Musculoskeletal (MSK) conditions are one of the most persistent and costly burdens on health systems, accounting for around 30% of GP consultations in England (1). They frequently coexist with other long-term conditions and mental health challenges, compounding impact on quality of life and the ability to stay active and independent (2).
Low back pain alone for example is the leading cause of disability globally, yet many MSK pathways remain fragmented, episodic, and reactive (3). Patients often cycle between pain management, referrals, and delays without sustained support that helps them recover, adapt, and stay well.
Moving beyond traditional MSK care, why a holistic, continuous model matters
MSK injury and chronic pain is rarely driven by one factor. It's shaped by a web of biomechanics, health history, stress, sleep, nutrition, beliefs about pain, and day-to-day behaviours. When care focuses only on isolated symptoms, it can miss root drivers and struggle to keep people engaged long enough to see meaningful change.
A whole-person model brings the key domains together, movement, education, behavioural and psychological support, sleep, and nutrition, into a plan that reflects how people actually live. It's also a practical response to capacity constraints: continuous support doesn't have to mean continuous clinic time.
Where traditional models struggle:
- Limited access to multimodal care: an audit found only 10.4% of clinics offered a combination of procedures, medication management, and behavioural therapy (4).
- Over-reliance on prescription pain medication: a UK national primary care analysis found musculoskeletal indications were linked to ~81% of new opioid initiation episodes (5).
- Mental health burden is high: meta-analysis evidence suggests that around 39% of adults with chronic pain have clinically significant symptoms associated with depression, and 40% or so have clinically significant signs of anxiety (6).
- Sleep disruption is the norm, not the exception: pooled estimates show sleep disturbance affects roughly 75% of people with chronic non-cancer pain (7).
- Inflammation and lifestyle factors matter: higher inflammatory markers have been associated with higher odds of chronic pain in population studies (8).
- Multimorbidity is common: analysis by the CDC reports that approximately 73% of adults with arthritis have additional chronic conditions, highlighting the need for joined-up support rather than single-issue pathways (9).
How AI enables truly personalised, continuously updated care
Digital MSK support becomes materially more effective when it adapts to the person, not just the diagnosis. Modern approaches like just-in-time adaptive interventions use real-world signals (for example symptoms, context, and engagement patterns) to tailor support in the moment, nudging the right action at the right time, and adjusting recommendations as needs change (10).
For MSK pathways, this creates a shift from static "exercise sheets" to living care plans that can be refined continuously using real-world data while still meeting the evidence and governance expectations increasingly applied to AI and adaptive digital health technologies (11,12).
apo: a pathway layer for holistic MSK transformation
Holistic MSK care works when it is consistent, personalised, and joined-up, but most pathways are not designed to deliver that day-to-day support at scale. Clinics don't have the capacity to maintain continuous touchpoints, and patients often fall into gaps between appointments, referrals, flare-ups, and competing life demands.
apo is a CE-marked, Class I medical device that acts as a digital pathway layer that helps patients safely serve themselves and aid recovery and strength, while helping services extend capacity and improve continuity by providing structured, evidence-informed support between clinical contacts, and by improving visibility of patient progress over time.
Extending capacity without extending clinic time
apo is designed to support the parts of MSK care that often don't need a live appointment every time, education, guided self-management, pacing, recovery behaviours, and adherence support, while enabling timely escalation when needed. The aim is a more efficient pathway:
- More support for more people, without proportionally increasing clinician workload
- A clearer split between self-management support and clinical time reserved for complexity
- Fewer patients "cycling" through repeat contacts because they lack ongoing structure
Improving adherence by design
Pathways can only succeed if people can stick with them. apo is designed to strengthen adherence through:
- Clear daily/weekly structure and progression
- Behavioural support that reduces drop-off (motivation, confidence, habit-building)
- Practical help with common blockers (fear of movement, flare-ups, low energy, stress, poor sleep)
- A feedback loop that encourages persistence when progress is slow
Measuring outcomes that matter to pathways
apo is intended to support consistent measurement and follow-up, so services can see what's working and for whom. Depending on deployment, that can include:
- Symptom change and functional improvement over time
- Patient-reported outcomes and experience
- Engagement/adherence signals that indicate risk of drop-off
- Trigger points for earlier support or escalation
This makes MSK care more "trackable" and improvable, moving from episodic snapshots to a longitudinal view.
Using AI to keep plans aligned with real-world need
Static care plans break when real life changes. apo's personalisation is designed to adjust support based on real-world inputs such as symptom check-ins, progress feedback, and engagement patterns so recommendations remain appropriate as the person improves, plateaus, or flares.
Crucially, this is positioned as decision support and personalisation, not autonomous clinical diagnosis, supporting consistency and responsiveness while keeping appropriate clinical oversight in the pathway.
Built for clinical governance from day one
For MSK leaders, adoption depends on trust. apo is built with governance in mind, including:
- Clear role boundaries (what's self-management support vs what requires clinical input)
- Auditability and transparency of changes to plans and recommendations
- Clinical oversight and escalation routes where appropriate
- Ongoing monitoring and learning (including post-market-style feedback loops)
- Information governance and privacy controls suitable for deployment in health settings
Read more about our approach to safety here: our approach to safety.
What apo supports in practice
apo is organised around the key domains that modern MSK pathways increasingly recognise as essential to outcomes:
- Move: progressive movement, strengthening and conditioning support
- Unwind: stress, recovery and sleep support that influences pain and resilience
- Nourish: nutrition guidance aligned to healing and inflammation-aware goals
- Discover: education that builds understanding, confidence and self-management skills
Learn more about our pillars here: explore apo.
What we're aiming for is straightforward: better adherence, better continuity, and better MSK outcomes at scale.