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Background: Non-pharmacological treatment (NPT) is a useful treatment option in the management of hip or knee osteoarthritis. To our knowledge however, no studies have investigated the effect of NPT in patients with generalized osteoarthritis (GOA). The primary aim of this study is to compare the effectiveness of two currently existing health care programs with different intensity and mode of delivery on daily functioning in patients with GOA. The secondary objective is to compare the cost-effectiveness of both interventions. Methods/Design: In this randomized, single blind, clinical trial with active controls, we aim to include 170 patients with GOA. The experimental intervention consist of six self-management group sessions provided by a multidisciplinary team (occupational therapist, physiotherapist, dietician and specialized nurse). The active control group consists of two group sessions and four sessions by telephone, provided by a specialized nurse and physiotherapist. Both therapies last six weeks. Main study outcome is daily functioning during the first year after the treatment, assessed on the Health Assessment Questionnaire. Secondary outcomes are health related quality of life, specific complaints, fatigue, and costs. Illness cognitions, global perceived effect and self-efficacy, will also be assessed for a responder analysis. Outcome assessments are performed directly after the intervention, after 26 weeks and after 52 weeks. Discussion: This article describes the design of a randomized, single blind, clinical trial with a one year follow up to compare the costs and effectiveness of two non-pharmacological interventions with different modes of delivery for patients with GOA. Trial registration: Dutch Trial Register NTR2137 [ABSTRACT FROM AUTHOR]

A recently published paper by te Molder and colleagues in BMC Musculoskeletal Disorders confirmed prior reports indicating that definitions of good versus poor outcome cutoff scores for relevant knee arthroplasty outcomes including pain and function are heterogeneous and that this heterogeneity prevents generalizable inferences. In this Correspondence, we highlight an additional and, in our view, a more important problem with the substantial literature on this topic. There also is high homogeneity in that all studies relied on arbitrarily defined cutoff scores to differentiate good versus poor outcome. We discuss this problem and propose a method to avoid repeating the same problem in future studies designed to group patients into those with good versus those with poor outcome following knee arthroplasty. [ABSTRACT FROM AUTHOR]