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

• Main Authors: Orchard Jo, Morton Veronica, King David, Houston Helen, Hood Kerenza, Hendry Maggie, Gillan Maureen GC, Gilbert Fiona J, Garratt Andrew, Fylan Fiona, Cross Ben, Cox Helen, Coulton Simon, Bryan Stirling, Atwell Christine, Brealey Stephen D, Robling Michael, Russell Ian T, Torgerson David, Wadsworth Valerie, Wilkinson Clare
• Format: Article
• Language: English
• Published: BMC 2006-10-01
• Series: BMC Health Services Research
• Online Access: http://www.biomedcentral.com/1472-6963/6/133

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods/Design</p> <p>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.</p> <p>Discussion</p> <p>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.</p>