Journal of clinical medicineApr 14, 2026

Testing a Personalized Treatment for Nervous System Problems in Patients with Dizziness and Chronic Fatigue or Long COVID

Updated Apr 15, 2026

Abstract

The COMPASS-31 symptom score improved by 7.7 points over 8 weeks in patients with ME/CFS and Long COVID participating in a personalized Dysautonomia Management Protocol.

Sixteen participants completed the 8-week program, while five discontinued and one was withdrawn due to a severe crash.
A non-significant improvement of 2 points was observed in the Yorkshire Rehabilitation Scale symptom severity score over the same period.
Mean heart rate during the Lean Test decreased by 4.8 beats per minute from the first two weeks to the final two weeks of the program.
Adherence to the four intervention recommendations varied widely among participants, with none fully implementing all strategies.
The findings suggest that targeted conservative interventions may have an impact on autonomic function and symptom reduction, although changes were limited.

Simplified

: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID (LC) are complex multisystem conditions with significant functional disability. Many patients experience symptoms of orthostatic intolerance, which can be captured in some cases as Orthostatic Hypotension (OH) or Postural orthostatic Tachycardia Syndrome (PoTS) on objective testing. Conservative treatments are recommended for first-line symptom management, but there is a lack of efficacy evidence. This study aims to assess the feasibility of an 8-week clinically supervised, personalised Dysautonomia Management Protocol (DMP) in a cohort of ME/CFS and LC patients with subjective and objective evidence of orthostatic intolerance (dysautonomia).: ME/CFS and LC patients with objective dysautonomia on the 10 min active Lean Test (LT) were recruited to an 8-week DMP, with interventions introduced cumulatively every two weeks. Interventions included increasing daily fluid intake to 3 litres and salt intake to 10 g, pacing to avoid crashes and calf activation. Baseline and weekly data collection included the LT, Composite Autonomic Symptom Score questionnaire (COMPASS-31) and Yorkshire Rehabilitation Scale (YRS).: Sixteen participants completed the 8-week program, five discontinued during the program, and one was withdrawn following a severe crash. The COMPASS-31 improved by 7.7 points from week 1 to week 8 (= 0.045), with a medium Cohen's d effect size of 0.55. For the same period, there was a non-significant (= 0.16) improvement in the YRS symptom severity score by 2 points. Comparing the final two weeks of the program with the first two weeks, mean heart rate during the LT decreased by 4.8 beats per minute (= 0.032), with a medium Cohen's d effect size of 0.44. Adherence to the interventions was highly variable, with none of the patients able to fully employ all four recommendations.: The results suggest that targeted conservative interventions could influence autonomic function and symptom reduction. However, the magnitude of change was limited, and statistical significance might not necessarily relate to a clinically significant improvement in symptoms. Background/Objectives Methods Results Conclusions p p p

Funding

Competing interests

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

PubMed

Testing a Personalized Treatment for Nervous System Problems in Patients with Dizziness and Chronic Fatigue or Long COVID

Abstract

Funding

Competing interests

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Abstract

Funding

Competing interests

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