OBJECTIVE: To compare the effects of phonophoresis of piroxicam (PhP) and ultrasound therapy (UT) on mild to moderate degree of symptomatic knee osteoarthritis (OA). DESIGN: A randomized double-blind, controlled trial. SETTING: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. PARTICIPANTS: OA knee patients (n = 46; age 58.91 +/- 10.50y) with 50 to 92 mm (mean 71.5) visual analog scale (VAS) of knee pain intensity and Kellgren-Lawrence score of grades I to III were randomly allocated into 2 groups: PhP and UT (23 in each group). INTERVENTIONS: Both the PhP and UT groups were treated with an ultrasound program using the stroking technique, continuous mode, 1.0 watt/cm2, 10 minutes per session and 5 times per week for 2 weeks. Four grams of 0.5% piroxicam gel (20 mg of piroxicam drug) was used in the PhP group, while the non-drug coupling gel was used in the UT. MAIN OUTCOME MEASURES: A 100-mm VAS for usual pain and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index were evaluated before and after treatment in both groups using a double blinded procedure. RESULTS: The VAS and total WOMAC scores were significantly improved after treatment in both groups (p < 0.001). Comparing between the groups, the PhP group showed more significant effects than the UT group, both in reducing the VAS pain score (p = 0.009) and in improving the WOMAC score, although it did not reach the level of significance (p = 0.143). CONCLUSIONS: Our 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. In accordance to this study, PhP is suggested as a new effective method for treatment of symptomatic knee OA.

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