Comparative effectiveness of ultrasonophoresis and iontophoresis in impingement syndrome: a double-blind, randomized, placebo controlled trial

Abstract

Objective: To estimate the effectiveness of ultrasonophoresis and iontophoresis with sodium diclofenac used in addition to an exercise program for patients with impingement syndrome. Design: Multicentre, double-blind, placebo randomized controlled trial. Setting: “Mancha Centro” Outpatient primary care clinic (Spain). Participants: A total of 175 patients were considered, of whom 88 met criteria and agreed. Intervention: The patients were randomly assigned to one of three groups: a) standard treatment (supervised exercises and cryotherapy) along with placebo iontophoresis and placebo ultrasonophoresis; b) standard treatment, iontophoresis, and placebo ultrasonophoresis; and c) standard treatment, ultrasonophoresis, and placebo iontophoresis. All patients received 15 treatment sessions. Outcome measures: Baseline, 6-, and 12-week evaluations were carried out. Functionality, pain, range of motion, strength and quality of life were assessed with the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Constant-Murley score, and SF-36 scale. Results: Ultrasonophoresis group experienced significant decreases in pain compared to the standard treatment group (12.7 and 13.5 points in “bodily pain” dimension of SF-36; and 1,5 and 2,2 points in “pain” dimension of Constant Murley after 6 and 12 weeks of therapy, respectively). They also reported improved range of motion compared to the exercises group (2,1 points in Constant-Murley after 6 weeks and 12 weeks), better vitality and overall health (SF-36 dimensions). Iontophoresis, however, led to no significant improvements when added to the standard treatment. Conclusion: In patients with impingement syndrome, a combination of ultrasonophoresis and an exercise program are better than a combination of iontophoresis and the same exercise program or the exercise program alone.