- Design
- Mixed-methods cluster-randomised trial in 19 practices
- Population
- 10,182 adults with musculoskeletal conditions in UK general practice
- Primary outcome
- Records with non-evidence-based management (blinded review of 120)
- Effect
- 3% vs 25% when used; aOR 12.30 (95% CI 2.52–59.9); tool used in 8.6%
A cluster-randomised trial in the Journal of Medical Internet Research (15 October) gave 19 UK practices either access to a web-based musculoskeletal decision-support tool for three months or usual care. Over 10,000 adults with musculoskeletal problems were seen.
The tool was used in only 8.6% of eligible cases. Where it was used, non-evidence-based management (such as unnecessary imaging or inappropriate prescribing) appeared in 3% of records against 25% in control practices. It increased self-management advice and community referrals, and reduced prescribing and fit notes. No high-risk safety issues were found.
The content works; the barrier is workflow. A tool that sits outside the clinical record is rarely opened in a ten-minute consultation.
- When used, the tool cut non-evidence-based MSK care from 25% to 3% of records
- It increased self-management advice and reduced prescribing
- Uptake was under one in ten consultations
- The lesson for practices: decision aids need to sit inside the record to be used
Why it matters
Musculoskeletal problems are a large share of primary care, and much of their management departs from guidance.
Don't overread it
The headline comparison counts only consultations where the tool was used — clinicians who chose it may already practise differently.
The statistics, in plain English
The odds ratio of 12.3 has a very wide 95% CI (2.5 to 59.9) because only 120 records were reviewed. On an intention-to-treat basis — every patient in intervention practices — the only clear change was more self-management advice.
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