56% vs 26%
pain reduction with Apos® vs traditional physical therapy
Reported in a randomised controlled trial for chronic lower back pain.
Evidence-led care
Clinical evidence behind Apos®
Apos® is a personalised, non-invasive, CE-marked medical device treatment clinically proven to reduce knee, hip and chronic lower back pain. It is recommended in NICE guidance for knee osteoarthritis.
70+Peer-reviewed publications
53Clinical trials
15,000+Patients studied
Biomechanics in practice
The science behind Apos®
Most musculoskeletal conditions are driven by 2 key, modifiable factors; joint load, and how muscles can control these forces.
As an example, the knee adduction moment is a well-established biomechanical marker related to knee osteoarthritis. Apos® redistributes loads by precisely controlling the foot’s centre of pressure, and thereby the forces acting on the joints and how muscles are working. Its convex pods also create controlled instability that stimulates neuromuscular retraining, helping improve muscle activation and walking control over time. Together, these mechanisms aim to reduce excessive forces while the device is worn and support more efficient movement beyond the time it is worn.
NICE guidance · HTG671
NICE recommends Apos® for people with knee osteoarthritis
NICE recommends AposHealth® for people with knee osteoarthritis. A high-quality randomised controlled trial showed improvements in pain, stiffness and function compared with a sham device.
NICE's independent External Assessment Group reviewed the clinical evidence base for AposHealth®.
What was reviewed
29
publications reviewed
19
unique studies
3,767
participants included
Key outcomes
The numbers that matter in practice
Published clinical, real-world and claims data show where Apos® can make a measurable difference.
84–89%
of knee-replacement-eligible patients avoided or delayed surgery
Reported across follow-up lasting two to six years.
Source: Greene et al. (2022); Benn et al. (2023)
43%
lower overall care costs
A payer claims analysis found lower overall healthcare costs after treatment.
NICE evidence & economics
NICE resource impact model
The NICE Resource Impact Template models the impact of providing Apos® to 100 people over five years compared with standard care. This is a modelled cohort, not a limit on the potential benefit: applying the pathway across a wider NHS population could deliver substantially greater impact.
£498,270
net saving over five years
NICE modelled net saving for a cohort of 100 people over five years.
49 fewer
knee operations
NICE modelled 49 fewer knee operations for 100 people over five years.
24 lists
four-hour theatre lists
NICE modelled capacity equivalent to 24 four-hour theatre lists for 100 people over five years.
£247,350
net saving in year one
NICE modelled cash saving in year one for a cohort of 100 people over five years.
These modelled savings are based on just 100 patients. They represent a small cohort; the potential impact is much greater when the pathway is adopted across the wider NHS population.
Source: NICE resource impact and evidence, which opens in a new tab.
Publications & resources
Explore the full evidence
Read the full articles and NICE guidance behind the headline findings.
NICE · Evidence review
NICE full evidence review — HTG671
Read the articleGlobal Spine Journal · 2025 · Full article
Clinical outcomes of a new foot-worn non-invasive biomechanical intervention compared to traditional physical therapy in patients with chronic low back pain — a randomised clinical trial
Read the articleRetrospective claims analysis · Journal of Health Economics and Outcomes Research
Reduction in healthcare resource utilisation following Apos® — retrospective claims study
Read the articleJHEOR · Real-world claims-based economic analysis