Between baseline and 12 months , the mean ( SD ) within-group difference in POEM score in patients in the direct-access online group was -5.1 ( 5.48 ) ( 95 % CI , -6.32 to -3.88 ) ; in the in-person group , the within-group difference was -4.86 ( 4.87 ) ( 95 % CI , -6.27 to -3.46 ) .