Development and implementation of the physiotherapy-led exercise interventions for the treatment of rotator cuff disorders for the 'Getting it Right: Addressing Shoulder Pain' (GRASP) trial

David J Keene; Hessam Soutakbar; Sally Hopewell; Peter Heine; Anju Jaggi; Chris Littlewood; Zara Hansen; Karen Barker; Willie Hamilton; Andrew J Carr; Sarah E Lamb

doi:10.1016/j.physio.2019.07.002

Development and implementation of the physiotherapy-led exercise interventions for the treatment of rotator cuff disorders for the 'Getting it Right: Addressing Shoulder Pain' (GRASP) trial

Physiotherapy. 2020 Jun:107:252-266. doi: 10.1016/j.physio.2019.07.002. Epub 2019 Jul 9.

Authors

Affiliations

¹ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. Electronic address: david.keene@ndorms.ox.ac.uk.
² Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
³ Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK.
⁴ Primary Care and Health Sciences, Keele University, Keele, UK.
⁵ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁶ Institute of Health Research, University of Exeter, Exeter, UK.

PMID: 32026827
DOI: 10.1016/j.physio.2019.07.002

Abstract

Objectives: The Getting it Right: Addressing Shoulder Pain (GRASP) trial is a large-scale, multicentre, 2×2 factorial randomised controlled trial investigating clinical and cost-effectiveness of a progressive exercise programme versus best-practice advice, with or without corticosteroid injection, for treating people with rotator cuff disorders. Here we describe the development, implementation and details of the physiotherapy-led interventions.

Methods: Medical Research Council guidance for developing complex interventions were used, taking into account clinical guidelines, expert and patient opinion, research evidence, current practice variation, and deliverability. A stakeholder meeting of 26 experts, clinicians, researchers, and patient representatives was used to design key components of the interventions. Stakeholders prioritised strengthening posterior rotator cuff muscles and using practical, easy-to-do exercises. The interventions were designed to be deliverable across the UK National Health Service.

Results: Progressive exercise consists of up to six sessions with a physiotherapist over 16 weeks. The best-practice advice consists of one face-to-face session with a physiotherapist with substantially greater reliance on self-management. Both interventions include self-management advice, home-exercise instruction, and behaviour-change strategies to target exercise adherence. All participants receive a Participant Information Booklet. The best-practice advice intervention is a self-guided system of progressively challenging exercises, with demonstration videos and written materials. The progressive exercise intervention has a wider range of exercise options, and greater flexibility for tailoring, progression, supervised practice and feedback.

Conclusion: GRASP has recruited 708 participants and will provide high quality evidence to inform management of people with shoulder pain due to a rotator cuff disorder. Results are anticipated in 2020.

Trial registration number: ISRCTN16539266; EudraCT number:2016-002991-28.

Keywords: Clinical Trial; Exercise; Shoulder Pain.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Adrenal Cortex Hormones / administration & dosage*
Adult
Combined Modality Therapy
Disability Evaluation
Exercise Therapy / methods*
Humans
Injections, Intra-Articular
Pain Measurement
Rotator Cuff Injuries / drug therapy*
Rotator Cuff Injuries / rehabilitation*
Shoulder Pain / drug therapy*
Shoulder Pain / rehabilitation*
Young Adult

Substances

Adrenal Cortex Hormones

Abstract

Publication types

MeSH terms

Substances

Grants and funding