Effectiveness of GP access to magnetic resonance imaging of the knee:  a randomised trial

DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) Trial Team; Stephen Derek Brealey; Helen Cox; Veronica Mary Morton; David John Torgerson

doi:10.3399/bjgp08X342651

Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial

DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) Trial Team, Stephen Derek Brealey, Helen Cox, Veronica Mary Morton, David John Torgerson

Health Sciences

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

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 language	English
Pages (from-to)	767-774
Number of pages	8
Journal	British Journal of General Practice
Volume	58
Issue number	556
DOIs	https://doi.org/10.3399/bjgp08X342651
Publication status	Published - Nov 2008

Keywords

family practice
knee injuries
magnetic resonance imaging
randomised controlled trial
GENERAL-PRACTITIONERS
LUMBAR SPINE
PRIMARY-CARE
QUESTIONNAIRE
QUALITY
SF-36
MRI

Access to Document

10.3399/bjgp08X342651

http://www.ingentaconnect.com/content/rcgp/bjgp/2008/00000058/00000556/art00001?token=005e1ebc104da826a8b25c383a4b3b25702a7b425f4038592c74634c2a726e2d58464340592f3f3b578c5b88db82da

Cite this

@article{d9d8150b7f6a4ad0b7730da2386a41b7,

title = "Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial",

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.",

keywords = "family practice, knee injuries, magnetic resonance imaging, randomised controlled trial, GENERAL-PRACTITIONERS, LUMBAR SPINE, PRIMARY-CARE, QUESTIONNAIRE, QUALITY, SF-36, MRI",

author = "{DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) Trial Team} and Brealey, {Stephen Derek} and Helen Cox and Morton, {Veronica Mary} and Torgerson, {David John}",

year = "2008",

month = nov,

doi = "10.3399/bjgp08X342651",

language = "English",

volume = "58",

pages = "767--774",

journal = "The British journal of general practice : the journal of the Royal College of General Practitioners",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "556",

}

Effectiveness of GP access to magnetic resonance imaging of the knee : a randomised trial. / DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) Trial Team ; Brealey, Stephen Derek ; Cox, Helen et al.

In: British Journal of General Practice, Vol. 58, No. 556, 11.2008, p. 767-774.

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

TY - JOUR

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

T2 - a randomised trial

AU - DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) Trial Team

AU - Brealey, Stephen Derek

AU - Cox, Helen

AU - Morton, Veronica Mary

AU - Torgerson, David John

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

UR - http://www.scopus.com/inward/record.url?scp=56249132662&partnerID=8YFLogxK

U2 - 10.3399/bjgp08X342651

DO - 10.3399/bjgp08X342651

M3 - Article

C2 - 19000393

VL - 58

SP - 767

EP - 774

JO - The British journal of general practice : the journal of the Royal College of General Practitioners

JF - The British journal of general practice : the journal of the Royal College of General Practitioners

SN - 0960-1643

IS - 556

ER -

Effectiveness of GP access to magnetic resonance imaging of the knee: a randomised trial

Abstract

Keywords

Access to Document

Other files and links

Cite this