Vink, Mark, Vink-Niese, Alexandra · Diseases (Basel, Switzerland) · 2023 · DOI
This study examined whether a German health institute's recommendation for graded exercise therapy (GET) and cognitive behavioral therapy (CBT) to treat ME/CFS was supported by good evidence. The researchers found serious problems with the studies being used to make this recommendation, including weak study designs, reliance on patient reports rather than objective measurements, and inclusion of people who may not have had ME/CFS. They concluded these treatments should not be recommended based on the available evidence.
This analysis is critical for ME/CFS patients because it demonstrates that major health policy recommendations may be based on flawed evidence, potentially leading to harm if patients pursue treatments that have not been proven safe or effective. Understanding the quality of evidence underlying clinical guidelines helps patients and clinicians make informed decisions and highlights the need for rigorous research meeting modern methodological standards.
This critique does not prove that GET and CBT are ineffective for all patients or in all contexts, only that the specific evidence IQWiG cited contains significant methodological limitations. It does not establish what treatments would be effective alternatives for ME/CFS, nor does it definitively rule out potential benefit in specific patient subgroups, though it does suggest current evidence cannot support such claims.
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
Vink, Mark & Vink-Niese, Alexandra (2023). The Draft Report by the Institute for Quality and Efficiency in Healthcare Does Not Provide Any Evidence That Graded Exercise Therapy and Cognitive Behavioral Therapy Are Safe and Effective Treatments for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.. Diseases (Basel, Switzerland). https://doi.org/10.3390/diseases11010011
BibTeX
@article{mecfsatlas-vink-2023-draft-report,
author = {Vink, Mark and Vink-Niese, Alexandra},
title = {The Draft Report by the Institute for Quality and Efficiency in Healthcare Does Not Provide Any Evidence That Graded Exercise Therapy and Cognitive Behavioral Therapy Are Safe and Effective Treatments for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.},
journal = {Diseases (Basel, Switzerland)},
year = {2023},
doi = {10.3390/diseases11010011},
note = {PubMed: 36648876},
url = {https://www.mecfsatlas.com/evidence/vink-2023-draft-report},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/vink-2023-draft-report
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