Join me for an exciting presentation on MS wellness apps at the MS Trust Conference! I am sharing my slides with the public, discussing the latest apps that can help individuals living with MS improve their physical and mental health. From exercise tracking to stress management tools, there are many wellness apps available that can help you live your best life with MS. Don't miss out on this opportunity to learn more and enhance your wellness journey. Check out my slides and let's explore the world of MS wellness apps together! #MSawareness #MSwellnessapps #MSTconference2023 #mstrust"

1. Wellness apps in MS
Dr Agne Straukiene
Torbay and South Devon NHS Foundation Trust
Photo by NordWood Themes on Unsplash
Our digital partners:

2. What is wellness and healthy lifestyle?

3. Pillars of healthy living
Diet Exercises Meditation Positive
psychology
Social
Connection
Self management Spiritual/Religion Independence Healthy aging Art and music

4. Why are we
discussing about
MS apps?
What are MS apps
available?
What are health
benefits for using
apps?
Integration of
apps into EHR and
call for action
Real world
examples and
users shared
experience
Setting the Stage: A Preview
of Today's Presentation on
Wellness apps in MS:

5. How Patients' Expectations Meet Reality: The Downside of Documenting Problems
on Paper

6. Walton C, King R, Rechtman L, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Multiple Sclerosis Journal. 2020;26(14):1816-
1821. doi:10.1177/1352458520970841
The Global Impact of Multiple Sclerosis: A Disease That Robs People of
Their Ability to Live Life to the Fullest Photo by Annie Spratt on Unsplash

7. Have you ever recommended an app to a patient before?
• A)Yes;
• B)No;
• C)I am a patient and I use apps for MS management;
• D)I am a patient and I don’t use apps for MS.

8. Revolutionizing MS Patient Wellbeing: A Look at the Top-Ranked Apps and Their Impact
Tracking your health - Momentum Magazine (momentummagazineonline.com)

9. Exploring the Features and Functions of Multiple Sclerosis Apps: An Overview
Salimzadeh Z, Damanabi S, Kalankesh LR, Ferdousi R. Mobile Applications for Multiple Sclerosis: a Focus on Self-Management.
Acta Inform Med. 2019 Mar;27(1):12-18. doi: 10.5455/aim.2019.27.12-18. PMID: 31213737; PMCID: PMC6511265.

10. Unlocking the Potential: Evidence-Based Benefits of Mobile Health Apps in Improving Quality of Life for Multiple
Sclerosis Patients
Make a big impact on people with MS wellbeing
Better Symptom
management
Improvements in fatigue,
depression, and anxiety over a six-
week period
Increase patient
engagement
In their own care by providing personalized
feedback, education, and social support. This
can lead to improved self-efficacy and
empowerment.
Improves
adherence to
treatment
Reminders to take medication and
track symptoms
Challenges of MS
app
Limited access to tech, privacy
concerns, limited upper limb
function, cognitive issues, visual
problems, lack of evidence based
content
Graetz, C., Gold, S. M., & Heesen, C. (2018). A systematic review of evidence-based MS mobile applications: Potential benefits and current challenges. Neurology Research International, 2018. doi: 10.1155/2018/8609482
Bayas A, Ouallet JC, Kallmann B, Hupperts R, Fulda U, Marhardt K; SMART study group. Adherence to, and effectiveness of, subcutaneous interferon β-1a administered by RebiSmart® in patients with relapsing multiple sclerosis: results of the 1-year, observational SMART
study. Expert Opin Drug Deliv. 2015 Aug;12(8):1239-50. doi: 10.1517/17425247.2015.1057567. Epub 2015 Jun 22. PMID: 26098143.

11. From Challenge to Opportunity: Digital Successes at Torbay MS Service
MS connect plus
app
Education and self
management enhancer
BeewellwithMS
podcasts
Making small steps
for big changes to
preserve brain
health for pwMS.
MS Patients Know
Best (MS PKB)
Patients self lead platform
Virtual reality MS
clinics
Care closer to patients home.
MS Infoflex
database
HCP lead
management
platform/ MS
Tracker

12. Exploring Patient Engagement with Mobile Connect plus app :
Saves my consultation time
by ~ 15min
Co- designed by Dr Agne Straukiene and HCI

13. Patient Feedback and Evaluation of MS Connect Plus App: Insights and Learnings :
Torbay data, HCI dashboard

14. Empowering MS Patients: The Transformative Potential of Wellness Apps in
Improving Quality of Life
• CONNECTPlus App: MS Case Study | Health and Care Innovations (hci.digital) play video from 2.32 min

15. Have you seen any improvements in patient outcomes as a result of using MS apps?
• A)Yes;
• B)No;
• C)I have no idea what my patients are doing for their self care and MS app activity wise.

16. Navigating the Challenges of Integrating Digital Tools into Healthcare
Systems:

17. Navigating the Challenges of Integrating Digital Tools into Healthcare
Systems:

18. 1. Wearable devices
These devices can track various health metrics,
such as heart rate, sleep patterns, and activity
levels, and provide users with feedback and
insights on their health
2. Telemedicine
Video conferencing or other digital
communication tools. This can be especially
helpful for individuals with chronic conditions
who need to monitor their health regularly.
3. EHR
Allow patients to access and manage their own
health information, including lab results,
medication lists, and appointment schedules
4. Online support groups
Online support groups can provide a sense
of community and support for individuals
who are dealing with similar health
challenges.
5. Digital health coaching
Digital health coaching uses technology to provide
personalized guidance and support for individuals
who are looking to make lifestyle changes or
manage their health.
6. Wellness MS apps
Help individuals track their health metrics,
manage medications, and access health
resources.
7. Virtual reality
Virtual reality can be used to provide immersive
experiences that promote relaxation, stress
reduction, and pain management, assessment
measures.
01
02
03
04
05
06
07
Unlocking the Full Potential of Wellness for MS Patients in the
digital space:

19. Linking MS Connect plus app to HCP-led MS database ( MS
Infoflex)

20. Empowering MS Patients with Remote Self-Management: Introducing MSPKB
(MS Patients Know Best) software

21. MS PKB- self management platform log in activity- MS PKB Dashboard:

22. Voices of MS Patients: Feedback and Reviews of the
MS PKB software:
Torbay, survey results 2021

23. Access to patients data in real-time, enabling HCP to provide more personalised care
and support to MS patients ( MS infoflex database- Torbay)

24. Individual Patient profile- MS Infoflex database
* YourMS (patient version) and Prodiscuss (HCP version) is algorithm defining early signs of MS progression

25. Revolutionising MS Care: Using Predictive Modelling and Traffic Light System to Identify
Early Signs of Worsening with Prodiscuss algorithm on MS Infoflex Database
Validated Scoring system of MS symptoms ( vision, balance, motor skills, ambulation, daily
living etc):
EDSS score included
Green >=46
Amber >46 and <58
Red >=58
This algorithm helps to predict who is at most risk and require more
input in the OPD setting/ better symptom/ comorbidities management
and prevention

26. Using Traffic Colour to Predict Healthcare Resource Utilization in MS
Patients Care Plan:
0
200
400
600
800
1000
1200
1400
1600
1800
2021/2022
Green Amber Red
~ 50%
Torbay MS, real world data from MS infoflex database
N - 659

27. Eating Habits in a New Light: Predicting Diet Behaviours with
Traffic Light Colours:
40
4
8
162
Diets by Pro-discuss score
Red - Unhealthy Amber - Unhealthy Green - Unhealthy Healthy
N =214 (52 unhealthy, 162 healthy diet)
Torbay MS, real world data from MS infoflex database
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Red - Unhealthy Amber - Unhealthy Green - Unhealthy
Percentage of Patients eating Processed
Food
Processed/Ready Meals/Unhealthy Healthy

28. MS Diagnosis Delayed: A Costly Burden on the NHS
0 20 40 60 80 100 120
0-2 years
3-5 years
6-10 years
11-15 years
16-20 years
21-25 years
Over 25 years
Years Till Offical Diagnosis
Red Total Amber Total Green Total
0
20
40
60
80
100
120
0-2 years 3-5 years 6-10 years 11-15 years 16-20 years 21-25 years Over 25 years
Years Till Offical Diagnosis
Green Total Amber Total Red Total
Torbay MS, real world data from MS infoflex database
N - 659

29. Uncovering the True Cost of Delayed MS Diagnosis: Insights
from Diagnosis to Present
R- 0.06, linear trend model
P <0.0001 means that your model doesn't explain much of variation of the data but it is significant (better than
not having a model)
N -659
1 to 54 years between diagnosis and now. The darker the colour and larger the circle shows patients diagnosed longer ago in years. There are not so many large dark circles in the
Green pro-discuss score band which may suggest that as time passes patients who were green may move to red in the cohort of patients whose diagnosis is made 10+ years after
onset of symptoms. We would of course need more data over a longer time period collecting the pro-discuss score to enable a comparison to be made.

30. Delay in MS diagnosis and missed opportunity
to treatment implications
Missed opportunity to treat
early MS
Missed opportunity to treat
early MS
R- 0.06, linear trend model
P <0.0001 means that your model doesn't explain much of variation of the data but it is significant (better than not having a model)
N - 659

31. Delay in MS diagnosis and missed opportunity
to treatment implications
Early diagnosis and access to
DMTs
The Benefits of Early
Digital Adoption for
Health Management
Early diagnosis,
prodrome of MS

32. Why MS diagnosis is delayed?

33. Delay in MS diagnosis due to factors:
Non specific symptoms/
multiple
comorbidities/Lack of
awareness/ RRMS course
Numbness, fatigue, blurred vision,
diagnosis of FMG, DM, HTN, Depression
Health inequities/Lack of
access to health care
People with color, rural, systemic biases
Fear of diagnosis
Some individuals may delay seeking
medical attention due to fear of a potential
MS diagnosis, leading to a delay in
diagnosis and treatment.
Marrie RA, Hanwell H. General health issues in multiple sclerosis: comorbidities, secondary conditions, and health behaviors. Continuum (Minneap Minn). 2013 Aug;19(4 Multiple
Sclerosis):1046-57. doi: 10.1212/01.CON.0000433284.07844.6b. PMID: 23917100.
Patti F, Chisari CG, Arena S, Toscano S, Finocchiaro C, Fermo SL, Judica ML, Maimone D. Factors driving delayed time to multiple sclerosis diagnosis: Results from a population-based
study. Mult Scler Relat Disord. 2022 Jan;57:103361. doi: 10.1016/j.msard.2021.103361. Epub 2021 Nov 1. PMID: 35158432.
Different MRI scanners, subjective
evaluation of signs and symptoms,
systemic biases
Inconsistent reporting

34. NHS digital, HES data 2019- 2022, provided by Biogen
Double Trouble: Exploring the Top Comorbidities Among MS Patients in
England

35. Understanding the Prevalence of Multiple Comorbidities Among MS
Patients
N- 12600
67% with comorbidities and MS
Kappus N, Weinstock-Guttman B, Hagemeier J, et al
Cardiovascular risk factors are associated with increased lesion burden
and brain atrophy in multiple sclerosis
Journal of Neurology, Neurosurgery & Psychiatry 2016;87:181-187.
BVL, brain volume loss; CIS, clinically isolated syndrome;
CVD, cardiovascular disease; HC, healthy control.
Jakimovski D, et al. J Neurol 2019; 266:866–875.
Prospective study, N= 326

37. H e a l t h y l i f e s t y l e M e d i c i n e
Public Health
promotion
Primary care ( Gatekeepers,
RF, 2nary prevention
Secondary
care (
management of
acute episodes,
worsening of
chronic conditions)
BUDGET
Secondary care ( acute
therapy, MI, discharge to Primary
care)
Tertiary care
Tertiary
care
Primary care ( BP, DM, BMI)
Public health promotion
Prioritising Patient-Centered Care: Flipping the Traditional Healthcare Pyramid
Current system:
Aiming:

38. NHS digital, HES data 2019- 2022, provided by Biogen
Unpacking the Cost of MS and Comorbidities: A Look into Non-elective
Admissions
Cost of Non- Elective admissions per patient with MS and without MS
and various comorbidities
Cost of Non- Elective admissions per patient with MS and without
MS and various comorbidities

39. NHS digital, HES data 2019- 2022, provided by Biogen
MS Torbay service saved £ by 17.9% for non-
elective admissions 2021 vs 2022

40. NHS digital, HES data 2019- 2022, provided by Biogen
Comparing Non-elective Admissions with UTI and MS as Secondary
Diagnosis: Torbay vs Rest of NHS Trusts
£
0 100,000 200,000 300,000 400,000 500,000 600,000
Barts Health NHS Trust
Royal Free London NHS Trust
Leeds Teaching Hospitals Trust
UCLA
University Hospitals Plymouth NHS Trust
Torbay & South Devon NHS Trust
£
NHS
Trusts
2022
2021
2020
2019

41. NHS digital, HES data 2019- 2022, provided by Biogen
Reducing Non-elective Admissions with Digital Tech: The Case of UTIs
Connect plus app
MS PKB platform MS Hololens clinics
£

42. Comparing Non-elective Admissions with UTI and MS as Secondary
Diagnosis: Torbay vs Royal Free London NHS Trust
0
20,000
40,000
60,000
80,000
100,000
120,000
2019 2020 2021 2022
Torbay & South Devon NHS Trust-
urgent admissions with UTI( primary
cause) and MS
Torbay & South Devon NHS Trust
440,000
460,000
480,000
500,000
520,000
540,000
560,000
2019 2020 2021 2022
Royal Free London NHS Trus- urgent
admissions with UTI(primary cause)
and MS
Royal Free London NHS Trust
£ £
Connect plus app
MS PKB platform MS Hololens
clinics

43. NHS digital, HES data 2019- 2022, provided by Biogen
Empowering Self-Management in MS Care: A Key to Preventing
Non-Elective Admissions and Reducing Costs
0
20
40
60
80
100
120
2019 2020 2021 2022
Urgent ( non- elective admissions) with UTI ( primary diagnosis) and MS
Barts Health NHS Trust Torbay & South Devon NHS Trust
41% reduced
11% reduced
Connect plus app

44. Taking Torbay MS Service to the Next Level: Additional Steps for Digitalization
Make a big impact with our professional slides and charts
Augmented reality (AR)
Artificial Intelligence (AI)
based MRI reporting
Consistency, and more sensitivity and
specificity in MRI reporting
Doctor’s digital assistant (Chat
Bot)
Future suggest this is possible
Integration with MS Infoflex,
MS PKB, and Connect plus app
Big ideas, but feasible to achieve, tech allows
us
Integration with MS Infoflex,
MS PKB, and Connect plus app
Big ideas, but feasible to achieve, tech allows
us
Prediction modeling of disease activity,
objective neurology, gait analysis
Integration with MS Infoflex,
MS PKB, and Connect plus app
Big ideas, but feasible to achieve, tech allows
us

45. Driving Digital Transformation: A Roadmap to Success
D r i v i n g i n n o v a t i o n s t o p r e s e r v e M S b r a i n h e a l t h
Explore what is already available
Looks around what IT
tools exist at your site
Come and visit Torbay MS team and
the rest MS teams who are digitally
more advanced than you
Visit Digitally equipped
MS service
Discuss your narratives and seek
some support
Meet with IT director
Make friends and have coffee breaks
together
Go and meet your CFO
Allocate time, find the local team to
deliver this project
Research/ Project
mindset
1 2 3 4 5

46. Partner up with
developers,
have a project
manager,
inform
Information
governance, IT
deps
Find the
sponsor
Allocate your
time for
developing and
testing
Collaborate
with more
experienced
than you in this
area
Never give up
and be
prepared
people don’t
like change!
Navigating Digital Transformation: Practical Steps for Your Site
P o s i t i v e m i n d s e t h e l p s t o d e l i v e r a n y p r o j e c t

47. Do you think healthcare providers have a responsibility to recommend
MS apps to their patients?
• A)Yes
• B)No
• C)Not enough evidence to recommend it as yet for health benefits
• D)Not sure

48. The Power of Proactivity: How HCPs Can Improve MS Outcomes?
Share info about MS
apps with your
patients
Training sessions
from developers
how to navigate
apps
Make sure app
provides
meaningful and
accurate info
Advocate
integration with
EHR at your Trust

49. Empowering MS Patients: Take Charge of their Health with These Action Steps
Identify the best
apps for
patients(your)
needs
Voice assistance, meeting
cognitive and sensory
abilities. Touch screen
device, head control, bridge
of the glasses screen
control, eye gaze function-
modifiable options
Better adherence
achieved-
rewards,
personalised,
gamification
involved
Encourage
patients to track
their symptoms
and adherence to
medicine Peer to peer
support through
MS app

50. Summary:
MS wellbeing
apps have a
potential to
improve QOL
for HCP and
MS patients
Apps saves time
and helps to
provide
personalised care
We should all
pursue for these
innovations for
better health
outcomes
I call for you
to action
now!
Real world
examples shows
positive impact on
patients wellbeing
Managing
comorbidities
reduces the
burden on the
NHS
We must have
digital strategies
to identify MS
early to preserve
the brain health
for pwMS

52. Thank you!
#BeewellwithMS
@DrAgneStraukiene