Apostherapy

Founded 2004
Founder Dr Amit Mor and Dr Avi Elbaz
Area served
 Several countries worldwide
Website apostherapy.com/en/home,

Apostherapy is a medical program for the treatment of various orthopedic conditions, based on an individually calibrated foot-worn biomechanical device. The name, often spelt AposTherapy, is derived from the acronym for All Phases of Step [Cycle].[1]

Papers published in medical journals report that it was shown to reduce pain and restore function, mobility and quality of life in patients suffering from knee osteoarthritis. [2][3][4] and anterior knee pain.[5] The treatment is administered and monitored by physical therapists trained and licensed by the manufacturers.

According to Dr James Noake writing in the BJSM blog, the evidence as of 2013, discussed below, comprised retrospective, prospective and controlled (non-randomised) trials, showing favourable results. Noakes said that the research was enough to pique interest in a non-invasive, relatively low-cost treatment, but that a rigorous randomized controlled trial with larger numbers would be interesting.[6]

History

The program was developed by the orthopedists Dr. Avi Elbaz and Dr. Amit Mor, based on the increased understanding of biomechanics and the central role of the neuromuscular system in the development and the rehabilitation of orthopedic conditions.[7]

In 2014 the company, which already had clinics in the USA, Singapore, Israel and the UK, announced that it was to invest a further £10m in clinics in the UK over three years.[8]

Method

Apos biomechanical system. a The device, comprising two individually calibrated elements attached to the hind-foot and forefoot regions of a foot-worn platform. b The elements have variable amounts of convexity and resilience. c The sole includes two mounting rails and a positioning matrix

AposTherapy addresses the biomechanical abnormalities characteristic of various orthopedic conditions – the body's mal-alignment, muscle weakness, impaired neuromuscular control and the resulted abnormal pathological movement patterns. The ultimate goal of the treatment is to promote and restore desired motor pattern.

The treatment is based on a foot-worn biomechanical device which is individually-calibrated by a physical therapist. The calibration is based on a proprietary methodology coupled by computerized gait, pain, function and quality of life measurements (WOMAC and SF-36 questionnaires). Patients wear the device for about an hour a day whilst performing their normal daily activities. The device combines two rehabilitation principles – bringing the body and chain of joints to an optimal alignment, while simultaneously introducing perturbation through the creation of controlled micro-instability through the patients’ entire step-cycle.

First, by adjusting the foot’s point of contact with the ground (the center of pressure), the biomechanical device re-distributes the loads acting on the various joints of the lower limb.[9][10][11][12][13][14] When calibrating the device, the therapist considers which specific structures in the lower limb need to be supported or offloaded in order to bring the patient to optimal body alignment and provide the patient with pain relief. This decision is based upon the findings from a clinical interview, physical assessment and computerised gait-lab, as well as pain, function and quality of life questionnaire scores.

Second controlled micro-instability is introduced. through perturbation[14] during the gait cycle (and any other weight bearing activity), hence the name APOS which stands for All-Phases-of-Step-cycle. This restores neuromuscular control and over time retrains the muscles to adopt an optimal movement pattern.[2][4] Orthopaedic surgeon professor Oliver Pearce says: "This instinctively makes sense. Muscles support and protect the joint, so if there is any weakness or asymmetry in the way those muscles are working, there can be extra pressure on the joint." [15]

The device use two convex-shaped Pertupod™ caps, (pods which provide perturbation) under the main weight bearing areas of the foot, the heel and forefoot, see Figure 1. The therapist adjusts their location, height, and resilience. The level of perturbation is adjusted by varying the convexity of the Pertupod™ caps.

Additional Information

In 2013 the UK Advertising Standards Authority adjudicated following a complaint about advertisements for apostherapy as they existed at the time. Following the representations from Apos Uk and consultation with an independent expert ASA has stated that the evidence showed that AposTherapy did have an effect on the gait patterns and biomechanical characteristics associated with knee osteoarthritis and considered that the initial part of the claim "This therapy has been shown to improve the gait patterns and biomechanical characteristics of knee osteoarthritis that correlate with disease severity" had therefore been supported. The further subsequent claims that AposTherapy could "prevent further deterioration of the disease and instead promote a reversal of the pathology" was considered to be a plausible hypothesis, but the evidence was not sufficient to support the claims,. which were misleading.[7] Claims that apostherapy had been "Welcomed by the medical community in the UK following successful pilot" and "The increased levels of mobility and overall improvement in quality of life among patients has been significant" were also considered not to have a sufficient evidence and thus were likely to be misleading in their current form. Thus in accordance with CAP Code (Edition 12) rules 3.1 (Misleading advertising), 3.7 (Substantiation) and 12.1 (Medicines, medical devices, health-related products and beauty products) the company was requested not to use these claims in their current form.[7]

The expansion of Apostherapy

Up until 2015, treatment using the trainers was only available via a small number of specialized clinics, but now it is being rolled out nationwide via established physiotherapy clinics. Commenting on the treatment, UK based orthopaedic surgeon Professor Oliver Pearce said: "This represents a new tool in the box for those patients who don’t yet need a knee replacement." The expansion will make the treatment far more accessible to people who suffer with chronic knee pain and osteoarthritis. Specialist Physiotherapist Paul Hobrough commented: "The days of thinking that osteoarthritis is a simple problem of wear and tear are long gone. All evidence suggests that biomechanical approaches, such as Apostherapy, can make a real difference for some patients." [16]

Patient experience

From the patient's viewpoint, there is a 90-minute initial consultation in which stride length, walking speed, leg load distribution, and gait symmetry are analysed, with a detailed interview, including questions about past injuries. Then special shoes are supplied, fitted with Pertupod™ discs. The shoes combine the principles of orthotic footbeds to assist gait and posture, and balance boards, used by physiotherapists to improve balance and joint strength.

They are said to alter the way the feet are placed, taking the stress away from worn-out or damaged areas of the joints. The shoes create mild instability underfoot, so leg muscles and tendons weakened by age and injury must constantly readjust, strengthening them. After using them for a relatively short time each day the improvements are supposed to continue when wearing normal footwear.[17]

AposTherapy patient Stephen Hall stated "I was very cynical about doing it. They look gimmicky, but they are not and they do work. It has become a routine: I put them on when I come to the office and tend to wear them for several hours. They train your legs to walk correctly. I play golf and have started playing cricket again and can swim and can have a kick about with my son. My quality of life is far better."[18]

A study of 1,300 UK patients found that nine out of ten of those assessed as suitable for AposTherapy gained significant benefits from wearing the foot-worn device for around an hour a day.

The treatment in UK is covered by major private medical insurers such as Bupa, WPA, Cigna and others, and is also available as self pay. The company says that various treatment plans are offered with different duration and degree of support, at prices ranging from about £2,000 to £3,500 in the UK[20]

Relative contra-indications

Side-effects

Side effects may occur and manifest in mild fatigue and muscle spasms. Those side effects are rare, minor and transient.

References

  1. ↑ BBC News, 24 May 2010
  2. 1 2 Bar-Ziv, Yaron; Beer, Yiftah; Ran, Yuval; Benedict, Shaike; Halperin, Nahum (10 August 2010). "A treatment applying a biomechanical device to the feet of patients with knee OA results in reduced pain and improved function. A prospective controlled study". BMC Musculoskeletal Disorders 11 (179). Retrieved 5 March 2013.
  3. ↑ Bar-Ziv, Yaron; Debbi, Eytan M.; Ran, Yuval; Benedict, Shaike; Halperin, Nahum; Beer, Yiftah (28 January 2013). "Long-Term Effects of AposTherapy in Patients with Osteoarthritis of the Knee: A Two-Year Followup". Arthritis Journal 2013: 9. doi:10.1155/2013/689236. PMID 689236. Retrieved 5 March 2013.
  4. 1 2 Haim, Amir; Rubin, Guy; Rozen, Nimrod; Goryachev, Yulya; Wolf, Alon (3 January 2012). "Reduction in knee adduction moment via non-invasive biomechanical training: A longitudinal gait analysis study". Journal of Biomechanics 45 (1): 41–45. doi:10.1016/j.jbiomech.2011.10.017. Retrieved 5 March 2013.
  5. ↑ Haim, Amir; Segal, Ganit; Elbaz, Avi; Mor, Amit; Agar, Gabriel; Bar-Ziv, Yaron; Beer, Yiftah; Morag, Guy; Debi, Ronen; Atoun, Ehud (28 November 2012). "The outcome of a novel biomechanical therapy for patients suffering from anterior knee pain". The Knee. doi:10.1016/j.knee.2012.11.009.
  6. ↑ Dr James Noake, BJSM blog: Best foot forward: "AposTherapy – ‘con’ or convert?", 14 June 2013
  7. ↑ Block, Joel A.; Shakoor, Najia (February 2009). "The biomechanics of osteoarthritis: Implications for therapy". Current Rheumatology Reports 11 (1): 15–22. doi:10.1007/s11926-009-0003-7. Retrieved 5 March 2013.
  8. ↑ www.gov.uk, UK Trade & Investment press release, 13 March 2014
  9. ↑ Haim, Amir; Rozen, Nimrod; Dekel, Samuel; Halperin, Nahum; Wolf, Alon (22 September 2008). "Control of knee coronal plane moment via modulation of center of pressure: A prospective gait analysis study". Journal of Biomechanics 41 (14): 3010–3016. doi:10.1016/j.jbiomech.2008.07.029. Retrieved 5 March 2013.
  10. ↑ Haim, Amir; Rozen, Nimrod; Wolf, Alon (4 January 2010). "The influence of sagittal center of pressure offset on gait kinematics and kinetics". Journal of Biomechanics 43 (5): 969–977. doi:10.1016/j.jbiomech.2009.10.045.
  11. ↑ Haim, Amir; Wolf, Alon; Rubin, Guy; Genis, Yulya; Khoury, Mona; Rozen, Nimrod (13 April 2011). "Effect of center of pressure modulation on knee adduction moment in medial compartment knee osteoarthritis". Journal of Orthopaedic Research 29 (11): 1668–1674. doi:10.1002/jor.21422. Retrieved 5 March 2013.
  12. ↑ Goryachev, Yulya; Debbi, Eytan M.; Haim, Amir; Rozen, Nimrod; Wolf, Alon (October 2011). "Foot center of pressure manipulation and gait therapy influence lower limb muscle activation in patients with osteoarthritis of the knee.". Journal of Electromyography and Kinesiology 21 (5): 704–711. doi:10.1016/j.jelekin.2011.05.001. PMID 21684760.
  13. ↑ Goryachev, Yulya; Debbi, Eytan M.; Haim, Amir; Wolf, Alon (2011). "The effect of manipulation of the center of pressure of the foot during gait on the activation patterns of the lower limb musculature". Journal of Electromyography and Kinesiology 21 (2): 333–339. doi:10.1016/j.jelekin.2010.11.009. Retrieved 5 March 2013.
  14. 1 2 Debbi, Eytan M.; Wolf, Alon; Haim, Amir (13 April 2012). "Detecting and quantifying global instability during a dynamic task using kinetic and kinematic gait parameters". Journal of Biomechanics 45 (8): 1366–1371. doi:10.1016/j.jbiomech.2012.03.007. Retrieved 5 March 2013.
  15. ↑ Talk Health - A simple, Non-Surgical Treatment for Osteoarthritis, retrieved 29 July 2015
  16. ↑ Daily Mirror, retrieved 28 July 2015
  17. ↑ Apos therapy – can it save your knees?
  18. ↑ BBC News - 'These shoes were made for walking', retrieved 28 July 2015
  19. ↑ AposTherapy - The answer for a nation in knee-d, retrieved 29 July 2015
  20. ↑ AposTherapy brochure, retrieved 13 September 2014

External links

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