Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a randomised controlled trial

Review written by Ben Cormack info

Key Points

  1. Progressive and supervised exercise was not found to be superior to best practice advice including a home exercise program.
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BACKGROUND & OBJECTIVE

For adults over 45, around 1% will seek help through primary care for a new episode of shoulder pain. Of these, 70% are disorders of the rotator cuff. These disorders can be painful and functionally limiting up to two years later.

Exercise is a commonly used intervention to manage shoulder pain (1), but currently it is unclear which dosages and programmes produce the best outcomes, including whether they should be supervised or self-directed by the patient. Corticosteroid injections are also used increasingly for patients with shoulder pain, with some evidence for benefit in the short-term, but the evidence is unclear in the longer term.

The GRASP (Getting it Right: Addressing Shoulder Pain) trial set out to compare two things:

  1. An individually tailored, progressive exercise programme prescribed and supervised by a physiotherapist, versus a best practice advice session with a physiotherapist.
  2. Subacromial corticosteroid injection versus no injection.

70% of shoulder pain episodes in adults over 45 are related to disorders of the rotator cuff.
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There may be a diminishing return from time spent constructing highly specialized programs.

METHODS

This was a multicentre, pragmatic, superiority, randomized controlled trial that recruited patients over 18 years of age from across 20 UK health services. Patients were eligible if they had rotator cuff disorder (cuff tendonitis, impingement syndrome, tendinopathy, or rotator cuff

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