From: "Effects of x-ray based diagnosis and explanation of knee osteoarthritis on patient beliefs about osteoarthritis management: A randomised clinical trial." published in PLOS MedicineAbstractBackground. Although x-rays are not recommended for routine diagnosis of osteoarthritis, clinicians and patients often use or expect x-rays. We evaluated whether: i) a radiographic diagnosis and explanation of knee osteoarthritis influences patient beliefs about management, compared to a clinical diagnosis and explanation that does not involve x-rays; and ii) showing the patient their x-ray images when explaining radiographic report findings influences beliefs, compared to not showing x-ray images.Methods and findings. This was a 3-arm randomised controlled trial conducted between May 23 2024 and May 28 2024 as a single exposure (no follow-up) online survey. 617 people aged ≥45 years, with and without chronic knee pain, were recruited from the Australian-wide community. Participants were presented with a hypothetical scenario where their knee was painful for six-months and they had made an appointment with a general practitioner (primary care physician). Participants were randomly allocated to one of three groups where they watched a 2-minute video of the general practitioner providing them with either: i) clinical explanation of knee osteoarthritis (no x-rays); ii) radiographic explanation (not showing x-ray images) or; iii) radiographic explanation (showing x-ray images). Primary comparisons were: 1) clinical explanation (no x-rays) versus radiographic explanation (showing x-ray images), and; 2) radiographic explanation (not showing x-ray images) versus radiographic explanation (showing x-ray images). Primary outcomes were perceived i) necessity of joint replacement surgery; and ii) helpfulness of exercise and physical activity, both measured on 11-point numeric rating scales (NRS) ranging 0-10.Compared to clinical explanation (no x-rays), those who received radiographic explanation (showing x-ray images) believed surgery was more necessary (mean 3.3 [standard deviation: 2.7] versus 4.5 [2.7], respectively; mean difference 1.1 [Bonferroni-adjusted 95% confidence interval: 0.5, 1.8]), but there were no differences in beliefs about the helpfulness of exercise and physical activity (mean 7.9 [standard deviation: 1.9] versus 7.5 [2.2], respectively; mean difference -0.4 [Bonferroni-adjusted 95% confidence interval: -0.9, 0.1]). There were no differences in beliefs between radiographic explanation with and without showing x-ray images (for beliefs about necessity of surgery: mean 4.5 [standard deviation: 2.7] versus 3.9 [2.6], respectively; mean difference 0.5 [Bonferroni-adjusted 95% confidence interval: -0.1, 1.2]; for beliefs about helpfulness of exercise and physical activity: mean 7.5 [standard deviation: 2.2] versus 7.7 [2.0], respectively; mean difference -0.2 [Bonferroni-adjusted 95% confidence interval: -0.7, 0.3]). Limitations of our study included the fact that participants were responding to a hypothetical scenario, and so findings may not necessarily translate to real-world clinical situations, and that it is unclear whether effects would impact subsequent OA management behaviours.Conclusions. An x-ray-based diagnosis and explanation of knee osteoarthritis may have potentially undesirable effects on people’s beliefs about management.Trial registration. ACTRN12624000622505

From: "Effects of x-ray based diagnosis and explanation of knee osteoarthritis on patient beliefs about osteoarthritis management: A randomised clinical trial." published in PLOS MedicineAbstractBackground. Although x-rays are not recommended for routine diagnosis of osteoarthritis, clinicians and patients often use or expect x-rays. We evaluated whether: i) a radiographic diagnosis and explanation of knee osteoarthritis influences patient beliefs about management, compared to a clinical diagnosis and explanation that does not involve x-rays; and ii) showing the patient their x-ray images when explaining radiographic report findings influences beliefs, compared to not showing x-ray images.Methods and findings. This was a 3-arm randomised controlled trial conducted between May 23 2024 and May 28 2024 as a single exposure (no follow-up) online survey. 617 people aged ≥45 years, with and without chronic knee pain, were recruited from the Australian-wide community. Participants were presented with a hypothetical scenario where their knee was painful for six-months and they had made an appointment with a general practitioner (primary care physician). Participants were randomly allocated to one of three groups where they watched a 2-minute video of the general practitioner providing them with either: i) clinical explanation of knee osteoarthritis (no x-rays); ii) radiographic explanation (not showing x-ray images) or; iii) radiographic explanation (showing x-ray images). Primary comparisons were: 1) clinical explanation (no x-rays) versus radiographic explanation (showing x-ray images), and; 2) radiographic explanation (not showing x-ray images) versus radiographic explanation (showing x-ray images). Primary outcomes were perceived i) necessity of joint replacement surgery; and ii) helpfulness of exercise and physical activity, both measured on 11-point numeric rating scales (NRS) ranging 0-10.Compared to clinical explanation (no x-rays), those who received radiographic explanation (showing x-ray images) believed surgery was more necessary (mean 3.3 [standard deviation: 2.7] versus 4.5 [2.7], respectively; mean difference 1.1 [Bonferroni-adjusted 95% confidence interval: 0.5, 1.8]), but there were no differences in beliefs about the helpfulness of exercise and physical activity (mean 7.9 [standard deviation: 1.9] versus 7.5 [2.2], respectively; mean difference -0.4 [Bonferroni-adjusted 95% confidence interval: -0.9, 0.1]). There were no differences in beliefs between radiographic explanation with and without showing x-ray images (for beliefs about necessity of surgery: mean 4.5 [standard deviation: 2.7] versus 3.9 [2.6], respectively; mean difference 0.5 [Bonferroni-adjusted 95% confidence interval: -0.1, 1.2]; for beliefs about helpfulness of exercise and physical activity: mean 7.5 [standard deviation: 2.2] versus 7.7 [2.0], respectively; mean difference -0.2 [Bonferroni-adjusted 95% confidence interval: -0.7, 0.3]). Limitations of our study included the fact that participants were responding to a hypothetical scenario, and so findings may not necessarily translate to real-world clinical situations, and that it is unclear whether effects would impact subsequent OA management behaviours.Conclusions. An x-ray-based diagnosis and explanation of knee osteoarthritis may have potentially undesirable effects on people’s beliefs about management.Trial registration. ACTRN12624000622505