GRASP

Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial.

Hopewell S, Keene DJ, Marian IR, et al. Lancet (London, England) 2021 · PMID 34265255 · doi:10.1016/s0140-6736(21)00846-1

Question

Does a progressive physiotherapist-led exercise programme, or a subacromial corticosteroid injection, improve rotator cuff disorder pain and function more than a single session of best practice advice?

Design

Pragmatic 2x2 factorial multicentre superiority RCT across 20 UK NHS trusts.

Patients

Adults with a new episode (within six months) of rotator cuff disorder not being considered for surgery.

Intervention

Progressive exercise (up to six physiotherapy sessions) and/or corticosteroid injection

Comparison

Single session of best practice advice and/or no injection

Primary outcome

Shoulder Pain and Disability Index (SPADI) over 12 months

Key result

Progressive exercise was not superior to a single advice session at 12 months. Injection gave a short-term benefit at 8 weeks but not at 12 months.

Limitations

The advice session was itself of high quality, and adherence to home exercises was not fully controlled.

Impact on practice

Supports a single, well-delivered advice and home exercise session as first-line care, with injection reserved for short-term relief.