Effects of Phonophoresis of Piroxicam and Ultrasound on Symptomatic Knee Osteoarthritis

ObjectiveTo compare the effects of phonophoresis of piroxicam (PhP) and ultrasound therapy (UT) in patients with mild to moderate, symptomatic knee osteoarthritis (OA).DesignA randomized, double-blind, controlled trial.SettingDepartment of rehabilitation medicine, university hospital.ParticipantsPatients with knee OA (N=46; mean age ± SD, 58.91±10.50y) who had visual analog scale (VAS) scores of 50 to 92mm (mean, 71.5mm) for knee pain intensity and Kellgren-Lawrence grades of I to III were randomly allocated into 2 groups: PhP and UT (23 in each group).InterventionsBoth the PhP and UT groups were treated with an ultrasound program using the stroking technique, continuous mode, 1.0W/cm2, 10 minutes per session, and 5 times per week for 2 weeks. Four grams of 0.5% piroxicam gel (20mg of piroxicam drug) was used in the PhP group, while the nondrug coupling gel was used in the UT group.Main Outcome MeasuresA 100-mm VAS for usual pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated before and after treatment in both groups using a double-blinded procedure.ResultsThe VAS and total WOMAC scores were significantly improved after treatment in both groups (P<.001). The PhP group showed more significant effects than the UT group, both in reducing the VAS pain score (P=.009) and in improving the WOMAC score, although it did not reach the level of significance (P=.143).ConclusionsOur results indicated that PhP was significantly more effective than UT in reducing pain and tended to improve knee functioning in Kellgren-Lawrence grades I to III knee OA. PhP is suggested as a new, effective method for treatment of symptomatic knee OA.