The DAMASK trial protocol: a pragmatic randomised trial to evaluate whether GPs should have direct access to MRI for patients with suspected internal derangement of the knee

Brealey, S.D. and Atwell, C. and Bryan, S. and Coulton, S. and Cox, H. and Cross, B. and Fylan, F. and Garratt, A. and Gilbert, F.J. and Gillan, M.G.C. and Hendry, M. and Hood, K. and Houston, H. and King, D. and Morton, V. and Orchard, J. and Robling, M. and Russell, I.T. and Torgerson, D. and Wadsworth, V. and Wilkinson, C. (2006) The DAMASK trial protocol: a pragmatic randomised trial to evaluate whether GPs should have direct access to MRI for patients with suspected internal derangement of the knee. Bmc Health Services Research, 6 . p. 133. ISSN 1472-6963. (The full text of this publication is not available from this repository)

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Abstract

Background: Though new technologies like Magnetic Resonance Imaging (MRI) may be accurate, they often diffuse into practice before thorough assessment of their value in diagnosis and management, and of their effects on patient outcome and costs. MRI of the knee is a common investigation despite concern that it is not always appropriate. There is wide variation in general practitioners (GPs) access to, and use of MRI, and in the associated costs. The objective of this study was to resolve uncertainty whether GPs should refer patients with suspected internal derangement of the knee for MRI or to an orthopaedic specialist in secondary care. Methods/Design: The design consisted of a pragmatic multi-centre randomised trial with two parallel groups and concomitant economic evaluation. Patients presenting in general practice with suspected internal derangement of the knee and for whom their GP was considering referral to an orthopaedic specialist in secondary care were eligible for inclusion. Within practices, GPs or practice nurses randomised eligible and consenting participants to the local radiology department for an MRI examination, or for consultation with an orthopaedic specialist. To ensure that the waiting time from GP consultation to orthopaedic appointment was similar for both trial arms, GPs made a provisional referral to orthopaedics when requesting the MRI examination. Thus we evaluated the more appropriate sequence of events independent of variations in waiting times. Follow up of participants was by postal questionnaires at six, twelve and 24 months after randomisation. This was to ensure that the evaluation covered all events up to and including arthroscopy. Discussion: The DAMASK trial should make a major contribution to the development of evidence-based partnerships between primary and secondary care professionals and inform the debate when MRI should enter the diagnostic pathway.

Item Type: Article
Additional information: Times Cited: 5
Uncontrolled keywords: Adolescent Adult Clinical Competence Clinical Protocols Confidence Intervals Family Practice/education/*standards Female Great Britain Health Services Accessibility/*organization & administration Humans Knee Injuries/*diagnosis Magnetic Resonance Imaging/*utilization Male Middle Aged Orthopedics Physical Therapy (Specialty) Range of Motion, Articular Referral and Consultation/*organization & administration Research Design Risk Factors
Subjects: R Medicine > R Medicine (General)
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Simon Coulton
Date Deposited: 19 Mar 2009 15:07
Last Modified: 25 Jun 2012 15:48
Resource URI: http://kar.kent.ac.uk/id/eprint/16978 (The current URI for this page, for reference purposes)
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