Strand, Elin B, Nacul, Luis, Mengshoel, Anne Marit et al. · PloS one · 2019 · DOI
This study looked at how ME/CFS is diagnosed and treated across 17 European countries by surveying doctors and health organizations. The researchers found that different countries use different diagnostic tests and treatment approaches, with no standard way of doing things across Europe. The study shows that there is confusion and inconsistency in how ME/CFS patients are evaluated and cared for, which suggests that Europe needs to agree on common guidelines.
This research reveals significant gaps in ME/CFS care standardization across Europe, which directly affects patients by creating uncertainty about whether they receive evidence-based, consistent care. The findings highlight an urgent need for harmonized diagnostic and treatment guidelines, which could improve diagnosis rates, reduce diagnostic delays, and ensure more equitable access to appropriate management strategies. This study provides evidence supporting calls for coordinated European healthcare policy on ME/CFS.
This survey does not evaluate the effectiveness or superiority of any particular diagnostic criteria or treatment approach—it only describes what is currently being used. The study does not establish whether countries with guidelines have better patient outcomes than those without them. It also does not prove that harmonization alone would improve patient care; implementation quality and resources would also be critical factors.
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
Strand, Elin B, Nacul, Luis, Mengshoel, Anne Marit, Helland, Ingrid B, Grabowski, Patricia, Krumina, Angelika, et al. (2019). Myalgic encephalomyelitis/chronic fatigue Syndrome (ME/CFS): Investigating care practices pointed out to disparities in diagnosis and treatment across European Union.. PloS one. https://doi.org/10.1371/journal.pone.0225995
BibTeX
@article{mecfsatlas-strand-2019-myalgic-encephalomyelitis,
author = {Strand, Elin B and Nacul, Luis and Mengshoel, Anne Marit and Helland, Ingrid B and Grabowski, Patricia and Krumina, Angelika and Alegre-Martin, Jose and Efrim-Budisteanu, Magdalena and Sekulic, Slobodan and Pheby, Derek and Sakkas, Giorgos K and Sirbu, Carmen Adella and Authier, F Jerome and European Network on ME/CFS (EUROMENE)},
title = {Myalgic encephalomyelitis/chronic fatigue Syndrome (ME/CFS): Investigating care practices pointed out to disparities in diagnosis and treatment across European Union.},
journal = {PloS one},
year = {2019},
doi = {10.1371/journal.pone.0225995},
note = {PubMed: 31805176},
url = {https://www.mecfsatlas.com/evidence/strand-2019-myalgic-encephalomyelitis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/strand-2019-myalgic-encephalomyelitis
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