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

Autor:	Swart NM; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., van Oudenaarde K; Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands., Bierma-Zeinstra SM; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.; Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Bloem HJ; Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands., van den Hout WB; Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands., Algra PR; Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands., Bindels PJ; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Koes BW; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Nelissen RG; Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands., Verhaar JA; Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Reijnierse M; Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands., Luijsterburg PA; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	British journal of sports medicine [Br J Sports Med] 2019 Oct; Vol. 53 (20), pp. 1285-1292. Date of Electronic Publication: 2018 Jul 24.
DOI:	10.1136/bjsports-2017-098932
Abstrakt:	Objective: To determine whether referral to MRI by the general practitioner (GP) is non-inferior to usual care (no access to MRI by GPs) in patients with traumatic knee complaints regarding knee-related daily function. Methods: This was a multicentre, non-inferiority randomised controlled trial with 1-year follow-up. GPs invited eligible patients during or after their consultation. Eligible patients (18-45 years) consulted a GP with knee complaints due to a trauma during the previous 6 months. Patients allocated to the MRI group received an MRI at (median) 7 (IQR 1-33) days after the baseline questionnaire. Patients in the usual care group received information on the course of knee complaints, and a referral to a physiotherapist or orthopaedic surgeon when indicated. The primary outcome measure was knee-related daily function measured with the Lysholm scale (0 to 100; 100=excellent function) over 1 year, with a non-inferiority margin of 6 points. Results: A total of 356 patients were included and randomised to MRI (n=179) or usual care (n=177) from November 2012 to December 2015. MRI was non-inferior to usual care concerning knee-related daily function during 1-year follow-up, for the intention-to-treat (overall adjusted estimate: 0.33; 95% CI -1.73 to 2.39) and per-protocol (overall adjusted estimate: 0.06; 95% CI -2.08 to 2.19) analysis. There were no differences between both groups in the amount of patients visiting other healthcare providers. Conclusion: MRI in general practice in patients with traumatic knee complaints was non-inferior to usual care regarding knee-related daily function during 1-year follow-up. Trial Registration Number: NTR3689. Competing Interests: Competing interests: The authors had financial support from ZonMW (the Netherlands Organisation for Health Research and Development) for the submitted work. (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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