Gladwell, Peter William, Pheby, Derek, Rodriguez, Tristana et al. · Disability and rehabilitation · 2014 · DOI
This study asked 76 people with ME/CFS about their experiences with rehabilitation therapies like graded exercise. Researchers found that people had both positive and negative experiences. Good experiences happened when therapists communicated well, helped patients set realistic goals, and worked at a sustainable pace. Bad experiences occurred when therapists pushed patients too hard, didn't listen to their concerns, or blamed patients when symptoms got worse.
This study bridges the gap between clinical trials showing GET can help and patient reports of harm, suggesting the problem may lie in how therapy is delivered rather than the approach itself. Understanding what makes rehabilitation experiences positive or negative helps patients, clinicians, and trainers improve care quality. The findings support need for better therapist training and quality standards specific to ME/CFS management.
This study does not prove that GET itself is ineffective—only that poor implementation can harm patients. It cannot establish causation between specific therapist behaviors and clinical outcomes, as it relies on patient recall and perception rather than objective outcome measures. The findings are not generalizable to all rehabilitation programs, as this represents experiences of survey respondents who may differ systematically from the broader ME/CFS population.
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
Gladwell, Peter William, Pheby, Derek, Rodriguez, Tristana, & Poland, Fiona (2014). Use of an online survey to explore positive and negative outcomes of rehabilitation for people with CFS/ME.. Disability and rehabilitation. https://doi.org/10.3109/09638288.2013.797508
BibTeX
@article{mecfsatlas-gladwell-2014-use-online,
author = {Gladwell, Peter William and Pheby, Derek and Rodriguez, Tristana and Poland, Fiona},
title = {Use of an online survey to explore positive and negative outcomes of rehabilitation for people with CFS/ME.},
journal = {Disability and rehabilitation},
year = {2014},
doi = {10.3109/09638288.2013.797508},
note = {PubMed: 23735013},
url = {https://www.mecfsatlas.com/evidence/gladwell-2014-use-online},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/gladwell-2014-use-online
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