Effectiveness of Four Orthotic Insoles on Pain in the Lower Body Associated With Musculoskeletal Stress

Musculoskeletal Pain Clinical Trial

Official title:

An Open-label, Single-centre, Parallel-group Clinical Investigation, to Evaluate the Effectiveness and In-use Tolerability of a Range of Four Orthotic Insoles on Target Areas of Pain in the Lower Body, Associated With Musculoskeletal Stress, Experienced by Those Who Spend Most of Their Working Day on Their Feet

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT04746755
• Other study ID #: NPD85302
• Status: Terminated
• Phase: N/A
• Start date: June 21, 2019
• Est. completion date: March 5, 2020

Study information

• Verified date: February 2021
• Source: Reckitt Benckiser Healthcare (UK) Limited
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This was an open-label, single-centre, parallel-group clinical investigation, to evaluate the effectiveness and in-use tolerability of a range of four orthotic insoles on target areas of pain in the lower body, associated with musculoskeletal stress, experienced by those who spend most of their working day on their feet

Description:

This was an open-label, single-centre, parallel-group clinical investigation, to evaluate the effectiveness and in-use tolerability of a range of four orthotic insoles on target areas of pain in the lower body, associated with musculoskeletal stress, experienced by those who spend most of their working day on their feet. The investigation design included two periods; 'run-in' period and 'treatment' period. The treatment period comprised of two sub-periods; a 'breaking-in' period and the 'full use' period. The breaking-in period was intended to allow time for the subjects' feet to accustom to wearing the insoles. The full-use period was used to determine effectiveness of the insoles. These periods constitute lengths of time defined for the purpose of the investigation as "working episodes". Working episodes were defined as at least 3 (up to 6) consecutive working days of at least 6 hours each at work, following at least 2 consecutive non-working days. Eligible subjects at Visit 1 (screening) were enrolled into the run-in period, where subjects were assessed prior to treatment with the insoles under investigation. During the run-in period, consisting of one working episode, subjects self-reported their pain without using insoles on a daily basis (Q3-9 of the Brief Pain Inventory (BPI)), in order to provide the baseline data to which the insoles were compared. Eligible subjects were enrolled into the treatment period at Visit 2 and assigned the insole relevant to the target pain area/pain area combination. Insole use was built up gradually during a breaking-in period, which constituted one working episode, with at least one nonworking day prior to the start of the working episode. Following the breaking-in period, the full-use period commenced. During the treatment period, subjects wore the insoles on working days and as much as possible on non-working days, self-reporting their pain daily (BPI Questions 3 - 9 inclusive).

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 145
• Est. completion date: March 5, 2020
• Est. primary completion date: December 16, 2019
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Those who gave informed consent.

2. Those who understood the purpose of the investigation, cooperate with the investigation procedures and tasks and were to attend the investigational site for all investigation assessments.

3. Those were willing to continue with their normal daily activities, including any cosmetic foot care regimens (including the use of products) throughout the investigation and not partake in exercise which is not normal for them and which would be deemed by the Investigator to impact study assessments, or any new foot care or podiatric treatments unless agreed in advance with the Investigator.

4. Those who wore the same or similar type of standard shoe during their working day/shift for at least the 4 weeks prior to enrolment (Visit 1) (or they have worn a different shoe which cause no change to their pain) and who were able to wear the same standard* shoe during their working day / shift for the duration of the investigation. Eligibility regarding this criterion was confirmed at Visit 1 but will also confirmed by the physiotherapist at Visit 2, following their assessment. *A standard shoe was defined as closed shoe, =2-inch heel, with an adequate sole, upper and toe box to accommodate the orthotic insole, as determined by the physiotherapist. Shoes with orthotic-type internal contouring (as determined by the physiotherapist to include features which could alter gait) or shoes with an arch support greater than 12 mm would not be permitted. Odour-eaters cannot be used during the treatment period.

5. Male and female subjects from the age of 18 years and a BMI of 18.5-29.9 kg/m² inclusive.

6. Those who had access to a mobile device (iOS or Android smart phone or tablet), with access to the internet, and are able to operate an app.

7. Those with a shoe size between 4.5 to 11 (UK).

8. Those who worked at least 30 hours per week which usually involved "working episodes" (defined as at least 3 (up to 6) consecutive working days (of at least 6 hours each at work) following at least 2 consecutive non-working days), which were expected to continue throughout their involvement in the investigation, and included at least 4 working episodes during the 4 (up to 5)-week treatment period. These working episodes should be non-complex in the opinion of the Investigator, to ensure continued eligibility.

9. Those who spent most (at least three quarters) of their working day on their feet, and remained in their current employment/work environment throughout the investigation period.

10. Those who have experienced pain associated with musculoskeletal stress during working episodes, for at least 4 weeks prior to enrolment (Visit 1) that they can distinguish as being in one of the following primary areas of pain or combination thereof, that the Investigator or designee considers could be treated with the relevant insole to be

used in the investigation:

• Lower back
• Knee and/or Heel
• Arch
• Heel Eligibility regarding this criterion will also be confirmed by the physiotherapist at Visit 2, following their assessment.

11. Those who scored an average of 5 (±1) on the BPI average pain item (question 5) over the first three consecutive working days of the run-in period working episode**, when assessed specifically in their primary target pain area/pain area combination, as confirmed at Visit 2.

• If the run-in period constituted more than one working episode (e.g. due to the scheduling of Visit 2), only the data from the first working episode was included in the calculation to determine eligibility, providing this included at least three consecutive working days. Otherwise data from the second working episode was used.

Exclusion Criteria:

1. Those who had a current medical condition that is contraindicated by the use of the orthotic insoles (e.g. peripheral vascular disease, sensory neuropathy or diabetes).

2. Those who currently use prescribed orthotics for biomechanical or other issues, or have received and used prescribed orthotics within the last 12 months or over-the-counter (OTC) orthotics in the last 6 months (odour-eaters and any non-structured/non-orthotic shock-absorber insole were permitted).

3. Those with any significant medical history which in the opinion of the Investigator could have interfered with the assessments of the investigation. For example; structural conditions (e.g. bunion or bunionette), lower limb or foot injury, rheumatic disease (e.g. rheumatoid arthritis, scleroderma, polymyalgia rheumatica), fibromyalgia, neurological disease or moderate to severe depression.

4. Those who were taking any of the following medications:

1. Anti-psychotic, sedatives, muscle-relaxants or medicines intended to treat neuropathic pain

2. Anti-inflammatory medications which would reduce systemic inflammation or locally at the target pain areas (low dose Aspirin (75 mg daily) and nasal/inhaled steroids could have been considered acceptable, where in the opinion of the Investigator they would not interfere with the assessments of the investigation)

3. An unstable dose of anti-depressants (defined as a change in therapy within the last 6 months).

5. Those who are taking regular medication for targeted pain (including OTC pain relief, in excess of 2g paracetamol daily) which is either beyond the maximum recommended daily dose according to the SmPC or which the Investigator deems inappropriate for the subject to continue at the same dose throughout the investigation.

6. Those who were pregnant or who had given birth within the past 6 months.

7. Females of child-bearing potential who were unwilling to use a minimum of an "acceptable" (as defined by the Clinical Trials Facilitation Group (CFTG; 2014) recommendations) level of birth control, for the entire duration of the investigation. Suitable methods of birth control (in accordance with "highly effective" and

"acceptable" methods of birth control defined by the CTFG) included:

1. Combined (estrogen and progestogen containing) hormonal contraception associated with the inhibition of ovulation; oral, intravaginal, transdermal.

2. Progestogen-only hormonal contraception associated with the inhibition of ovulation; oral, intravaginal, transdermal.

3. Progestogen-only oral hormonal contraception, where inhibition of ovulation is not the primary mode of action

4. Male or female condom with or without spermicide

5. Cap, diaphragm or sponge with spermicide

6. Intrauterine device

7. Intrauterine hormone-releasing system

8. Bilateral tubal occlusion

9. Vasectomised partner (where this was the subject's sole sexual partner and where the vasectomised partner had received medical assessment of the surgical success)

10. Sexual abstinence (where the subject was willing to refrain from heterosexual intercourse during the entire period of the investigation in line with their preferred and usual lifestyle) Females who were considered to be of child-bearing potential were those who were fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A post-menopausal state is defined as no menses for 12 months without an alternative medical cause (Clinical Trials Facilitation Group, 2014).

8. Those who suffered from allergies or sensitivities to the raw material of the insoles (as detailed in the Investigator Brochure).

9. Those who had participated in another clinical investigation within the 3 months prior to enrolment into the run-in period.

10. Employee at the investigational site, or a partner or first degree relative of the Investigator or member of the investigation team at the site.

11. Those, in the opinion of the Investigator, who were not deemed suitable or were unable to comply fully with the investigation requirements, for any other reason.

Related Conditions & MeSH terms

• Musculoskeletal Pain

Intervention

Device:
• Orthotic Insole: Lower Back
This Insole is a full-length shaped orthotic insole, with a heel cup and an arch support. The insole can cover several shoe sizes and can be cut to the correct size to fit in the shoe.
• Orthotic Insole: Heel
This Insole is a horseshoe shaped flexible heel cup with a softer area where the heel would be expected.
• Orthotic Insole: Knee to Heel
This Insole is a ¾ length rigid orthotic insole with a softer area where the heel would be expected. Each insole will cover several shoe sizes.
• Orthotic Insole: Arch
This Insole is a ¾ length shaped medical device with a softer area incorporated into the ball of foot and heel area and an external arch. support and 6-8 mm metatarsal dome. The slim fit insole runs from the heel along under the arch of the foot and reaches to just behind the toes to prevent squashing the toes in tight fitting shoes.

Locations

Country	Name	City	State
United Kingdom	CPS Research	Glasgow	Scotland

Sponsors (2)

Lead Sponsor	Collaborator
Reckitt Benckiser Healthcare (UK) Limited	SynteractHCR Deutschland GmbH

Country where clinical trial is conducted

United Kingdom, 

References & Publications (12)

Almeida JS, Vanderlei FM, Pastre EC, Martins RA, Padovani CR, Filho GC. Comparison of Two Types of Insoles on Musculoskeletal Symptoms and Plantar Pressure Distribution in a Work Environment: A Randomized Clinical Trial. Clin Med Res. 2016 Jun;14(2):67-74. doi: 10.3121/cmr.2016.1301. Epub 2016 May 26. — View Citation

Amer AO, Jarl GM, Hermansson LN. The effect of insoles on foot pain and daily activities. Prosthet Orthot Int. 2014 Dec;38(6):474-80. doi: 10.1177/0309364613512369. Epub 2013 Dec 13. — View Citation

Basford JR, Smith MA. Shoe insoles in the workplace. Orthopedics. 1988 Feb;11(2):285-8. — View Citation

Bonanno DR, Landorf KB, Munteanu SE, Murley GS, Menz HB. Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis. Br J Sports Med. 2017 Jan;51(2):86-96. doi: 10.1136/bjsports-2016-096671. Epub 2016 Dec 5. Review. — View Citation

Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001 Nov;94(2):149-158. doi: 10.1016/S0304-3959(01)00349-9. — View Citation

Gill TK, Menz HB, Landorf KB, Arnold JB, Taylor AW, Hill CL. Identification of Clusters of Foot Pain Location in a Community Sample. Arthritis Care Res (Hoboken). 2017 Dec;69(12):1903-1908. doi: 10.1002/acr.23212. Epub 2017 Nov 14. — View Citation

Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993 Nov;4(5):353-65. — View Citation

Shabat S, Gefen T, Nyska M, Folman Y, Gepstein R. The effect of insoles on the incidence and severity of low back pain among workers whose job involves long-distance walking. Eur Spine J. 2005 Aug;14(6):546-50. Epub 2005 Jan 25. — View Citation

Sobel E, Levitz SJ, Caselli MA, Christos PJ, Rosenblum J. The effect of customized insoles on the reduction of postwork discomfort. J Am Podiatr Med Assoc. 2001 Nov-Dec;91(10):515-20. — View Citation

Stanhope J. Brief Pain Inventory review. Occup Med (Lond). 2016 Aug;66(6):496-7. doi: 10.1093/occmed/kqw041. Epub 2016 Apr 11. Review. — View Citation

Stolt M, Suhonen R, Virolainen P, Leino-Kilpi H. Lower extremity musculoskeletal disorders in nurses: A narrative literature review. Scand J Public Health. 2016 Feb;44(1):106-15. doi: 10.1177/1403494815602989. Epub 2015 Sep 9. Review. — View Citation

Waters TR, Dick RB. Evidence of health risks associated with prolonged standing at work and intervention effectiveness. Rehabil Nurs. 2015 May-Jun;40(3):148-65. doi: 10.1002/rnj.166. Epub 2014 Jul 7. Review. — View Citation

* Note: There are 12 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress during the first three days of the break-in working episode. As assessed by the change in BPI questionnaire. (For each of the four orthotic insoles)	The average change from baseline in the daily composite score of the worst, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), during the first three consecutive working days of the working episode (WE)of the breaking-in period.; The baseline WE first 3 up to 5 consecutive working days (CWD) of baseline working episode therefore in the context of this endpoint the baseline assessment is an average of the responses Day 0-3 or Days 0-5 depending on the working pattern of the subjects.; The break- in period was defined as the first working episode where the subject was provided with the device, it started with at least one non-working and included three up to five consecutive working days. For this endpoint the first three days would take place over Day 7-10.; The average pain during the break-in period was compared to the baseline.	Average pain on Days 0-3 compared to Days 7-10 for subjects that worked three consecutive working days, Average pain on Days 0-5 compared to Days 9-14 for subjects that worked five consecutive working days
Other	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress during the break-in working episode. As assessed by the change in the BPI score. (For each of the four orthotic insoles separately)	The change from baseline in the composite score of the worse, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), completed at the end of the working episode of the breaking-in period. For each of the four orthotic insoles separately.; The baseline WE defined as the first 3 up to 5 consecutive working days (CWD) of baseline working episode therefore the baseline assessment would occur on Day 3 or Days 5 depending on the working pattern of the subjects.; The break- in period was defined as the first working episode where the subject was provided with the device, at least one non-working and included three up to five CWD. For this endpoint the end of the working episode would occur on Day 10 or Day 14 depending on the working pattern of the subjects.; The average pain at the end of the break-in period was compared to the baseline.	Average pain on Days 3 was compared that on Day 10 for subjects that worked three consecutive working days, Average pain on Days 5 compared to Day 14 for subjects that worked five consecutive working days.
Other	Change in quality of life, associated with improvement pain as assessed by the Brief Pain Inventory questionnaire following the break-in period (For each of the four orthotic insoles separately)	The change from baseline in quality of life, associated with overall improvement in pain in the primary area of pain, assessed by the Brief Pain Inventory (BPI) pain interference scores (Question 9; composite (average) score), completed at the end of the working episode of the breaking-in period. For each of the four orthotic insoles separately.; The baseline WE occurred on Day 3 or Days 5 depending on the working pattern: WE- occurred from Day 12-15 for subjects that worked 3 consecutive working days (CWD) up to Day 23-28 for subjects that worked 5 CWD; WE- occurred from Day 17-20 for subjects that worked 3 CWD up to Day 30-35 for subjects that worked 5 CWD; WE- occurred from Day 22-25 for subjects that worked 3 CWD up to Day 37-42 for subjects that worked 5 CWD; WE- occurred from Day 27-30 for subjects that worked 3 CWD up to Day 44-49 for subjects that worked 5 CWD The BPI questions is on a scale of 0-10 with the lower number indicating less pain.	Day 5 compared to Day 23-28, Day 30-35, Days 37-42, Day 44-49 for subjects that worked five CWD or Day 3 compared to Day 12-15, Day 17-20, Day 22-25, Day 27-30 for subjects that worked 3 CWD
Other	Subject perceived improvement of symptoms (questionnaire) (For each of the four orthotic insoles separately)	Improvement of symptoms as a result of wearing the insoles, recorded through a Subject Perceived Questions, daily for the first ten days of the treatment period. For each of the four orthotic insoles separately.; This assessment was scored on five statements with the subject selecting the most appropriate statement with statement 1 being no change and statement 5 being completely better.	Days 11-21 of the full-use period for subjects that worked 3 consecutive working days. Days 22-32 of the full-use period for subjects that worked 5 consecutive working days.
Other	Subjects impressions of comfort and impact of insoles (questionnaire) (For each of the four orthotic insoles separately)	Comfort of the insole and impact on daily activity, recorded through Subject Perceived Questions on a daily basis throughout the treatment period. For each of the four orthotic insoles separately.; This assessment was scored on a scale of 0 to 10 with 0 being very uncomfortable and 10 very comfortable.	Daily though out the treatment period. Day 11 to Day 30 of the full-use period for subjects that worked 3 consecutive working days. Day 21 to 49 for subjects that worked 5 consecutive working days.
Other	Subjects impressions tolerability (Visual Analogue Scale) (For each of the four orthotic insoles separately)	Subject impression of tolerability, as assessed through comfort, irritation and ADEs, completed at the end of the last working episode of the treatment period.; This assessment was scored on a scale of -3 to +3 with 0 indicating no change, a positive number indicating well tolerated and negative indicating an not well tolerated.	Day 31 for subjects that worked 3 consecutive working days. Day 50 for subjects that worked 5 consecutive working days.
Other	Subject experience and satisfaction of insoles (Visual Analogue Scale)	Overall subject experience and satisfaction completed at the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; Experience and satisfaction assessed as separately as two questions and scored on a scale of -3 to +3 with 0 indicating no change, a positive number indicating an improvement and negative number indicating a negative experience/ satisfaction.	Daily though out the treatment period. Day 11 to Day 30 of the full-use period for subjects that worked 3 consecutive working days. Day 21 to 49 for subjects that worked 5 consecutive working days.
Other	Investigator impression of tolerability (Visual Analogue Scale) (For each of the four orthotic insoles separately)	Overall subject experience and satisfaction, completed at the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; Experience and satisfaction assessed as separately as two questions and scored on a scale of -3 to +3 with 0 indicating no change, a positive number indicating an improvement and negative number indicating an negative experience/ satisfaction.	Day 31 for subjects that worked 3 consecutive working days. Day 50 for subjects that worked 5 consecutive working days
Other	Investigator global impression of tolerability (Statement) (For each of the four orthotic insoles separately)	Investigator global impression of tolerability, as assessed through comfort, irritation and ADEs across the investigation, completed following the end of the last working episode of the treatment period for the last subject. For each of the four orthotic insoles separately.; Statement from the Investigator included within the Clinical Investigation Report	Day 31 for subjects that worked 3 consecutive working days. Day 50 for subjects that worked 5 consecutive working days
Other	Subjects impressions (questionnaire)	End of study Subject Perceived Questions, completed on the day of Visit 3. For each of the four orthotic insoles separately.; Subjects answered questions with each question having five levels of agreement (strongly disagree to strongly agree), the subjects selected the most appropriate statement.	Day 31 for subjects that worked 3 consecutive working days. Day 50 for subjects that worked 5 consecutive working days
Other	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress. Assessed though the change in pain, measured by the Brief Pain Inventory questionnaire. (analysed for all insoles collectively)	The average change from baseline in the daily composite score of the worst, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), during the first three consecutive working days of the last working episode of the treatment period.; To account for differences in subjects working patterns a definition was created, a valid working episode was considered to be two non-working days followed by at least three and up to five working days .; The baseline was defined as the first three consecutive working days of baseline working episode (Days 0-3). The first three days of the last working episode could occur from Days 27-30 for subjects that worked 3 consecutive working days up to Days 44-47 for subjects that worked five consecutive working days	Time frame is dependent on working pattern Days 0-5 compared to Days 44-47 and Days 0-3 compared to Days 27-30
Other	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress over the first three days of each working episode. Assessed change in pain, measured by the BPI questionnaire. (analysed for all insoles)	The average change from baseline in the daily composite score of the worst, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), during the first three consecutive working days of each working episode (WE) of the treatment period; The baseline WE was defined as the first three consecutive working days of (Days 0-3): st WE- the first three days could occur from Days 12-15 for subjects that worked 3 consecutive working days up to Days 23-26 for subjects that worked five consecutive working days; nd WE- the first three days could occur from Days 17-20 for subjects that worked 3 consecutive working days up to Days 30-33 for subjects that worked five consecutive working days; rd WE- the first three days could occur from Days 22-25 for subjects that worked 3 consecutive working days up to Days 37-40 for subjects that worked five consecutive working days	Days 0-5 compared to Days 23-26, Days 30-33, Days 37-40, Days 0-3 compared to Day 12-15, Day 17-20, Day 22-25, Day 27-30 for subjects that worked 3 consecutive working days
Other	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress over each working episode. Assessed though the change in pain, measured by the BPI questionnaire.(analysed for all insoles collectively)	The change from baseline in the composite score of the worse, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), completed at the end of each working episode (WE) of the treatment period.; The baseline WE was defined as Days 0-3 or Days 0-5 depending on the working pattern of the subjects: WE- the last working day could occur on Day 12-15 for subjects that worked 3 consecutive working days (CWD) up to Days 23-28 for subjects that worked 5 CWD; WE- the last working day could occur on Day 17-20 for subjects that worked 3 CWD up to Day 30-35 for subjects that worked 5 CWD; WE- the last working day of the 3rd working episode could occur from Day 22-25 for subjects that worked 3 CWD up to Day 37-42 for subjects that worked 5 CWD; WE- the last working day could occur from Day 27-30 for subjects that worked 3 CWD up to Day 44-49 for subjects that worked 5 CWD	Days 0-5 compared to Day 23-28, Day 30-35, Day 37-42, Day 44-49 for subjects that worked five consecutive working days, Days 0-3 compared to Day 12-15, Day 17-20, Day 22-25, Day 27-30 for subjects that worked 3 consecutive working days
Other	Proportion of subjects who achieve a change of =1 unit from baseline.Assessed though the change in pain, measured by the Brief Pain Inventory questionnaire. (analysed for all insoles collectively)	The overall proportion of subjects who achieve a change of =1 unit from baseline in the daily composite score of the worst, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), during the first three consecutive working days of the last working episode of the treatment period.; To account for differences in subjects working patterns a definition was created, a valid working episode was considered to be two non-working days followed by at least three and up to five working days .; The baseline was defined as the first three consecutive working days of baseline working episode (Days 0-3). The first three days of the last working episode could occur from Days 27-30 for subjects that worked 3 consecutive working days up to Days 44-47 for subjects that worked five consecutive working days	Days 0-5 compared to Days 44-47 for subjects that worked 5 consecutive working days, Days 0-3 compared to Days 27-30 for subjects that worked 3 consecutive working days
Other	Subject impression of change in pain (Visual Analogue Scale) (analysed for all insoles collectively)	Subjects' rating of overall improvement in pain since pre-treatment, completed at the end of the last working episode of the treatment period.; Analysed for all insoles collectively.; Scored on a scale of -3 to +3 with 0 indicating no change in pain, a positive number indicating an improvement and negative indicating an increase in the pain	Day 6 and Day 15 (Visit 1) compared to Day 31 and Day 50 depending on the subjects working pattern.
Other	Investigator impression of change in subjects' pain (Visual Analogue Scale) (analysed for all insoles collectively)	Investigator's rating of the subjects' overall improvement in pain since pre-treatment, completed following the end of the last working episode of the treatment period.; Scored on a scale of -3 to +3 with 0 indicating no change in pain, a positive number indicating an improvement and negative indicating an increase in the pain; Analysed for all insoles collectively.	Day 6 and Day 15 (Visit 1) compared to Day 31 and Day 50 depending on the subjects working pattern.
Other	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress during the first three days of the break-in working episode. Assessed change in pain, measured by the BPI questionnaire. (analysed for all insoles)	The average change from baseline in the daily composite score of the worst, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), during the first three consecutive working days of the working episode (WE)of the breaking-in period.; The baseline WE first 3 up to 5 consecutive working days (CWD) of baseline working episode therefore in the context of this endpoint the baseline assessment is an average of the responses Day 0-3 or Days 0-5 depending on the working pattern of the subjects.; The break- in period was defined as the first working episode where the subject was provided with the device, it started with at least one non-working and included three up to five consecutive working days. For this endpoint the first three days would take place over Day 7-10.; The average pain during the break-in period was compared to the baseline.	Average pain on Days 0-3 compared to Days 7-10 for subjects that worked three consecutive working days, Average pain on Days 0-5 compared to Days 9-14 for subjects that worked five consecutive working days
Other	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress during the break-in working episode Assessed though the change in pain, measured by the BPI questionnaire.(analysed for all insoles collectively)	The change from baseline in the composite score of the worse, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), completed at the end of the working episode of the breaking-in period. For each of the four orthotic insoles separately.; The baseline WE defined as the first 3 up to 5 consecutive working days (CWD) of baseline working episode therefore the baseline assessment would occur on Day 3 or Days 5 depending on the working pattern of the subjects.; The break- in period was defined as the first working episode where the subject was provided with the device, at least one non-working and included three up to five CWD. For this endpoint the end of the working episode would occur on Day 10 or Day 14 depending on the working pattern of the subjects.; The average pain at the end of the break-in period was compared to the baseline.	Average pain on Days 3 was compared that on Day 10 for subjects that worked three consecutive working days, Average pain on Days 5 compared to Day 14 for subjects that worked five consecutive working days.
Other	Change in quality of life, associated with improvement pain as assessed by the Brief Pain Inventory questionnaire (analysed for all insoles collectively)	The change from baseline in quality of life, associated with overall improvement in pain in the primary area of pain, assessed by the Brief Pain Inventory pain (BPI) interference scores (Question 9; composite (average) score), completed at the end of each working episode (WE) of the treatment period.; The baseline WE was defined as Day 3 or Days 5 depending on the working pattern: st WE- occurred from Day 12-15 for subjects that worked 3 consecutive working days (CWD) up to Day 23-28 for subjects that worked 5 CWD; nd working episode- occurred from Day 17-20 for subjects that worked 3 CWD up to Day 30-35 for subjects that worked 5 CDW; rd working episode- occurred from Day 22-25 for subjects that worked 3 CWD up to Day 37-42 for subjects that worked five consecutive working days; th working episode- occurred from Day 27-30 for subjects that worked 3 CWD up to Day 44-49 for subjects that worked 5 CWD The BPI question is a scale of 0-10 with the lower number indicating less pain.	Day 5 compared to Day 23-28, Day 30-35, Days 37-42 Day 44-49 for subjects that worked 5 CWD or Day 3 compared to Day 12-15, Day 17-20, Day 22-25, Day 27-30 for subjects that worked 3 CWD
Other	Change in quality of life, associated with improvement in pain as assessed by the EQ-5D-5L questionnaire (analysed for all insoles collectively)	Change from baseline in quality of life, associated with overall improvement in pain in the primary area of pain, assessed by the EQ-5D-5L, completed at the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; The baseline was defined as the first three up to five consecutive working days of baseline working episode therefore in the context of this endpoint the baseline assessment would occur on Day 3 or Days 5 depending on the working pattern of the subjects. Compared to the responses at the end of last working episode which could occur from Day 30 for subjects that worked 3 consecutive working days up to Day 49 for subjects that worked five consecutive working days.; The EuroQol- 5 dimension - 5 level (EQ-5D-5L), is made up of 5 questions scored 1 to 5 from these questions an index is created with a range between zero and 1 with a zero being death and 1 being perfect quality of life.	Day 3 up to 5 compared to Day 49 for subjects that worked five consecutive working days or Day 30 for subjects that worked 3 consecutive working days
Other	Change in work productivity and activity as assessed by the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (analysed for all insoles collectively)	Change from baseline in work productivity and activity, assessed by the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP), completed at the end of last working episode of the treatment period. For each of the four orthotic insoles separately.; The baseline was defined as the first 3 up to 5 consecutive working days (CWD) of baseline working episode therefore in the context of this endpoint the baseline assessment would occur on Day 3 or Days 5 depending on the working pattern of the subjects. Compared to the responses at the end of last working episode which could occur from Day 30 for subjects that worked 3 CWD up to Day 49 for subjects that worked 5 CWD.; The WPAI:SHP six questions on the subjects productivity and activity Impairment. Questions comprised of information on employment, including hours at work, hours missed from work and reasons for work missed. As well as the effect that pain had on their daily activities..	Quality of life on Day 3 up to 5 compared to Day 49 for subjects that worked five consecutive working days or Day 30 for subjects that worked 3 consecutive working days
Other	Subject impression of change in their work productivity and activity. (Visual Analogue Scale) (analysed for all insoles collectively)	Subjects' rating of overall improvement in their quality of life and work productivity and activity since pre-treatment, completed at the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; The last working day is different for each subject working pattern this could occur from Day 30 for subjects that worked 3 consecutive working days (CWD) up to Day 49 for subjects that worked 5 CWD.; This assessment was scored on a scale of -3 to +3 with 0 indicating no change, a positive number indicating an improvement and negative indicating an increase in quality of life	Quality of life improvement assessed on Day 49 for subjects that worked five consecutive working days or Day 30 for subjects that worked 3 consecutive working days
Other	Investigator impression of change in quality of life (Visual Analogue Scale) (analysed for all insoles collectively)	Investigator's rating of the subjects' overall improvement in their quality of life since pre-treatment, following the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; The last working day is therefore different for each subjects working pattern this could occur from Day 30 for subjects that worked 3 consecutive working days up to Day 49 for subjects that worked five consecutive working days.; This assessment was scored on a scale of -3 to +3 with 0 indicating no change in quality of life, a positive number indicating an improvement and negative indicating an increase in quality of life	Quality of life improvement assessed on Day 49 for subjects that worked five consecutive working days or Day 30 for subjects that worked 3 consecutive working days
Other	Safety and tolerability of the device (analysed for all insoles collectively)	Overall proportion of subjects with AEs and adverse device effects (ADEs), i.e. the occurrence of one or more AEs/ADEs per subject.; Analysed for all insoles collectively.	through study completion, from point of informed consent (Day 1) up to Visit 3 (Day 50)
Other	Change in quality of life, associated with improvement pain as assessed by the Brief Pain Inventory following the break-in period (analysed for all insoles collectively)	The change from baseline in quality of life, associated with overall improvement in pain in the primary area of pain, assessed by the Brief Pain Inventory (BPI) pain interference scores (Question 9; composite (average) score), completed at the end of the working episode of the breaking-in period. For each of the four orthotic insoles separately.; The baseline WE occurred on Day 3 or Days 5 depending on the working pattern: WE- occurred from Day 12-15 for subjects that worked 3 consecutive working days (CWD) up to Day 23-28 for subjects that worked 5 CWD; WE- occurred from Day 17-20 for subjects that worked 3 CWD up to Day 30-35 for subjects that worked 5 CWD; WE- occurred from Day 22-25 for subjects that worked 3 CWD up to Day 37-42 for subjects that worked 5 CWD; WE- occurred from Day 27-30 for subjects that worked 3 CWD up to Day 44-49 for subjects that worked 5 CWD The BPI questions is on a scale of 0-10 with the lower number indicating less pain.	Day 5 compared to Day 23-28, Day 30-35, Days 37-42, Day 44-49 for subjects that worked five CWD or Day 3 compared to Day 12-15, Day 17-20, Day 22-25, Day 27-30 for subjects that worked 3 CWD
Other	Subject perceived improvement of symptoms (questionnaire) (analysed for all insoles collectively)	Improvement of symptoms as a result of wearing the insoles, recorded through a Subject Perceived Questions, daily for the first ten days of the treatment period. Analysed for all insoles collectively.; This assessment was scored on five statements with the subject selecting the most appropriate statement with statement 1 being no change and statement 5 being completely better.	Days 11-21 of the full-use period for subjects that worked 3 consecutive working days. Days 22-32 of the full-use period for subjects that worked 5 consecutive working days.
Other	Subjects impressions of comfort and impact of insoles (questionnaire) (analysed for all insoles collectively)	Comfort of the insole and impact on daily activity, recorded through Subject Perceived Questions on a daily basis throughout the treatment period. Analysed for all insoles collectively.; This assessment was scored on a scale of 0 to 10 with 0 being very uncomfortable and 10 very comfortable.	Daily though out the treatment period. Day 11 to Day 30 of the full-use period for subjects that worked 3 consecutive working days. Day 21 to 49 for subjects that worked 5 consecutive working days.
Other	Subjects impressions of tolerability (Visual Analogue Scale) (analysed for all insoles collectively)	Subject impression of tolerability, as assessed through comfort, irritation and ADEs, completed at the end of the last working episode of the treatment period. Analysed for all insoles collectively.; This assessment was scored on a scale of -3 to +3 with 0 indicating no change, a positive number indicating well tolerated and negative indicating an not well tolerated.	Day 31 for subjects that worked 3 consecutive working days. Day 50 for subjects that worked 5 consecutive working days.
Other	Subjects experience and satisfaction of insoles (Visual Analogue Scale) (analysed for all insoles collectively)	Overall subject experience and satisfaction, completed at the end of the last working episode of the treatment period.; Analysed for all insoles collectively.; Experience and satisfaction assessed as separately as two questions and scored on a scale of -3 to +3 with 0 indicating no change, a positive number indicating an improvement and negative number indicating an negative experience/ satisfaction.	Daily though out the treatment period. Day 11 to Day 30 of the full-use period for subjects that worked 3 consecutive working days. Day 21 to 49 for subjects that worked 5 consecutive working days.
Other	Investigator impression of tolerability (Visual Analogue Scale) (analysed for all insoles collectively)	Investigator impression of tolerability, as assessed through comfort, irritation and ADEs, completed following the end of the last working episode of the treatment period for each subject.; Analysed for all insoles collectively.; This assessment was scored on a scale of -3 to +3 with 0 indicating no change indifferent, a positive number indicating well tolerated and negative indicating not well tolerated	Day 31 for subjects that worked 3 consecutive working days. Day 50 for subjects that worked 5 consecutive working days
Other	Investigator global impression of tolerability(Statement) (analysed for all insoles collectively)	Investigator global impression of tolerability, as assessed through comfort, irritation and ADEs across the investigation, completed following the end of the last working episode of the treatment period for the last subject.; Analysed for all insoles collectively.; Statement from the Investigator included within the Clinical Investigation Report	Day 31 for subjects that worked 3 consecutive working days. Day 50 for subjects that worked 5 consecutive working days
Other	Subjects impressions (Questionnaires) (analysed for all insoles collectively)	End of study Subject Perceived Questions, completed on the day of Visit 3.; Analysed for all insoles collectively.; Subjects answered questions with each question having five levels of agreement (strongly disagree to strongly agree), the subjects selected the most appropriate statement.	Day 31 for subjects that worked 3 consecutive working days. Day 50 for subjects that worked 5 consecutive working days
Primary	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress. Assessed though the change in pain, measured by the Brief Pain Inventory questionnaire score. (For each of the four orthotic insoles separately.)	The average change from baseline in the daily composite score of the worst, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain) when compared to the first three days of the last working episode.; To account for differences in subjects working patterns a definition was created, a valid working episode was considered to be two non-working days followed by at least three and up to five working days. (this definition was used for all outcomes); The baseline was defined as the first three consecutive working days of baseline working episode (Days 0-3). The first three days of the last working episode could occur from Days 27-30 for subjects that worked 3 consecutive working days up to Days 44-47 for subjects that worked five consecutive working days; For each of the four orthotic insoles separately.	Time frame is dependent on working pattern Days 0-5 compared to Days 44-47 and Days 0-3 compared to Days 27-30
Secondary	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress over the first three days of each working episode. Assessed though change in pain, measured by the BPI. (For each of the four orthotic insoles)	The average change from baseline in the daily composite score of the worst, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), during the first three consecutive working days of each working episode (WE) of the treatment period; The baseline WE was defined as the first three consecutive working days of (Days 0-3): st WE- the first three days could occur from Days 12-15 for subjects that worked 3 consecutive working days up to Days 23-26 for subjects that worked five consecutive working days; nd WE- the first three days could occur from Days 17-20 for subjects that worked 3 consecutive working days up to Days 30-33 for subjects that worked five consecutive working days; rd WE- the first three days could occur from Days 22-25 for subjects that worked 3 consecutive working days up to Days 37-40 for subjects that worked five consecutive working days	Days 0-5 compared to Days 23-26, Days 30-33, Days 37-40, Days 0-3 compared to Day 12-15, Day 17-20, Day 22-25, Day 27-30 for subjects that worked 3 consecutive working days
Secondary	Evaluation of the pain relief caused by orthotic insoles on pain associated with musculoskeletal stress over each working episode. Assessed though change in pain, measured by the BPI questionnaire.(For each of the four orthotic insoles)	The change from baseline in the composite score of the worse, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), completed at the end of each working episode (WE) of the treatment period.; The baseline WE was defined as Days 0-3 or Days 0-5 depending on the working pattern of the subjects: st WE- the last working day could occur on Day 12-15 for subjects that worked 3 consecutive working days (CWD) up to Days 23-28 for subjects that worked 5 CWD; nd WE- the last working day could occur on Day 17-20 for subjects that worked 3 CWD up to Day 30-35 for subjects that worked 5 CWD; rd WE- the last working day of the 3rd working episode could occur from Day 22-25 for subjects that worked 3 CWD up to Day 37-42 for subjects that worked 5 CWD; th WE- the last working day could occur from Day 27-30 for subjects that worked 3 CWD up to Day 44-49 for subjects that worked 5 CWD	Days 0-5 compared to Day 23-28, Day 30-35, Day 37-42, Day 44-49 for subjects that worked five consecutive working days, Days 0-3 compared to Day 12-15, Day 17-20, Day 22-25, Day 27-30 for subjects that worked 3 consecutive working days
Secondary	Proportion of subjects who achieve a change of =1 unit from baseline Assessed though the change in pain, measured by the Brief Pain Inventory questionnaire score. (For each of the four orthotic insoles separately.)	The overall proportion of subjects who achieve a change of =1 unit from baseline in the daily composite score of the worst, least, average and current pain, as measured by Questions 3-6 of the Brief Pain Inventory (BPI, scored on a scale of 0-10 with the lower number indicating less pain), during the first three consecutive working days of the last working episode of the treatment period. For each of the four orthotic insoles separately.; To account for differences in subjects working patterns a definition was created, a valid working episode was considered to be two non-working days followed by at least three and up to five working days .; The baseline was defined as the first three consecutive working days of baseline working episode (Days 0-3). The first three days of the last working episode could occur from Days 27-30 for subjects that worked 3 consecutive working days up to Days 44-47 for subjects that worked five consecutive working days	Days 0-5 compared to Days 44-47 for subjects that worked 5 consecutive working days, Days 0-3 compared to Days 27-30 for subjects that worked 3 consecutive working days
Secondary	Subject impression of change in pain (Visual Analogue Scale) (For each of the four orthotic insoles separately.)	Subjects' rating of overall improvement in pain since pre-treatment, completed at the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; Scored on a scale of -3 to +3 with 0 indicating no change in pain, a positive number indicating an improvement and negative indicating an increase in the pain	Day 6 and Day 15 (Visit 1) compared to Day 31 and Day 50 depending on the subjects working pattern.
Secondary	Investigator impression of change in subjects' pain (Visual Analogue Scale) (For each of the four orthotic insoles separately.)	Investigator's rating of the subjects' overall improvement in pain since pre-treatment, completed following the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; Scored on a scale of -3 to +3 with 0 indicating no change in pain, a positive number indicating an improvement and negative indicating an increase in the pain	Day 6 and Day 15 (Visit 1) compared to Day 31 and Day 50 depending on the subjects working pattern.
Secondary	Change in quality of life, associated with improvement pain as assessed by the Brief Pain Inventory questionnaire. (For each of the four orthotic insoles separately.)	The change from baseline in quality of life, associated with overall improvement in pain in the primary area of pain, assessed by the Brief Pain Inventory pain (BPI) interference scores (Question 9; composite (average) score), completed at the end of each working episode (WE) of the treatment period.; The baseline WE was defined as Day 3 or Days 5 depending on the working pattern: st WE- occurred from Day 12-15 for subjects that worked 3 consecutive working days (CWD) up to Day 23-28 for subjects that worked 5 CWD; nd working episode- occurred from Day 17-20 for subjects that worked 3 CWD up to Day 30-35 for subjects that worked 5 CDW; rd working episode- occurred from Day 22-25 for subjects that worked 3 CWD up to Day 37-42 for subjects that worked five consecutive working days; th working episode- occurred from Day 27-30 for subjects that worked 3 CWD up to Day 44-49 for subjects that worked 5 CWD The BPI question is a scale of 0-10 with the lower number indicating less pain	Day 5 compared to Day 23-28, Day 30-35, Days 37-42 Day 44-49 for subjects that worked 5 CWD or Day 3 compared to Day 12-15, Day 17-20, Day 22-25, Day 27-30 for subjects that worked 3 CWD
Secondary	Change in quality of life, associated with improvement in pain as assessed by the EQ-5D-5L (questionaire) (For each of the four orthotic insoles separately.)	Change from baseline in quality of life, associated with overall improvement in pain in the primary area of pain, assessed by the EQ-5D-5L, completed at the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; The baseline was defined as the first three up to five consecutive working days of baseline working episode therefore in the context of this endpoint the baseline assessment would occur on Day 3 or Days 5 depending on the working pattern of the subjects. Compared to the responses at the end of last working episode which could occur from Day 30 for subjects that worked 3 consecutive working days up to Day 49 for subjects that worked five consecutive working days.; The EuroQol-5 dimension-5 Level (EQ-5D-5L), is made up of 5 questions scored 1 to 5 from these questions an index is created with a range between zero and 1 with a zero being death and 1 being perfect quality of life.	Day 3 up to 5 compared to Day 49 for subjects that worked five consecutive working days or Day 30 for subjects that worked 3 consecutive working days
Secondary	Change in work productivity and activity as assessed by the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (For each of the four orthotic insoles separately.)	Change from baseline in work productivity and activity, assessed by the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP), completed at the end of last working episode of the treatment period. For each of the four orthotic insoles separately.; The baseline was defined as the first 3 up to 5 consecutive working days (CWD) of baseline working episode therefore in the context of this endpoint the baseline assessment would occur on Day 3 or Days 5 depending on the working pattern of the subjects. Compared to the responses at the end of last working episode which could occur from Day 30 for subjects that worked 3 CWD up to Day 49 for subjects that worked 5 CWD.; The WPAI:SHP six questions on the subjects productivity and activity Impairment. Questions comprised of information on employment, including hours at work, hours missed from work and reasons for work missed. As well as the effect that pain had on their daily activities.	Quality of life on Day 3 up to 5 compared to Day 49 for subjects that worked five consecutive working days or Day 30 for subjects that worked 3 consecutive working days
Secondary	Subject impression of change in their work productivity and activity. (Visual Analogue Scale) (For each of the four orthotic insoles separately.)	Subjects' rating of overall improvement in their quality of life and work productivity and activity since pre-treatment, completed at the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; The last working day is therefore different for each subjects working pattern this could occur from Day 30 for subjects that worked 3 consecutive working days (CWD) up to Day 49 for subjects that worked 5 CWD.; This assessment was scored on a scale of -3 to +3 with 0 indicating no change, a positive number indicating an improvement and negative indicating an increase in quality of life	Quality of life improvement assessed on Day 49 for subjects that worked five consecutive working days or Day 30 for subjects that worked 3 consecutive working days
Secondary	Investigator impression of change in quality of life (Visual Analogue Scale) (For each of the four orthotic insoles separately.)	Investigator's rating of the subjects' overall improvement in their quality of life since pre-treatment, following the end of the last working episode of the treatment period. For each of the four orthotic insoles separately.; The last working day is therefore different for each subjects working pattern this could occur from Day 30 for subjects that worked 3 consecutive working days up to Day 49 for subjects that worked five consecutive working days.; This assessment was scored on a scale of -3 to +3 with 0 indicating no change in quality of life, a positive number indicating an improvement and negative indicating an increase in quality of life	Quality of life improvement assessed on Day 49 for subjects that worked five consecutive working days or Day 30 for subjects that worked 3 consecutive working days
Secondary	Safety and tolerability of the device (For each of the four orthotic insoles separately.)	Overall proportion of subjects with AEs and adverse device effects (ADEs), i.e. the occurrence of one or more AEs/ADEs per subject. For each of the four orthotic insoles separately.	through to study completion, from point of informed consent (Day 1) up to Visit 3 (Day 50)