theshan and Almutairi, Norah and McKeever, Vikki and Gaber, Tarek and Tarrant, Rachel and Godfrey, Belinda and Witton, Sharon and Sivan, Manoj},
title = {Testing a Personalised Dysautonomia Management Protocol in Patients with Orthostatic Intolerance and a Diagnosis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome or Long COVID.},
journal = {Journal of clinical medicine},
year = {2026},
doi = {10.3390/jcm15072510},
note = {PubMed: 41976810},
url = {https://www.mecfsatlas.com/evidence/barr-2026-testing-personalised},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/barr-2026-testing-personalised
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