Influence of magnetic resonance imaging of the knee on GPs' decisions: 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. TorgersonV. Wadsworth, C. Wilkinson, DAMASK Trial Team

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Abstract

Background Magnetic resonance imaging (MRI) of the knee for meniscus and ligament injuries is an accurate diagnostic test. Early and accurate diagnosis of patients with knee problems may prevent the onset of chronic problems such as osteoarthritis, a common cause of disability in older people consulting their GR

Aim To assess the effect of early access to MRI compared with referral to an orthopaedic specialist, on GPs' diagnoses and treatment plans for patients with knee problems.

Design of study A multicentre, pragmatic, randomised controlled trial.

Setting Five hundred and fifty-three patients with knee problems were recruited from 163 general practices across the UK from November 2002 to October 2004.

Method Eligible patients were randomised to MRI or consultation with an orthopaedic specialist. GlPs made a concomitant provisional referral to orthopaeclics for patients who were allocated to imaging. GPs recorded patients' diagnoses, treatment plans, and their confidence in these decisions at trial entry and followup. Data were analysed as intention to treat.

Results There was no significant difference between MRI and orthopaeclic groups for changes in diagnosis (P = 0.79) or treatment plans (P = 0.059). Significant changes in diagnostic and therapeutic confidence were observed for both groups with a greater increase in diagnostic confidence (P<0.001) and therapeutic confidence (P 0.002) in the MRI group. There was a significant increase in within-group changes in diagnostic and therapeutic confidence.

Conclusion Access to MRI did not significantly alter GlPs' diagnoses or treatment plans compared with direct referral to an orthopaedic specialist, but access to MRI significantly increased their confidence in these decisions.

Original languageEnglish
Pages (from-to)622-629
Number of pages8
JournalThe British Journal of General Practice
Volume57
Issue number541
Publication statusPublished - 1 Aug 2007

Keywords

  • decision making
  • family practice
  • knee
  • magnetic resonance imaging
  • low-back-pain
  • direct access
  • general-practitioners
  • lumbar spine
  • primary-care
  • MRI
  • radiography
  • management

Cite this

Andronis, L., Bryan, S., Atwell, C., Brealey, S. D., Coulton, S., Cox, H., Cross, B., Fylan, F., Garratt, A. M., Gilbert, F. J., Gillan, M. G. C., Hendry, M., Hood, K., Houston, H., King, D., Morton, V., Orchard, J., Robling, M., Russell, I. T., ... DAMASK Trial Team (2007). Influence of magnetic resonance imaging of the knee on GPs' decisions: A randomised trial. The British Journal of General Practice, 57(541), 622-629.