The aim of the GRASP trial is to assess the clinical and cost effectiveness of individually tailored, progressive exercise compared with best practice advice, with or without corticosteroid injection, in adults with a new episode of shoulder pain attributable to a rotator cuff disorder.
Shoulder pain is very common. Rotator cuff disorders are the most common type of shoulder pain, accounting for 70% of all new cases. Common treatments include advice, rest, painkillers, physiotherapy and steroid injections. Although used quite often, the effectiveness of physiotherapy is unclear. There is uncertainty about which techniques are most effective, how they should be delivered and whether an injection, in addition to exercise, may be of more benefit. We have been commissioned by the NIHR Health Technology Assessment Programme to conduct a randomised trial that aims to give a definitive answer to find the best treatments for rotator cuff disorders.
The primary objectives of the GRASP trial are to assess whether:
1) An individually tailored progressive exercise programme supervised by a physiotherapist provides greater improvement in shoulder pain and function at 12 months compared to a best practice advice session with a physiotherapist, supported by high quality materials; and whether
2) Sub-acromial corticosteroid injection provides greater improvement in shoulder pain and function at 12 months compared to no injection.
We will conduct a within-trial economic analysis and estimate treatment effects in a range of secondary outcomes.
GRASP is a multicentre randomised controlled trial using a 2x2 factorial design. We plan to recruit 704 participants with a new episode of shoulder pain, attributable to a rotator cuff disorder, across at least eight musculoskeletal services and their related physiotherapy services in the UK.