Effectiveness of the 'LeapForward' program on return-to-work and injury-related outcomes: a pragmatic randomised controlled trial

The “LeapForward Program” is a 6-week online program that integrates evidence-based strategies from the Lifestyle Medicine and Positive Psychology literature. Underpinning the intervention is numerous behaviour change techniques to target determinants of lifestyle behaviours, including goal-setting, problem-solving, goal-review, self-monitoring, feedback, social support and education with credible sources. Participants access the program via a smart device which consisted of the following components: ‘Lucy’, an AI health coach; the LeapForward website including daily educational video content; a weekly telehealth call with an allied health coach; and a LeapForward workbook. Each day participants receive a text and/or email prompting them to log in and complete the daily content. The educational content which is delivered via short ~5-minute videos, and discussed by Lucy and the health coach is broken down into the following topics: Week 1: Foundations Introduction, short-term goal setting, why movement is medicine, why work is good for wellbeing, your brain and pain. Week 2 and 3: My Mind Power of your mind, mindfulness, self-esteem, resilience, coping skills, gratitude, stress, power of thoughts, cognitive re-framing, unhelpful thinking styles, diffusion strategies, choosing different responses vs reactions. Week 4: My Body Finding things you enjoy, movement is medicine, food and mood, eating for energy, identifying uppers and downers. Week 5 and 6: My Life Coping with stress, importance of meaningful connections, understanding depression, recognising what you can control, reflecting on goals. The weekly telehealth calls are scheduled via the website and involve a 30-minute phone discussion with an allied health professional. These calls are designed as an opportunity to assess and provide any additional support in order for participants to fully engage, understand and apply the concepts and exercises from the program into their day-to-day lives. The workbook compliments the themes (My Foundations, My Mind, My Body, My Life) and learning concepts discussed in each video. The workbook follows the same content structure as the videos, and provides space for written exercises (e.g., reflections, journalling). Lucy is a rules-based virtual health coach (i.e., a range of answers are presented for the user to select from when answering questions), created and hosted using Clevertar’s AI chatbot software (Clevertar Services Pty Ltd, Adelaide, Australia). Lucy performs three key roles: (1) guides participants through an introductory session involving baseline measures and program overview (~10 minutes); (2) guides users through a daily check-in regarding their mood and goal progress (~5 minutes); and (3) prompts the daily educational video and engages in a brief discussion to ensure comprehension of video concepts and then prompts goal setting based on the daily content (~5 minutes). Participants are required to create a user account to access the program. Total time: Engagement in each of the program components is estimated to take 15-20 minutes per day of content and is designed to be completed 5 days per week, with a 30-minute call each week. This equates to approximately 2 hours and 10 minutes per week of engagement with the program. Since the program is designed to target health lifestyle behaviours, there may be additional time spent working on goals such as going for a daily walk, doing 3 minutes of mindfulness etc. Please note that the time spent on these activities would be additional to the proposed time commitment calculated above. Since the activities chosen and time invested would vary greatly between users, we estimate that approximately 1-2 hours per week may be spent working on healthy lifestyle behaviours and goals. Adherence: Website use and engagement with Lucy is monitored via web-analytics. Completion of the workbook is not assessed and is not compulsory, however, it is strongly recommended and is frequently referenced in videos and by Lucy. Engagement in telehealth calls is recorded by the allied health coach. These calls are part of the program but are not compulsory.