How patient voices bring innovation to life

Recently, I listened to two patients, Bill and Kate, share their experience of living with knee osteoarthritis and how using Apos as part of their treatment had affected their daily lives. Both of their stories were powerful and moving, bringing to life the impact an innovation can have on quality of life and giving real meaning to the work that we support at Health Innovation East.

Osteoarthritis of the knee affects around one in five people aged over 45 in England (1). Total knee replacements is the most common effective treatment for end stage knee osteoarthritis once all other treatment options have been exhausted. However, surgery is not without risks, and recovery can be lengthy and challenging. For many patients, pain relief from medication or physiotherapy is limited or short-lived as the condition progresses.

Apos shoes are a medical device clinically proven to reduce knee pain by retraining a person’s gait and provides an alternative solution to surgical intervention. It is recommended by the National Institute for Health and Care Excellence (NICE) for patients that meet the criteria for a total knee replacement but cannot have or do not want surgery.

Since April 2024, Health Innovation East has supported Apos as part of its inclusion in the Med Tech Funding Mandate. As part of our work, we wanted to better understand the lived experiences of patients using Apos and their journey through the treatment pathway.

Bill’s story

Bill had lived with knee pain for over five years. Walking was a big part of Bill’s life, and what started as initial discomfort in his knee gradually got worse. He described how walking became more difficult, how he started limping, using a walking stick or needing to take rest breaks on a nearby bench. Physiotherapy exercises initially helped, but over time they became less effective at helping to manage his pain. A scan revealed degeneration of the knee and tissue damage, and Bill was told he qualified for a knee replacement. Faced with this news, Bill did his own research.

“The success rate is not fantastic…and the procedure involves quite a lot of time in hospital and rehabilitation…not the most convenient thing especially in a house with stairs.”

When his physiotherapist introduced Apos as an alternative, Bill decided it was worth trying – “really anything to avoid a knee replacement.”

He began wearing Apos, gradually increasing the length of time he wore them for whilst attending regular physiotherapy appointments for gait assessments and adjustments of the shoes. Bill spoke openly about his doubt and frustration when progress was not linear. There were good days, and bad days, and moments where his confidence in Apos wavered.

“It even got to the stage where I started feeling very negative about it…where I thought this was doing me more harm than good.”

Rather than giving up, Bill persevered. Over time, his mindset shifted and so did his symptoms.

“…come the spring, things did improve. I did start walking better. The pain levels were going away.”

Today, Bill describes himself as around 90% pain free.

“I feel that Apos has done its job…I’m managing this pain”.

Kate’s story

Kate’s experience echoed many of Bill’s challenges. She had lived with knee osteoarthritis for more than three years and described being unable to walk more than a few metres without pain. She relied on ice packs and freezing spray to make the pain more bearable. Everyday activities such as walking her dog, shopping and going out with her granddaughters had become difficult or impossible. She felt she could not do the things she wanted to do anymore.

After trying multiple treatments including massage therapy (which she was paying for herself) and injections into the knee, Kate felt she needed further help.

“It got too much. I said look you need to do something…I can’t fund it forever.”

The physiotherapist introduced Kate to Apos. She attended regular appointments for gait assessments and adjustments of the shoes. She spoke about how reassuring the appointments were – not just for the adjustments, but for having space to talk to someone about her pain and progress.

By around two months she noticed a difference.

“I could walk 20 minutes…you think it’s not much, but it was for me. 20 minutes was great just to walk the dog.”

This progress continued eventually leading to longer walks and even a walking holiday in Wales with her dog. For Kate, Apos meant regaining her independence and being able to do the things she enjoyed again.

What Bill and Kate’s stories taught us

Listening to Bill and Kate share their experiences gave us a different perspective on what impact really means. Alongside the clinical evidence, their stories show the day-to-day reality of living with knee osteoarthritis and what it feels like when a treatment starts to help, especially when it makes such a difference to their quality of life.

Patients are at the heart of health innovation so their voices should be too. Capturing patients ’ lived experience could help to make the case for change and strengthen implementation as well as help us to understand what enables uptake, adherence and sustained benefit.

Bill and Kate’s experiences reminded us that successful innovation is not only about clinical outcomes, but about whether people feel able to return to the lives they value.

As health systems continue to adopt new technologies and treatments, patient voices should not sit alongside implementation – they should help shape it from the beginning.

For us at Health Innovation East, conversations like these are an important reminder that supporting adoption also means understanding the lived realities behind the data.