If you have a chronic illness and are linked to the Internet, you likely use it on a regular basis. The Internet presents a number of options to you from keeping abreast of new findings with your conditions to reading about the side effects of any newly prescribed drugs. But, there are many other possible uses for the Internet, including its use in teaching you self-management skills. The small-group Chronic Disease Self-Management Program (CDSMP), developed by Kate Lorig and her colleagues at Stanford University, has proven effective in changing health-related behaviors and improving health statuses. It has been effective not only throughout the U.S., but in China and the Netherlands.

Recently, Internet-based self-management programs have been developed to reach a greater numbr of chronic-disease patients. The efficacy of the Internet-based CDSMP was tested in a study conducted by Kate and her colleagues by comparing randomized intervention participants using the Internet with usual-care controls at 1 year. Nine hundred and fifty-eight patients with chronic diseases (heart, lung, or type 2 diabetes) were randomly assigned to the CDSMP, plus Internet and e-mail access, intervention (457) or usual care control (501). Outcome measures included seven health status variables (pain, shortness of breath, fatigue, illness intrusiveness, health distress, disability, and self-reported global health), four health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians), and three utilization variables (physician visits, emergency room visits, and nights in hospital), and self-efficacy.

The investigators found that at one year, the intervention group had significant improvements in health statuses compared with usual care control patients. The intervention group also had similar results to the small-group CDSMP participants. Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year.

COMMENTS: Lorig and her coworkers concluded that the Internet-based CDSMP proved effective in improving health statutes by one year, and was a viable alternative to the small-group Chronic Disease Self Management Program. This could prove to be an invaluable study. The CDSMP has, as noted, has amassed solid data as to the effectiveness of the program. Teaching self-management via the Internet, however, greatly expands the possibility that others throughout the world can be taught these skills to help manage their chronic condition.

K.R. Lorig et al. Internet-based chronic disease self-management: a randomized trial. Medical Care, 2006;44:964-971.