Something I missed happening in Quebec. I know there is at least one other user from here.
INESSS, as far as I know the equivalent of NICE for Quebec (health is a provincial authority so we have 10 such authorities) has published a guideline in April 2023. From memory, it's probably around the time they published a similar one for Long Covid, although it makes no references to LC. It's very light on the infectious nature/trigger, however.
There is a currently ongoing consultation by INESSS, the body in charge of medical guidelines and recommandations. It's about clinical management of ME/CFS and currently has 3 surveys. It asks questions about those few recent publications.
Il y a présentement une consultation menée par l'INESSS, l'authorité en charge des recommandations cliniques. Pour l'instant il y a 3 sondages, sur les documents publiés cette année.
Main page with document links and surveys / page principale du projet avec liens sur les documents en sondages:
THE MANAGEMENT OF MYALGIC ENCEPHALOMYELITIS / CHRONIC FATIGUE SYNDROME
PRISE EN CHARGE DE L’ENCÉPHALOMYÉLITE MYALGIQUE / SYNDROME DE FATIGUE CHRONIQUE
French only:
Rapport en soutien à l’outil d’aide à la prise en charge et à l’aide-mémoire sur le soutien offrir aux personnes atteintes (Report supporting the management support tool and annexes on support offered to patients)
The main document for GPs:
Management support tool - Myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS)
Outil d'aide à la prise en charge - Encéphalomyélite myalgique/ Syndrome de fatigue (EM / SFC)
Some highlights from "Management support tool - Myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS)":
Æ Myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS):
· is a chronic and complex condition for which there is no diagnostic test and no
known cure.
· is a physical disease whose cause remains uncertain.
· can affect anyone regardless of age, gender, ethnicity or social status. Women are
more affected as well as adults between the ages of 30 and 60.
Æ The clinical presentation is variable and functional independence may be affected
to different degrees - e.g., the person could:
· be able to perform activities of daily living (ADLs - e.g., feeding, dressing, hygiene)
and instrumental activities of daily living (IADLs - e.g., cleaning, meal preparation,
shopping), but require accommodations to study or work;
· requiring assistance with ADLs and IADLs and being unable to study or work;
· depend on others for ADLs and unable to perform IADLs, study or work.
Æ Periods of remission may occur for varying lengths of time, but complete remissions
would rarely be observed.
ME / CFS may be suspected in a person presenting an atypical constellation of
multisystem clinical manifestations lasting ≥ 6 weeks.
Management of the individual should be initiated as soon as ME / CFS is
suspected, even if the diagnosis is not confirmed, to promote stabilization of the
condition and help prevent deterioration.
Children with suspected ME / CFS should be referred to a pediatrician.
Æ ME / CFS is the health status of a person who meets the following conditions:
1. Presence of the 4 following clinical manifestations:
- Asthenia1;
- Post-exertional malaise2;
- Cognitive difficulties;
- Non-restorative sleep or sleep disturbances.
2. Existence of clinical manifestations for ≥ 24 weeks on a continuous basis or not.
3. No other condition can explain the entire clinical picture.
1. Asthenia is an intense fatigue that results in a significant reduction in the ability to perform ADLs and IADLs.
2. Post-exertional malaise refers to the appearance or aggravation of a group of clinical manifestations that occur
following even minimal effort, whether physical, cognitive or emotional.
(ADL is activities of daily living)
...
The intensity of the manifestations may change during the day, from day to day and over the course of the illness.
· People with ME / CFS usually wait until they are well enough to seek primary care. Their symptoms may therefore
be more severe than they appear.
Æ The manifestations can be present continuously or episodically.
Æ The onset or worsening of manifestations is not always predictable. It may be due to a change in position (e.g., from
lying to sitting or standing, from sitting to standing), an episode of post-exertional malaise, a stress (physical, cognitive or emotional) or the perimenstrual period.
The person should not be encouraged to exceed personal limits or engage in activities to increase strength or endurance.
Activity programs, physical or cognitive exercise programs, or interventions with fixed or continuously increasing duration and intensity parameters should not be implemented.
There is a 168 pages annex (in French only but lots of the evidence being in English it quotes them directly) with supporting evidence. It quotes the 2021 NICE guidelines quite extensively, 171 references in total. Overall this looks like a pretty good effort.
Annexes - Prise en charge de l’encéphalomyélite myalgique/syndrome de fatigue chronique
they have never seen a Canadian GP apparently.
