Progressive exercise not superior to best practice advice in rotator cuff disorders: Lancet

Corticosteroid injections and physiotherapy exercise programmes are commonly used to treat rotator cuff disorders but the treatments' effectiveness is uncertain.

A group of researchers from the University of Oxford, Oxford, UK conducted a study to compare the clinical effectiveness and cost-effectiveness of a progressive exercise programme with a single session of best practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder.

The researchers conducted a pragmatic, multicentre, superiority, randomised controlled trial (2 × 2 factorial), wherein they recruited patients from 20 UK National Health Service trusts, who were aged 18 years or older with a rotator cuff.

Following which all the patients were randomly assigned to either progressive exercise (≤6 sessions), best practice advice (one session), corticosteroid injection then progressive exercise, or corticosteroid injection then best practice advice.

The primary outcome was the Shoulder Pain and Disability Index (SPADI) score over 12 months, analysed on an intention-to-treat basis (statistical significance set at 1%).

The results of the study are as follows:

• Over 12 months, SPADI data were available for 166 (95%) patients in the progressive exercise group, 164 (94%) in the best practice advice group, 177 (97%) in the corticosteroid injection then progressive exercise group, and 175 (98%) in the corticosteroid injection then best practice advice group.
• No evidence of a difference was found in SPADI score between progressive exercise and best practice advice when analysed over 12 months.
• Also, no evidence of a difference was found between corticosteroid injection compared with no injection when analysed over 12 months.
• No serious adverse events were reported.

The researchers concluded that progressive exercise was similar to a best practice advice session with a physiotherapist in improving shoulder pain and function. And subacromial corticosteroid injection provided no long-term benefit in patients with rotator cuff disorders.

Reference:

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 by Hopewell S et. al published in the Lancet.

DOI: https://doi.org/10.1016/S0140-6736(21)00846-1