Rheumatology International

, Volume 38, Issue 10, pp 1927–1932 | Cite as

Comparative short-term effectiveness of ibuprofen gel and cream phonophoresis in patients with knee osteoarthritis

  • Ilke Coskun Benlidayi
  • Neslihan Gokcen
  • Sibel Basaran
Physical Medicine and Rehabilitation


The objective of the present study was to compare the effectiveness of gel and cream ibuprofen phonophoresis in patients with knee osteoarthritis. A single-blinded, randomized, comparative design was applied. Patients diagnosed with knee osteoarthritis according to the American College of Rheumatology criteria were included in the study. After obtaining written informed consent, patients were randomized into ibuprofen gel and cream phonophoresis groups. Each patient was treated five sessions per week for 2 weeks (ten sessions). Main outcome measures were 100 mm visual analogue scale (VAS) for pain and the disease-specific questionnaire; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Sixty-one knee osteoarthritis patients with a mean age of 57.9 ± 9.7 years were included in the study. Baseline VAS and WOMAC scores were similar between gel (n = 30) and cream (n = 31) phonophoresis groups (p > 0.05 for both). Following the treatment, both groups showed improvement compared to baseline measures including VAS pain and WOMAC scores. In the gel phonophoresis group, the improvement in VAS score was higher than that observed in the cream phonophoresis group (p < 0.001). Similarly, the improvement in WOMAC total score was also higher in the gel phonophoresis group (p < 0.001). Ibuprofen phonophoresis is clinically effective in patients with knee osteoarthritis. Phonophoresis using the gel form of ibuprofen is associated with more clinical improvement than that using the cream form of the same molecule.


Ibuprofen Knee osteoarthritis Osteoarthritis Phonophoresis 



We thank physiotherapist Safine Havuc for her valuable contribution to the treatment sessions of phonophoresis.

Author contributions

ICB: contributed to the conception and design of the study; collection, analysis, and interpretation of data; drafting and revising the article; approval of the final version. NG: contributed to the acquisition of data; drafting the article and approval of the final version. SB: contributed to the design of the study; drafting the article and approval of the final version.


The study was funded by the Research Fund of Cukurova University (Project number: TF2014BAP11), which had no involvement in the design, execution, or reporting of the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical consent was obtained from the Local Ethics Committee of Cukurova University (Date: 23-June-2015, number: 42/8) and approved by the Turkish Ministry of Health.

Animal/human rights statement

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Tuncer T, Cay FH, Altan L, Gurer G, Kacar C, Ozcakir S et al (2018) 2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis. Rheumatol Int. PubMedCrossRefGoogle Scholar
  2. 2.
    Schmidt TW (2018) Approach to osteoarthritis management for the primary care provider. Prim Care 45:361–378CrossRefPubMedGoogle Scholar
  3. 3.
    McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM et al (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartil 22:363–388CrossRefGoogle Scholar
  4. 4.
    Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J et al, American College of Rheumatology (2012) American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 64:465–474CrossRefGoogle Scholar
  5. 5.
    Boonhong J, Suntornpiyapan P, Piriyajarukul A (2018) Ultrasound combined transcutaneous electrical nerve stimulation (UltraTENS) versus phonophoresis of piroxicam (PhP) in symptomatic knee osteoarthritis: a randomized double-blind, controlled trial. J Back Musculoskelet Rehabil. PubMedCrossRefGoogle Scholar
  6. 6.
    Luksurapan W, Boonhong J (2013) Effects of phonophoresis of piroxicam and ultrasound on symptomatic knee osteoarthritis. Arch Phys Med Rehabil 94:250–255CrossRefPubMedGoogle Scholar
  7. 7.
    Kozanoglu E, Basaran S, Guzel R, Guler-Uysal F (2003) Short term efficacy of ibuprofen phonophoresis versus continuous ultrasound therapy in knee osteoarthritis. Swiss Med Wkly 133:333–338PubMedGoogle Scholar
  8. 8.
    Akinbo S, Owoeye O, Adesegun S (2011) Comparison of the therapeutic efficacy of diclofenac sodium and methyl salicylate phonophoresis in the management of knee osteoarthritis. Turk J Rheumatol 26:111–119CrossRefGoogle Scholar
  9. 9.
    Deniz S, Topuz O, Simsir Atalay N, Asrsan A, Yildiz N, Findikoglu, Gulin et al (2009) Comparison of the effectiveness of pulsed and continuous diclofenac phonophoresis in treatment of knee osteoarthritis. J Phys Ther Sci 21:331–336CrossRefGoogle Scholar
  10. 10.
    Meshali M, Abdel-Aleem H, Sakr F, Nazzal S, El-Malah Y (2011) Effect of gel composition and phonophoresis on the transdermal delivery of ibuprofen: in vitro and in vivo evaluation. Pharm Dev Technol 16:93–101CrossRefPubMedGoogle Scholar
  11. 11.
    Cage SA, Rupp KA, Castel JC, Saliba EN, Hertel J, Saliba SA (2013) Relative acoustic transmission of topical preparations used with therapeutic ultrasound. Arch Phys Med Rehabil 94:2126–2130CrossRefPubMedGoogle Scholar
  12. 12.
    Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049CrossRefPubMedGoogle Scholar
  13. 13.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840PubMedGoogle Scholar
  15. 15.
    Basaran S, Guzel R, Seydaoglu G, Guler-Uysal F (2010) Validity, reliability and comparison of the WOMAC osteoarthritis index and lequesne algofunctional index in Turkish patients with hip or knee osteoarthritis. Clin Rheumatol 29:749–756CrossRefPubMedGoogle Scholar
  16. 16.
    Bellamy N (2003) WOMAC Osteoarthritis Index user guide VI, Queensland, AustraliaGoogle Scholar
  17. 17.
    Boyaci A, Tutoglu A, Boyaci N, Aridici R, Koca I (2013) Comparison of the efficacy of ketoprofen phonophoresis, ultrasound, and short-wave diathermy in knee osteoarthritis. Rheumatol Int 33:2811–2818CrossRefPubMedGoogle Scholar
  18. 18.
    Chhetri RS, Khatri KP, Khanal J, Kc M (2017) Outcome of needle fenestration, subacromial steroid and diclofenac phonophoresis in acute calcific tendinitis of shoulder. JNMA J Nepal Med Assoc 56:357–361PubMedCrossRefGoogle Scholar
  19. 19.
    Takla MKN, Rezk-Allah SS (2018) Immediate effects of simultaneous application of transcutaneous electrical nerve stimulation and ultrasound phonophoresis on active myofascial trigger points: a randomized controlled trial. Am J Phys Med Rehabil 97:332–338CrossRefPubMedGoogle Scholar
  20. 20.
    Yildiz N, Atalay NS, Gungen GO, Sanal E, Akkaya N, Topuz O (2011) Comparison of ultrasound and ketoprofen phonophoresis in the treatment of carpal tunnel syndrome. J Back Musculoskelet Rehabil 24:39–47CrossRefPubMedGoogle Scholar
  21. 21.
    Gurcay E, Unlu E, Gurcay AG, Tuncay R, Cakci A (2012) Assessment of phonophoresis and iontophoresis in the treatment of carpal tunnel syndrome: a randomized controlled trial. Rheumatol Int 32:717–722CrossRefPubMedGoogle Scholar
  22. 22.
    Bakhtiary AH, Fatemi E, Emami M, Malek M (2013) Phonophoresis of dexamethasone sodium phosphate may manage pain and symptoms of patients with carpal tunnel syndrome. Clin J Pain 29:348–353CrossRefPubMedGoogle Scholar
  23. 23.
    Soyupek F, Kutluhan S, Uslusoy G, Ilgun E, Eris S, Askin A (2012) The efficacy of phonophoresis on electrophysiological studies of the patients with carpal tunnel syndrome. Rheumatol Int 32:3235–3242CrossRefPubMedGoogle Scholar
  24. 24.
    Sarrafzadeh J, Ahmadi A, Yassin M (2012) The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point. Arch Phys Med Rehabil 93:72–77CrossRefPubMedGoogle Scholar
  25. 25.
    Ustun N, Arslan F, Mansuroglu A, Inanoglu D, Yagız AE, Guler H et al (2014) Efficacy of EMLA cream phonophoresis comparison with ultrasound therapy on myofascial pain syndrome of the trapezius: a single-blind, randomized clinical study. Rheumatol Int 34:453–457CrossRefPubMedGoogle Scholar
  26. 26.
    Durmus D, Alayli G, Goktepe AS, Taskaynatan MA, Bilgici A, Kuru O (2013) Is phonophoresis effective in the treatment of chronic low back pain? A single-blind randomized controlled trial. Rheumatol Int 33:1737–1744CrossRefPubMedGoogle Scholar
  27. 27.
    Durmus D, Alayli G, Tufekci T, Kuru O (2014) A randomized placebo-controlled clinical trial of phonophoresis for the treatment of chronic neck pain. Rheumatol Int 34:605–611CrossRefPubMedGoogle Scholar
  28. 28.
    Watson T, Young SR (2008) Therapeutic ultrasound. In: Watson T (ed) Electrotherapy: evidence-based practice, 12th edn. Chruchill Livingstone-Elsevier, Edinburgh, pp 179–200Google Scholar
  29. 29.
    Goraj-Szczypiorowska B, Zajac L, Skalska-Izdebska R (2007) Evaluation of factors influencing the quality and efficacy of ultrasound and phonophoresis treatment. Ortop Traumatol Rehabil 9:449–458PubMedGoogle Scholar
  30. 30.
    Warren CG, Koblanski JN, Sigelmann RA (1976) Ultrasound coupling media: their relative transmissivity. Arch Phys Med Rehabil 57:218–222PubMedGoogle Scholar
  31. 31.
    Balmaseda MT Jr, Fatehi MT, Koozekanani SH, Lee AL (1986) Ultrasound therapy: a comparative study of different coupling media. Arch Phys Med Rehabil 67:147–150CrossRefPubMedGoogle Scholar
  32. 32.
    Casarotto RA, Adamowski JC, Fallopa F, Bacanelli F (2004) Coupling agents in therapeutic ultrasound: acoustic and thermal behavior. Arch Phys Med Rehabil 85:162–165CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationCukurova University Faculty of MedicineAdanaTurkey
  2. 2.Division of Rheumatology, Department of Physical Medicine and RehabilitationCukurova University Faculty of MedicineAdanaTurkey

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