Online vs Offline Managment


An integral part of effectively dealing with a chronic illness is acquiring the knowledge needed to be able to change unhealthy behaviors while developing and adhering to an individualized treatment plan. Until recent years, knowledge sharing and learning about chronic diseases was largely limited to pamphlets or books.  Ongoing management efforts were difficult and largely dependent upon doctors restricted by limited time and abilities to interact with the patient on a frequent basis. The lack of systems available for ongoing management of chronic illnesses has traditionally made consistent implementation of knowledge gained and targeted treatment regimens very difficult to maintain.

Over the past decade, the Internet has exploded as a source of comprehensive medical information for those fighting chronic disease. The ability to rapidly gain broad knowledge about particular medical problems and research individual treatment approaches has fundamentally changed how those suffering from chronic illness can approach treatment and management. The medical research community is aware of the impact the internet is having on treatment approaches enabled by the internet.

A recent study at The University of California compared the effectiveness of web-based interventions with offline interventions.1 This study did not deal with Fibromyalgia exclusively,  but with a host of chronic health conditions for which self-care management initiatives have been proven effective.

The specific purpose of this study was to provide more information on patient knowledge and behavioral outcomes after web-based interventions as compared to outcomes after the implementation of non-web-based interventions. Authoritative medical databases were searched for relevant research study citations between the years 1996 and 2003.  Twenty-two research studies were chosen for analysis.

A group of 11,754 participants was used in the studies. 5,841 of the participants were women and 5,729 were men. The average age of all participants was 41.5 years. Time spent per web-based research was studied along with the number of logon sessions per week per person. Offline intervention programs were compared. The health outcomes of the web-based participants were compared to the health outcomes of the non-web-based participants. Results were obtained using various study algorithms.

Individuals who visited websites that directed them to relevant tailored material stayed on these websites longer, and they visited these sites more often.  When the site incorporated the use of a chat room or forums, the study noted increased social support scores. Having social support for chronic illnesses has been shown to lead to higher treatment intervention compliance rates and overall better health outcomes.

The results of the study clearly proved there was an increased improvement in the health of the individuals who used the web-based interventions. The health outcomes obtained with the web-based interventions included increased exercise time, increased knowledge of nutritional status, increased knowledge of asthma treatment, and increased participation in healthcare. It also showed a slower health decline, improved body shape perception and an 18-month weight loss maintenance. Therefore, this evidence points to the fact that web-based interventions will help the patient make and maintain positive changes to improve their health.

There are many advantages to using a web-based application to manage chronic diseases. There have been a number of online applications developed for the management of Diabetes which have demonstrated measurable improvements over traditional management efforts.

The biggest advantage is that the online application can be interactive in nature allowing the individual user to setup and manage the application in a targeted manner. Compared to a book or an audio / video recording, which can present knowledge in fixed format only, an online application can provide feedback and analysis of user provided data. This creates the ability for an online application to function as a “smart” management system that can facilitate the patient applying a scientific approach to building and managing an individual treatment program.

This study proved that when an individual is enabled to participate in self-managing their chronic illness, they are more likely to adhere to treatment regimens, and they have better results. Web-based programs now have the capability to provide interactive and on-demand health monitoring. These programs can provide immediate feedback along with information exchange that will help the patient understand their disease better and also make the necessary adjustments in their daily life that will improve their health. You cannot easily do this with paper or traditional off-line health interventions. A book can be great for telling you about how behavior modifications and self guided treatment efforts can be of benefit but a book is not very effective in facilitating an ongoing daily process of managing such efforts!

What does this mean for individuals living with Fibromyalgia? It simply means a web-based patient directed and customized health management program can be more beneficial than traditional offline methods of treatment.


1.  The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes.

Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM.

Department of Community Health Systems, University of California, San Francisco, N531M, School of Nursing, San Francisco CA 94143, USA.

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