AposTherapy® pilot study

The Circle Bedfordshire MSK Service is undertaking the first NHS pilot study of AposTherapy®, an innovative, personalised, non-surgical and drug-free programme which can be used for the relief of knee and hip pain caused by osteoarthritis, based on a shoe-like biomechanical device which is individually tailored to your needs by specially-trained chartered physiotherapists. Until now, this has only been available privately.

Please note that there are strict inclusion criteria into this study, so this therapy is not available to all patients. If you have been directed to this page on our website, we have spoken with you and you fit the inclusion criteria, and this page will give you some more information about AposTherapy®, and how the process works.

Patient selection

Chronic pain from osteoarthritis of the knee or hip can be very debilitating. During your telephone conversation with our Shared Decision Making team, you were identified as someone who has significant osteoarthritis but whose symptoms have not, unfortunately, been managed sufficiently well with traditional non-surgical measures such as painkillers and/or physiotherapy. In this case, AposTherapy® may be suitable for you.

As discussed over the phone, we would otherwise recommend that you would be a candidate for knee or hip replacement surgery. AposTherapy® has been shown to delay, or even prevent, the need for joint replacement surgery (with the potential risks associated with it) in some patients with significant osteoarthritis of the knee or hip, and you have agreed to be considered for this non-surgical approach.

How AposTherapy® works

Osteoarthritis is the most common cause of knee and hip pain, but research has shown that contrary to popular belief, knee or hip osteoarthritis is not just wear and tear of joint cartilage. The importance of soft tissues (such as muscles and ligaments) and neuromuscular control is often underestimated. The muscles and the instructions they receive from the brain play a major role in the aggravation of the illness. As a result, Abnormal walking patterns can occur and over time this can cause further pain and damage - not only to the affected knee or hip, but also to the other joints associated with walking, such as the ankles, and the lower back. Day to day quality of life can be significantly affected due to the pain and stiffness experienced doing the simplest of things, such as walking the dog or going down the stairs.

The AposTherapy®treatment corrects the way you walk through re-educating the brain and muscles to work properly in order to re-establish normal symmetrical walking. This is achieved in two stages:

1. initially, by bringing your body to optimal alignment with the help of the foot-worn device, the AposTherapy®treatment changes the way forces travel through your body, thus reducing the pressure and strain on painful areas in the joint;

2. then, as you walk with the device, it stimulates and re-trains your muscles, ultimately re‑educating your body to adopt a corrected and less painful walking style, even when you are not wearing the device.
When used over time, AposTherapy®, in conjunction with a healthy lifestyle, has been shown to alleviate pain, swelling, stiffness and limping.

What happens next?

Based on your eligibility for this therapy, we will arrange for you to come for an assessment to determine how suitable AposTherapy® is for you. This assessment is used to help you understand how and why the treatment could benefit you. Please note that not all patients are suitable for AposTherapy® (as an example, if your balance is not very good, this would not be appropriate for you); you will be assessed by a specially-trained physiotherapist. As part of this, you will also be asked to complete a few questionnaires to help plan and monitor your treatment. It is always up to you to decide whether you want to go ahead with the offered treatment.

If AposTherapy® is appropriate for you, your treatment course can start at this first assessment appointment. Based on your physiotherapist's assessment, you'll wear the AposTherapy® shoe-like device around the house or at work generally for about an hour each day going about your normal daily activities. No special exercise is required.
After this initial assessment, you will have a further five follow-up appointments over the following year to check on progress, and make fine adjustments to the device if needed.

If you are not a suitable candidate for AposTherapy® we will contact you after your appointment to discuss your options.

Intended benefits of AposTherapy®

  • Reduced pain
  • Improved function and walking pattern
  • Aim to delay or even prevent the need for knee replacement surgery, with its associated risks
  • Safe, clinically-proven, non-surgical, drug-free therapy
  • Personalised to your needs
  • Convenient and easy to use