Effectiveness of GP access to magnetic resonance imaging of the knee

a randomised trial

L. Andronis, S. Bryan, C. Atwell, S. D. Brealey, S. Coulton, H. Cox, B. Cross, F. Fylan, A. M. Garratt, Fiona Jane Gilbert, Maureen Grace Charles Gillan, M. Hendry, K. Hood, H. Houston, D. King, V. Morton, J. Orchard, M. Robling, I. T. Russell, D. Torgerson & 3 others V. Wadsworth, C. Wilkinson, DAMASK Trial Team

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background GPs commonly see patients with knee problems. Magnetic resonance imaging (MRI) of the knee is an accurate diagnostic test for meniscus and ligament injuries of the knee, but there is uncertainty about the appropriate use of MRI and when it should enter the diagnostic pathway for patients with these problems.

Aim To assess the effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems.

Design of study Pragmatic multicentre randomised trial with two parallel groups.

Setting A total of 553 patients consulting their GP about a continuing knee problem were recruited from 163 general practices at 11 sites across the UK.

Method Patients were randomised to MRI within 12 weeks of GP referral including a provisional orthopaedic appointment, or orthopaedic appointment without prior MRI within a maximum of 9 months from GP referral. The primary outcome measures were the Short Form 36-item (SF-36) physical functioning scale and the Knee Quality of Life 26-item Questionnaire (KQoL-26) at 6, 12, and 24 months.

Results Patients randomised to MRI improved mean SF-36 physical functioning scores by 2.81 (95% confidence interval [CI] = -0.26 to 5.89) more than those referred to orthopaedics (P = 0.072). Patients randomised to MRI improved mean KQoL-26 physical functioning scores by 3.65 (95% Cl = 1.03 to 6.28) more than controls (P = 0.007). There were no other significant differences.

Conclusion GP access to MRI yielded small, but statistically significant, benefits in patients' knee-related quality of life but non-significant improvements in physical functioning.

Original languageEnglish
Pages (from-to)e1-9
Number of pages9
JournalThe British Journal of General Practice
Volume58
Issue number556
DOIs
Publication statusPublished - Nov 2008

Keywords

  • family practice
  • knee injuries
  • magnetic resonance imaging
  • randomised controlled trial
  • general-practitioners
  • lumbar spine
  • primary-care
  • questionnaire
  • quality
  • SF-36
  • MRI

Cite this

Andronis, L., Bryan, S., Atwell, C., Brealey, S. D., Coulton, S., Cox, H., ... DAMASK Trial Team (2008). Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial. The British Journal of General Practice, 58(556), e1-9. https://doi.org/10.3399/bjgp08X342651

Effectiveness of GP access to magnetic resonance imaging of the knee : a randomised trial. / Andronis, L.; Bryan, S.; Atwell, C.; Brealey, S. D.; Coulton, S.; Cox, H.; Cross, B.; Fylan, F.; Garratt, A. M.; Gilbert, Fiona Jane; Gillan, Maureen Grace Charles; Hendry, M.; Hood, K.; Houston, H.; King, D.; Morton, V.; Orchard, J.; Robling, M.; Russell, I. T.; Torgerson, D.; Wadsworth, V.; Wilkinson, C.; DAMASK Trial Team.

In: The British Journal of General Practice, Vol. 58, No. 556, 11.2008, p. e1-9.

Research output: Contribution to journalArticle

Andronis, L, Bryan, S, Atwell, C, Brealey, SD, Coulton, S, Cox, H, Cross, B, Fylan, F, Garratt, AM, Gilbert, FJ, Gillan, MGC, Hendry, M, Hood, K, Houston, H, King, D, Morton, V, Orchard, J, Robling, M, Russell, IT, Torgerson, D, Wadsworth, V, Wilkinson, C & DAMASK Trial Team 2008, 'Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial', The British Journal of General Practice, vol. 58, no. 556, pp. e1-9. https://doi.org/10.3399/bjgp08X342651
Andronis, L. ; Bryan, S. ; Atwell, C. ; Brealey, S. D. ; Coulton, S. ; Cox, H. ; Cross, B. ; Fylan, F. ; Garratt, A. M. ; Gilbert, Fiona Jane ; Gillan, Maureen Grace Charles ; Hendry, M. ; Hood, K. ; Houston, H. ; King, D. ; Morton, V. ; Orchard, J. ; Robling, M. ; Russell, I. T. ; Torgerson, D. ; Wadsworth, V. ; Wilkinson, C. ; DAMASK Trial Team. / Effectiveness of GP access to magnetic resonance imaging of the knee : a randomised trial. In: The British Journal of General Practice. 2008 ; Vol. 58, No. 556. pp. e1-9.
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abstract = "Background GPs commonly see patients with knee problems. Magnetic resonance imaging (MRI) of the knee is an accurate diagnostic test for meniscus and ligament injuries of the knee, but there is uncertainty about the appropriate use of MRI and when it should enter the diagnostic pathway for patients with these problems.Aim To assess the effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems.Design of study Pragmatic multicentre randomised trial with two parallel groups.Setting A total of 553 patients consulting their GP about a continuing knee problem were recruited from 163 general practices at 11 sites across the UK.Method Patients were randomised to MRI within 12 weeks of GP referral including a provisional orthopaedic appointment, or orthopaedic appointment without prior MRI within a maximum of 9 months from GP referral. The primary outcome measures were the Short Form 36-item (SF-36) physical functioning scale and the Knee Quality of Life 26-item Questionnaire (KQoL-26) at 6, 12, and 24 months.Results Patients randomised to MRI improved mean SF-36 physical functioning scores by 2.81 (95{\%} confidence interval [CI] = -0.26 to 5.89) more than those referred to orthopaedics (P = 0.072). Patients randomised to MRI improved mean KQoL-26 physical functioning scores by 3.65 (95{\%} Cl = 1.03 to 6.28) more than controls (P = 0.007). There were no other significant differences.Conclusion GP access to MRI yielded small, but statistically significant, benefits in patients' knee-related quality of life but non-significant improvements in physical functioning.",
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author = "L. Andronis and S. Bryan and C. Atwell and Brealey, {S. D.} and S. Coulton and H. Cox and B. Cross and F. Fylan and Garratt, {A. M.} and Gilbert, {Fiona Jane} and Gillan, {Maureen Grace Charles} and M. Hendry and K. Hood and H. Houston and D. King and V. Morton and J. Orchard and M. Robling and Russell, {I. T.} and D. Torgerson and V. Wadsworth and C. Wilkinson and {DAMASK Trial Team}",
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TY - JOUR

T1 - Effectiveness of GP access to magnetic resonance imaging of the knee

T2 - a randomised trial

AU - Andronis, L.

AU - Bryan, S.

AU - Atwell, C.

AU - Brealey, S. D.

AU - Coulton, S.

AU - Cox, H.

AU - Cross, B.

AU - Fylan, F.

AU - Garratt, A. M.

AU - Gilbert, Fiona Jane

AU - Gillan, Maureen Grace Charles

AU - Hendry, M.

AU - Hood, K.

AU - Houston, H.

AU - King, D.

AU - Morton, V.

AU - Orchard, J.

AU - Robling, M.

AU - Russell, I. T.

AU - Torgerson, D.

AU - Wadsworth, V.

AU - Wilkinson, C.

AU - DAMASK Trial Team

PY - 2008/11

Y1 - 2008/11

N2 - Background GPs commonly see patients with knee problems. Magnetic resonance imaging (MRI) of the knee is an accurate diagnostic test for meniscus and ligament injuries of the knee, but there is uncertainty about the appropriate use of MRI and when it should enter the diagnostic pathway for patients with these problems.Aim To assess the effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems.Design of study Pragmatic multicentre randomised trial with two parallel groups.Setting A total of 553 patients consulting their GP about a continuing knee problem were recruited from 163 general practices at 11 sites across the UK.Method Patients were randomised to MRI within 12 weeks of GP referral including a provisional orthopaedic appointment, or orthopaedic appointment without prior MRI within a maximum of 9 months from GP referral. The primary outcome measures were the Short Form 36-item (SF-36) physical functioning scale and the Knee Quality of Life 26-item Questionnaire (KQoL-26) at 6, 12, and 24 months.Results Patients randomised to MRI improved mean SF-36 physical functioning scores by 2.81 (95% confidence interval [CI] = -0.26 to 5.89) more than those referred to orthopaedics (P = 0.072). Patients randomised to MRI improved mean KQoL-26 physical functioning scores by 3.65 (95% Cl = 1.03 to 6.28) more than controls (P = 0.007). There were no other significant differences.Conclusion GP access to MRI yielded small, but statistically significant, benefits in patients' knee-related quality of life but non-significant improvements in physical functioning.

AB - Background GPs commonly see patients with knee problems. Magnetic resonance imaging (MRI) of the knee is an accurate diagnostic test for meniscus and ligament injuries of the knee, but there is uncertainty about the appropriate use of MRI and when it should enter the diagnostic pathway for patients with these problems.Aim To assess the effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems.Design of study Pragmatic multicentre randomised trial with two parallel groups.Setting A total of 553 patients consulting their GP about a continuing knee problem were recruited from 163 general practices at 11 sites across the UK.Method Patients were randomised to MRI within 12 weeks of GP referral including a provisional orthopaedic appointment, or orthopaedic appointment without prior MRI within a maximum of 9 months from GP referral. The primary outcome measures were the Short Form 36-item (SF-36) physical functioning scale and the Knee Quality of Life 26-item Questionnaire (KQoL-26) at 6, 12, and 24 months.Results Patients randomised to MRI improved mean SF-36 physical functioning scores by 2.81 (95% confidence interval [CI] = -0.26 to 5.89) more than those referred to orthopaedics (P = 0.072). Patients randomised to MRI improved mean KQoL-26 physical functioning scores by 3.65 (95% Cl = 1.03 to 6.28) more than controls (P = 0.007). There were no other significant differences.Conclusion GP access to MRI yielded small, but statistically significant, benefits in patients' knee-related quality of life but non-significant improvements in physical functioning.

KW - family practice

KW - knee injuries

KW - magnetic resonance imaging

KW - randomised controlled trial

KW - general-practitioners

KW - lumbar spine

KW - primary-care

KW - questionnaire

KW - quality

KW - SF-36

KW - MRI

U2 - 10.3399/bjgp08X342651

DO - 10.3399/bjgp08X342651

M3 - Article

VL - 58

SP - e1-9

JO - The British Journal of General Practice

JF - The British Journal of General Practice

SN - 0960-1643

IS - 556

ER -