Lay summary
A shift from passive to active self-management of musculoskeletal disorders has been called for, including shoulder pain, one of the most common types of musculoskeletal pain. Long waiting lists and frequent cancellation for specialist orthopaedic care occur in the national health system. A new approach is needed to improve access to shoulder rehabilitation while minimising cost. The primary aim of this randomised clinical trial is to define the effectiveness of a Stepped Care Model for persistent rotator cuff shoulder pain, compared to usual, pragmatic physiotherapy. The second aim is to explore patient perspectives and experiences of the interventions. The third aim is to evaluate the cost-effectiveness of the Stepped Care Model with pragmatic physiotherapy. We hypothesize that a Stepped Care Model will (i) be equivalent to those of pragmatic usual physiotherapy for people with RCRSP for patient-reported outcomes and (ii) have lower individual and health system costs than usual.