Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2006 Oct 13:6:133.
doi: 10.1186/1472-6963-6-133.

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

Stephen D Brealey  1 , Christine Atwell, Stirling Bryan, Simon Coulton, Helen Cox, Ben Cross, Fiona Fylan, Andrew Garratt, Fiona J Gilbert, Maureen G C Gillan, Maggie Hendry, Kerenza Hood, Helen Houston, David King, Veronica Morton, Jo Orchard, Michael Robling, Ian T Russell, David Torgerson, Valerie Wadsworth, Clare Wilkinson
Affiliations
Randomized Controlled Trial

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

Stephen D Brealey et al. BMC Health Serv Res. .

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Trial Design.
Figure 2
Figure 2
Educational reminder.
Figure 3
Figure 3
Distinctive features of osteoarthritis rather than internal derangement of the knee.
Figure 4
Figure 4
Reasons to refer for physiotherapy.
See this image and copyright information in PMC

References

    1. Office of Population Censuses & Surveys Morbidity statistics from general practice: fourth national study 1991–92 London. 1995.
    1. Mackenzie R, Dixon AK, Keene GS, Hollingworth W, Lomas DJ, Villar RN. MRI of the knee: assessment of effectiveness. Clin Radiol. 1996;51:245–250. doi: 10.1016/S0009-9260(96)80340-0. - DOI - PubMed
    1. Mackenzie R, Logan BM, Shah NJ, Keene GS, Dixon AK. Direct anatomical-MRI correlation: the knee. Surg Radiol Anat. 1994;16:183–192. doi: 10.1007/BF01627593. - DOI - PubMed
    1. Fisher SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD. Accuracy of diagnosis from magnetic resonance imaging of the knee: a multi centre analysis of one thousand and fourteen patients. J Bone Joint Surg. 1991;73A:2–10. - PubMed
    1. Quinn SF, Brown TF. Meniscal tears diagnosed with MR imaging versus arthroscopy: how reliable a standard is arthroscopy? Radiology. 1991;181:843–847. - PubMed

Publication types

MeSH terms