Does MRI add value in general practice for patients with traumatic knee complaints? A 1-year randomised controlled trial

Swart, Nynke M; Oudenaarde, Kim van; Bierma-Zeinstra, Sita M A; Bloem, Hans J L; Hout, Wilbert B. van den; Algra, Paul R.; Bindels, Patrick J E; Koes, Bart W.; Nelissen, Rob G H H; Verhaar, Jan A N; Reijnierse, M.; Luijsterburg, Pim A J

doi:10.1136/bjsports-2017-098932

Cited by 2 publications

(4 citation statements)

References 19 publications

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“…A large Netherlands-based multi-centre, non-inferiority randomized control trial (TACKLE Trial ¼ TraumAtic Complaints of the Knee -Leiden University Medical Center (LUMC) and Erasmus MC Trial) provides new evidence that GP MRI referrals (356 patients aged 18-45 years) for traumatic knee complaints following clinical pathways resulted in neither worse nor better outcomes than usual care for quality-oflife knee-related daily function during a 1-year follow up. 27 Our study shows decisions for specialist referral and appropriate intervention are improved when guidelines were consistently followed. The TACKLE Trial could be seen as a difference in management of operative versus non-operative care, rather than the role of MRI in outcomes.…”

Section: Comparison With Existing Literaturementioning

confidence: 77%

“…Their inclusion criteria of generalised knee complaint due to trauma or sudden onset adds weight to the use of specific condition clinical guidelines, such as those used in our study. Kisser et al 12 and the TACKLE Trial team 27 both emphasise the importance of radiologist involvement in decision-making; something that our trial encouraged and was well-received by GPs.…”

Section: Comparison With Existing Literaturementioning

confidence: 79%

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Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

Kara¹,

Smart²,

Officer³

et al. 2019

J Prim Health Care

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INTRODUCTIONMagnetic resonance imaging (MRI) is an accurate diagnostic test used mainly in secondary care. Uncertainty exists regarding the ability of general practitioners (GPs) to use direct access high-tech imaging pathways appropriately when managing musculoskeletal injury. AIMTo evaluate the use of primary care-centric guidelines, training and quality assurance on the appropriateness of GP MRI referrals for patients with selected musculoskeletal injuries. METHODSThis is an 18-month primary care retrospective study. GPs participated in clinical musculoskeletal training, enabling patient referral for MRI on four body sites. Two reviewers categorised referral appropriateness independently, and reviewer inter-rater agreement between categorisations was measured. MRI results and patient management pathways were described. Associations of scan status and patient management were examined using logistic regression. RESULTSIn total, 273 GPs from 72 practices attended training sessions to receive MRI referral accreditation. Of these, 150 (55%) GPs requested 550 MRI scans, with 527 (96%) eligible for analysis, resulting in 86% considered appropriate; 79% consistent with guidelines and 7% clinically useful but for conditions outside of guidelines. Inter-rater agreement was 75%. Cohen's weighted kappa statistic was 0.38 (95% CI: 0.28–0.48). MRI referrals consistent with guidelines were more likely to show pathology requiring specialist intervention (reviewer 1: odds ratio=2.64, 95% CI 1.51–4.62; reviewer 2: odds ratio=4.44, 95% CI 2.47–7.99), compared to scan requests graded not consistent. DISCUSSIONStudy findings indicate GPs use decision support guidance well, and this has resulted in appropriate MRI referrals and higher specialist intervention rates for selected conditions.

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Section: Comparison With Existing Literaturementioning

confidence: 77%

Section: Comparison With Existing Literaturementioning

confidence: 79%

Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

Kara¹,

Smart²,

Officer³

et al. 2019

J Prim Health Care

View full text Add to dashboard Cite

show abstract

“…24 Another trial found that adding MRI in primary care for younger patients with traumatic knee complaints did not improve knee-related function after one year. 33 These studies show that adding imaging tests that are known to yield high rates of structural asymptomatic findings to the care pathway of musculoskeletal disorders do not translate into better patients' outcomes. It can contribute to overdiagnosis and overuse of subsequent treatments such as surgery.…”

Section: Trials Linking Diagnostic Tests To Patients' Outcomesmentioning

confidence: 99%

“…An interesting finding of the previous trials was that physicians and patients mostly preferred the use of the advanced imaging techniques and were more satisfied with their care although patients' outcomes were not improved. 27,33 This situation poses a real challenge for clinicians. Conceptual models propose that receiving a diagnostic label may have physical, psychosocial and financial consequences as well as increasing treatment burden, exposure to unnecessary tests and treatments and adverse events that lead to dissatisfaction with care.…”

Section: Prognosis-rarely Used But As Equally Importantmentioning

confidence: 99%

Higher order thinking about differential diagnosis

Cook

Décary

2020

Brazilian Journal of Physical Therapy

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Background: Differential diagnosis is a systematic process used to identify the proper diagnosis from a set of possible competing diagnoses. Methods: The goal of this masterclass is to discuss the higher order thinking components of differential diagnosis. Conclusions: For healthcare providers, diagnosis is one of many necessary components during the clinical decision making process and it is hallmarked by differentiation of competing structures for a definitive understanding of the underlying condition. The diagnostic process involves identifying or determining the etiology of a disease or condition through evaluation of patient history, physical examination, and review of laboratory data or diagnostic imaging; and the subsequent descriptive title of that finding. Whereas differential diagnosis is a varied skill set among all healthcare providers, the concept of a diagnosis is equally germane, regardless of one's background. In theory, a diagnosis improves the use of classification tools, improves clarity and communication, provides a trajectory of treatment, improves understanding of a person's prognosis, and in some cases, may be useful for preventative treatments. To achieve these improvements, one must have an understanding of relation of the clinical utility of tests and measures with diagnosis, and how to best implement these findings in clinical practice. This requires a deeper understanding (higher order thinking) of the role of diagnosis in the management of patients.

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Does MRI add value in general practice for patients with traumatic knee complaints? A 1-year randomised controlled trial

Abstract: NTR3689.

Cited by 2 publications

References 19 publications

Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

Corrigendum to: Guidelines, training and quality assurance: influence on general practitioner MRI referral quality

Higher order thinking about differential diagnosis

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