‘Make sure apps have a solid research foundation and support is provided to initiate and perpetuate engagement. Otherwise, it’s just another app that sits in the graveyard of apps on our phones,’ says Dr Julie Denning, Working To Wellbeing
Musculoskeletal (MSK) problems account for two fifths (40%) of all sickness absence, which in many cases become long-term absences. And that is based on data from last year. It is widely predicted that the prevalence of MSK issues will have increased during lockdown as a result of makeshift desk and seating arrangements.
So, while NICE currently consults on the assessment and management of chronic pain in the over 16s and we see new apps entering the market all the time (read here for the latest), COVER has spoken to two practitioners to gain their views on what works and what doesn't; and whether digital health technology is the answer to more widespread and inclusive support in the workplace, via either standalone means or as part of added value services.
Dr Julie Denning, managing director, Working To Wellbeing (W2W)
Digital health technology is an expanding marketplace. Apps represent an affordable way for employers to provide information and guidance to a large workforce. There are numerous options available for use within the public domain and provided as part of employee benefit packages.
it's important that apps are considered as part of a health programme, not in replacement of it
We would expect to see expansion in this space and call for strong research evidence supporting their implementation. Apps can be very beneficial and have their place within health interventions.
For example, at W2W we use them to understand initial baseline activity such as step count and then can help people to increase their walking activity using the app as a monitor. This can reinforce the benefits of behaviour change and supports graded exercise.
Apps can be very beneficial in the short term to help people to get going with activity and when used in conjunction with a health coach can be very powerful intervention tools.
However, in the longer term, without the embedding of the deeper rationale for why the change is important to the individual, exercise engagement may diminish.
In our opinion it is important that apps are considered as part of a health programme not in replacement of it. This is particularly important in the context of longer term conditions where there is more complexity of need, greater likelihood of boom/bust behaviour and where self-management is more challenging to do alone. In this space, ongoing support plus an app is a necessity.
When employers are considering buying apps as part of their employee benefits package our advice would be to ensure that the app has a solid research foundation and support is provided to initiate and perpetuate engagement. Otherwise, it's just another app that sits in the graveyard of apps on our phones.
Working To Wellbeing is an organisation that designs and delivers workplace wellbeing services, offering support from cancer and chronic illness to critical illness and mental health.
Beverly Knops, executive manager and specialist occupational therapist, Vitality360
We're seeing more apps and online platforms entering the market, with a view to helping people improve their physical fitness and manage chronic pain. Speaking as a practitioner for Vitrality360, I'd suggest this might work for some, but shouldn't be considered a catch-all solution as part of an employee benefit package.
The most effective programmes are those that involve a comprehensive assessment completed by a pain specialist followed by a bespoke programme. For certain individuals this programme could be an app based one. Some thrive on this way of learning new information and developing new skills. They can do it privately in their own time and at their own pace. However, it's not for everyone.
An easy way of looking at this would be to consider the use of an activity tracker, a very common way of measuring steps.
- Some people thrive on this, use it to monitor their steps and set realistic targets to increase their fitness.
- Others can become very competitive with self or others and push to achieve more and more steps, perhaps at a pace that is too quick.
- Others set a goal and try and stick to the same number of steps every day - some are happy if they achieve this, some beat themselves up if they do not, some become anxious if they go beyond their daily goal for fear of increasing pain or fatigue. I have known people with fatigue and pain where this anxiety has become a barrier to progression. And I have advised them to stop wearing the tracker.
- Many start using activity trackers with great enthusiasm. But give up within days or weeks.
Activity trackers that measure sleep can give some valuable information and help to sensibly change behaviours to improve sleep. Others will use it to add evidence to the fact that they are not getting sufficient sleep, which could lead to added anxiety about this and a sense of helplessness regarding how to change the situation.
In my experience, apps are useful for some people as part of a management plan. Many people I work with use apps like headspace, calm, curable as one of many management strategies. In other words, as part of a more comprehensive treatment plan.
As a therapist of 32 years, I think the most important skill I have developed is to truly listen to my clients and only then formulate their treatment programme. I am not convinced AI has the ability to do this yet.
Vitality360 is a specialist provider of rehabilitation programmes for people with persistent pain and fatigue.
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