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. Torgerson; V. Wadsworth; C. Wilkinson; DAMASK Trial Team

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

Applied Medicine

Research output: Contribution to journal › Article › peer-review

24 Citations (Scopus)

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 language	English
Pages (from-to)	622-629
Number of pages	8
Journal	The British Journal of General Practice
Volume	57
Issue number	541
Publication status	Published - 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

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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.

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 2007, 'Influence of magnetic resonance imaging of the knee on GPs' decisions: A randomised trial', The British Journal of General Practice, vol. 57, no. 541, pp. 622-629.

@article{df73888b77034f269f2919ea5283e276,

title = "Influence of magnetic resonance imaging of the knee on GPs' decisions: A randomised trial",

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 GRAim 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.",

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

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}",

year = "2007",

month = aug,

day = "1",

language = "English",

volume = "57",

pages = "622--629",

journal = "The British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "541",

}

TY - JOUR

T1 - Influence of magnetic resonance imaging of the knee on GPs' decisions

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 - 2007/8/1

Y1 - 2007/8/1

N2 - 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 GRAim 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.

AB - 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 GRAim 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.

KW - decision making

KW - family practice

KW - knee

KW - magnetic resonance imaging

KW - low-back-pain

KW - direct access

KW - general-practitioners

KW - lumbar spine

KW - primary-care

KW - MRI

KW - radiography

KW - management

M3 - Article

SN - 0960-1643

VL - 57

SP - 622

EP - 629

JO - The British Journal of General Practice

JF - The British Journal of General Practice

IS - 541

ER -

Influence of magnetic resonance imaging of the knee on GPs' decisions: A randomised trial

Abstract

Keywords

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