I have been thinking a lot about the evidence base for ME/CFS management. There are some good negative studies but a positive evidence base is hard to find, as we know. At the NICE scoping meetings there was a consensus that what could be justified in the current situation was more ongoing supportive care and diagnostic review, rather than short term efforts at rehabilitation. So I started looking around for the evidence base for specific recommendations for supportive care - in particular for severe bed bound cases. So far I have not even really found any specific recommendations, just an acknowledgement that support is needed. Which makes me think that we really ought to know what in practice helps to keep people functioning, and maybe even aid improvement or protect against worsening. We should have trials looking at a series of slightly different ways of providing support to see which if any is the most helpful. Of course the problems of unblinded comparisons would be present but if the comparisons are not theory laden and merely differ in practical procedures that are theory neutral and the endpoints are underpinned with objective measures then the prospect of a meaningful answer would not be too distant. So I am floating the idea that there ought to be some theory neutral trials of long term support for severe cases. I am also interested in what people have found to work. In particular I would be interested to know what the supportive care was during a period when someone was fortunate enough to rise up out of a severe phase and function at a moderate level. I guess that the responses to this might be endless but I am particularly interested in plans for daily routines that can fairly easily be defined as potential alternative ingredients. An obvious one would be regulating sleep and wake times and so on.