Background: Personal health informatics have the potential to help patients discover personalized health management strategies that influence outcomes. Fibromyalgia (FM) is a complex chronic illness requiring individualized strategies that may be informed by analysis of personal health informatics data. An online health diary program with dynamic feedback was developed to assist patients with FM in identifying symptom management strategies that predict their personal outcomes, and found reduced symptom levels associated with program use.
Objective: The aim of this study was to determine longitudinal associations between program use and functional impact of FM as measured by scores on a standardized assessment instrument, the Fibromyalgia Impact Questionnaire (FIQ).
Methods: Participants were self-identified as diagnosed with FM and recruited via online FM advocacy websites. Participants used an online health diary program ("SMARTLog") to report symptom ratings, behaviors, and management strategies used. Based on single-subject analysis of the accumulated data over time, individualized recommendations ("SMARTProfile") were then provided by the automated feedback program. Indices of program use comprised of cumulative numbers of SMARTLogs completed and SMARTProfiles received. Participants included in this analysis met a priori criteria of sufficient program use to generate SMARTProfiles (ie, ≥22 SMARTLogs completed). Users completed the FIQ at baseline and again each subsequent month of program use as follow-up data for analysis. Kendall tau-b, a nonparametric statistic that measures both the strength and direction of an ordinal association between two repeated measured variables, was computed between all included FIQ scores and both indices of program use for each subject at the time of each completed FIQ.
Results: A total of 76 users met the a priori use criteria. The mean baseline FIQ score was 61.6 (SD 14.7). There were 342 FIQ scores generated for longitudinal analysis via Kendall tau-b. Statistically significant inverse associations were found over time between FIQ scores and (1) the cumulative number of SMARTLogs completed (tau-b=-0.135, P<.001); and (2) the cumulative number of SMARTProfiles received (tau-b=-0.133, P<.001). Users who completed 61 or more SMARTLogs had mean follow-up scores of 49.9 (n=25, 33% of the sample), an 18.9% drop in FM impact. Users who generated 11 or more new SMARTProfiles had mean follow-up scores of 51.8 (n=23, 30% of the sample), a 15.9% drop.
Trial registration: ClinicalTrials.gov NCT02515552; https://clinicaltrials.gov/ct2/show/NCT02515552.
Keywords: fibromyalgia; fibromyalgia impact; functional status; health diary; health informatics; personalized medicine; predictive analytics; symptom reduction.
©William Collinge, Robert Soltysik, Paul Yarnold. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.04.2020.
Conflict of interest statement
Conflicts of Interest: The authors are co-owners of the AwareHealth program.
Evaluation of patient-rated stiffness associated with fibromyalgia: a post-hoc analysis of 4 pooled, randomized clinical trials of duloxetine.Clin Ther. 2012 Apr;34(4):824-37. doi: 10.1016/j.clinthera.2012.02.013. Epub 2012 Mar 14. Clin Ther. 2012. PMID: 22421576
Validation of a Finnish version of the Fibromyalgia Impact Questionnaire (Finn-FIQ).Scand J Pain. 2012 Jan 1;3(1):15-20. doi: 10.1016/j.sjpain.2011.10.004. Scand J Pain. 2012. PMID: 29913759
Evaluation of the fibromyalgia impact questionnaire at baseline as a predictor for time to pain improvement in two clinical trials of pregabalin.Int J Clin Pract. 2013 Jan;67(1):52-9. doi: 10.1111/ijcp.12035. Int J Clin Pract. 2013. PMID: 23241048
Resistance exercise training for fibromyalgia.Cochrane Database Syst Rev. 2013 Dec 20;2013(12):CD010884. doi: 10.1002/14651858.CD010884. Cochrane Database Syst Rev. 2013. PMID: 24362925 Free PMC article. Review.
Whole body vibration exercise training for fibromyalgia.Cochrane Database Syst Rev. 2017 Sep 26;9(9):CD011755. doi: 10.1002/14651858.CD011755.pub2. Cochrane Database Syst Rev. 2017. PMID: 28950401 Free PMC article. Review.
- Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S154–62. - PubMed
- Collinge W. ClinicalTrials.gov. 2015. Aug 04, [2019-08-01]. Web-based program for symptom management in fibromyalgia https://clinicaltrials.gov/ct2/show/NCT02515552.