Inelastic effects in bulge formation of inflated polymer tubes.

When a soft tube is inflated, it may sometimes show a bulge instability wherein a portion of the tube inflates much more than the rest. The bulge instability is well-understood for hyperelastic materials. We examine inflation of polyurethane tubes whose material behavior is not strictly hyperelastic. Upon inflating at constant rate, the tubes deform into a variety of shapes including irregular axisymmetric shapes with multiple localized bulges, a single axially-propagating bulge, or homogeneous cylindrical shapes. In all cases regardless of the inflation mode, the pressure first rises to a maximum, and then gradually reduces towards a plateau. We document numerous differences as compared to hyperelastic tubes. Most notably a pressure maximum can appear even without bulging, whereas for hyperelastic tubes, a pressure maximum is necessarily accompanied by bulging. Further, the decrease in pressure beyond the maximum occurs gradually over timescales as long as an hour, whereas bulging of hyperelastic tubes induces an instantaneous drop in pressure. We also observe permanent deformation upon deflation, a decrease in the pressure maximum during a subsequent second inflation, and more severe bulge localization at low inflation rates. Existing theory of hyperelastic tube inflation cannot capture the observed behaviors, even qualitatively. Finite element simulations suggest that many of the observations can be explained by viscoelasticity, specifically that a slow material response allows the pressure to remain high for long durations, which in turn allows growth of multiple bulges.

Physical therapist awareness of diagnostic imaging referral jurisdictional scope of practice: an observational study.

OBJECTIVES: To examine physical therapist awareness and utilization of imaging referral privileges in the United States (US) and how it relates to direct access frequency. METHODS: This study utilized survey data collected in 2020-2021 from US physical therapists. Subjects were asked about imaging referral jurisdictional authority in their state. Responses were analyzed for accuracy and compared to the level of jurisdictional authority and its impact on imaging referral. Analysis of imaging skills performance and imaging referral practices were compared to direct access frequency. RESULTS: Only 42.0% of physical therapists practicing in states that allow imaging referral were aware of this privilege. Those practicing where imaging referral was allowed via state legislation were significantly more likely (p < 0.01) to be aware of this privilege (71.4%) compared to those granted by the state board (25.2%). Those aware of their imaging referral scope were more likely (p < 0.01) to practice imaging referral (44.5%) compared to those who were unaware (3.2%). Direct access frequency was positively associated with imaging skill performance and imaging referral practice (p < 0.01). Doctors of Physical Therapy, residency/fellowship-trained physical therapists, and board-certified physical therapists all reported practicing greater frequency of direct access (p < 0.01). DISCUSSION/CONCLUSION: There is a striking lack of awareness of imaging privileges among physical therapists as influenced by the level of jurisdictional scope. These results suggest that the lack of awareness may have a dampening effect on diagnostic imaging referrals. The American Physical Therapy Association should consider engaging with state boards to raise imaging privilege awareness.

Immediate Effects of Adding Dry Needling to Thoracic Manipulation and Exercise in Cervical Range of Motion for Adults With Neck Pain: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to determine the immediate effects of adding dry needling (DN) to thoracic spine manipulation and neck-specific exercise in individuals with neck pain. METHODS: Forty-two participants with neck pain were randomized to either the true (n = 21) or sham (n = 21) DN groups, receiving treatment on the initial visit and 2 to 3 days later. Outcomes were assessed on day 1, both at baseline and immediately after the initial treatment, at the second treatment 2 to 3 days later, and at the final visit 5 to 7 days after visit 2. Primary outcomes were Neck Disability Index (NDI) (0-50) and current pain via numeric pain rating scale (0-10). Secondary outcomes were cervical range of motion, pain pressure threshold, and global rating of change. RESULTS: Repeated measures analysis of covariance with baseline value as covariate revealed no significant difference in NDI scores at either follow-up time point with adjusted mean differences (95% confidence interval) of -0.11 (-2.70 to 2.48) and 0.31 (-1.96 to 2.57). There were no between-group differences in pain at any time point via Independent-Samples Median Test (P value range of .54-1.0). Secondary outcome measures were similarly not statistically different between groups except for immediate improvements in rotation to the side opposite of pain, which favored DN, with an adjusted mean difference (95% confidence interval) of 7.85 (3.54-12.15) degrees. CONCLUSION: The addition of DN to thoracic spinal manipulation and neck-specific exercise did not affect improvements in NDI score or numeric pain rating scale but showed an increase in cervical range of motion.

Physical Therapists Are Routinely Performing the Requisite Skills to Directly Refer for Musculoskeletal Imaging: An Observational Study.

OBJECTIVES: To explore if physical therapists are practicing skills necessary to refer patients for musculoskeletal imaging. METHODS: An expert panel established a list of nine requisite skills to refer for musculoskeletal imaging. A blinded expert panel validated the list using a 5-point Likert scale. The skills list was examined via an electronic survey distributed to United States physical therapists. RESULTS: 4,796 respondents were included. Each of the nine skills were routinely performed by a majority of the respondents (range: 54.52-94.72%). Respondents routinely performed 6.95 (± 0.06) skills, with 67.41% routinely performing seven or more skills. Doctors of physical therapy routinely performed more imaging skills (7.15 ± 0.06) compared to their masters- (6.44 ± 0.19) and bachelors-trained (5.95 ± 0.21) counterparts (p < 0.001). Residency/fellowship-trained physical therapists were more likely to routinely perform more imaging skills (7.60 ± 0.11 vs. 6.79 ± 0.07, p < 0.001). Imaging skill performance was greater among board-certified physical therapists (7.39 ± 0.09 vs. 6.71 ± 0.08, p < 0.001) and APTA members (7.06 ± 0.07 vs. 6.65 ± 0.12, p < 0.001). CONCLUSION: Physical therapists are routinely practicing the requisite imaging skills to directly refer to a radiologist for musculoskeletal imaging.

The validity of the cervical rotation lateral flexion test in predicting benefit after manipulation treatment to the first and second rib.

STUDY DESIGN: Prospective cohort study. BACKGROUND: The cervical rotation lateral flexion (CRLF) test is frequently used in clinical practice to determine whether a thrust manipulation targeting the first rib should be performed. OBJECTIVES: To evaluate the predictive validity of the CRLF test and manual examination in determining whether patients with neck pain are likely to benefit from manipulative treatment to the first and second rib. METHODS: A physical examination incorporating the CRLF test was performed on 50 participants with neck pain followed by manipulation treatment to the first and second ribs. Clinical improvement was assessed immediately and one week after treatment. Participants who experienced at least a 30% improvement in their Neck Disability Index (NDI) score were considered "improved." Predictive validity was assessed by calculating sensitivity, specificity, and negative and positive likelihood ratios. RESULTS: Neither the CRLF test nor manual examination were predictive of clinical improvement after manipulative treatment to the first and second rib. However, being male, of older age, and exhibiting T1 and/or T2 restricted end-feel were associated with improved neck related-disability at one-week follow-up. CONCLUSION: The CRLF test does not appear to be helpful in determining whether patients with neck pain are likely to benefit from manipulative treatment to the first and second rib. Other factors from the history and clinical examination may be more helpful when selecting manipulative treatment including age and gender and possibly the presence of T1/T2 restricted end-feel.

Effect of dry needling on lumbar muscle stiffness in patients with low back pain: A double blind, randomized controlled trial using shear wave elastography.

BACKGROUND: Dry needling treatment focuses on restoring normal muscle function in patients with musculoskeletal pain; however, little research has investigated this assertion. Shear wave elastography (SWE) allows quantification of individual muscle function by estimating both resting and contracted muscle stiffness. OBJECTIVE: To compare the effects of dry needling to sham dry needling on lumbar muscle stiffness in individuals with low back pain (LBP) using SWE. METHODS: Sixty participants with LBP were randomly allocated to receive one session of dry needling or sham dry needling treatment to the lumbar multifidus and erector spinae muscles on the most painful side and spinal level. Stiffness (shear modulus) of the lumbar multifidus and erector spinae muscles was assessed using SWE at rest and during submaximal contraction before treatment, immediately after treatment, and 1 week later. Treatment effects were estimated using linear mixed models. RESULTS: After 1 week, resting erector spinae muscle stiffness was lower in individuals who received dry needling than those that received sham dry needling. All other between-groups differences in muscle stiffness were similar, but non-significant. CONCLUSION: Dry needling appears to reduce resting erector spinae muscle following treatment of patients with LBP. Therefore, providers should consider the use of dry needling when patients exhibit aberrant stiffness of the lumbar muscles.

Exercise Effects on Neck Function Among F-15E Aircrew.

BACKGROUND: Neck pain (NP) is common among high performance aircrew, yet evidence remains insufficient to guide examination, treatment, and prevention. The purpose of this randomized pilot study was to collect baseline data for neck function for F-15E aircrew and determine efficacy and feasibility of two separate exercise protocols in measuring short-term outcomes of subjective and objective neck function in order to inform future study design. METHODS: Randomized to either progressive (PRO) or general (GEN) exercise groups were 41 F-15E aircrew. Data collection occurred at baseline, 3 wk, and 3 mo. RESULTS: At baseline, 39% of the subjects reported current NP, 79.5% reported a history of NP attributed to flying, 12.8% reported being removed from flying duties due to NP, and 10% reported receiving medical care for NP. PRO and GEN group randomization showed similar baseline assessment data. Blinding was successful and exercise logs showed 31.6% compliance with prescribed exercise regimens. There were small but statistically significant increases in neck range of motion in both groups over the course of the study. Aircrew with current NP had significantly higher F-15E flight hours. DISCUSSION: This study supports the high prevalence of NP in aircrew, yet low frequency of seeking care for NP. Future studies to assess NP prevention and treatment in aircrew require an integrated approach that includes operational exercise policy and long-term data collection in flying units with dedicated resources for assessment and analysis. Lee MS, Briggs R, Scheirer V, Kearby G, Young BA. Exercise effects on neck function among F-15E aircrew. Aerosp Med Hum Perform. 2021; 92(10):815824.

Ultrasound shear wave elastography measurement of the deep posterior cervical muscles: Reliability and ability to differentiate between muscle contraction states.

The deep posterior cervical muscles (DPCM), specifically the semispinalis cervicis and cervical multifidus, are often impaired in patients with neck disorders and have been assessed by several imaging techniques. Prior ultrasound shear wave elastography (SWE) imaging and reliability assessments of the DPCM were performed utilizing similar positioning as assessments for the more superficial cervical extensors. Our objectives were to describe an SWE imaging technique for the DPCM, establish intra-rater reliability of DPCM SWE, and compare DPCM shear modulus during rest and submaximal contraction in both prone and seated positions in individuals without spinal pain. In sixteen participants, the DPCM was located using B-mode ultrasound, then muscle shear modulus was assessed via SWE at both rest and with contraction against a 2-kg resistance applied at the C2 spinous process. Within-day intra-rater reliability was moderate to good (ICC = 0.70-0.88). The DPCM were stiffer during contraction than at rest in the prone position (p = 0.002), and at rest in sitting versus at rest in prone (p = 0.003). Further research is needed to assess DPCM-specific SWE in symptomatic individuals and compare DPCM shear modulus to electromyography across contraction intensities.

Exploration of Medical Screening and Differential Diagnosis Instructional Methods and Faculty Perceptions in Physical Therapist Educational Programs.

BACKGROUND: Little is known about medical screening and differential diagnosis (MSDD) preparation of physical therapist students. METHODS: Professional degree physical therapist programs in the U.S. were surveyed regarding MSDD content and faculty perception of graduate competence. RESULTS: Fifty-five of 226 programs responded for a 24.3% response rate. Sixty-six percent strongly agreed that students were adequately prepared to perform MSDD with patients who are referred, whereas 47.3% strongly agreed for patients who are direct access. Faculty board specialty certification status affected perception of student competence (p=0.04). Increased emphasis during clinical affiliations was the most beneficial way to increase student knowledge of MSDD skills. Non-response bias assessment was non-significant. CONCLUSION: Increasing clinical exposure was the top recommendation for expanding both faculty and student knowledge and skills. Factors potentially impacting student preparation in MSDD content have been identified and require further study.

Estimating number of contributors in massively parallel sequencing data of STR loci.

In recent years a number of computer-based algorithms have been developed for the deconvolution of complex DNA mixtures in forensic science. These procedures utilize likelihood ratios that quantify the evidence for a hypothesis for the presence of a person of interest in a DNA profile compared to an alternative hypothesis. Proper operation of these software systems requires an assumption regarding the total number of contributors present in the mixture. Unfortunately, estimates based on counting the number of alleles at a locus can be inaccurate due to the sharing and masking of alleles at individual loci. The effects of allele masking become increasingly severe as the number of contributors increases, rendering estimates about high-order mixtures uncertain. The accuracy of these estimates can be improved by increasing the number of STR markers in panels, and by using highly polymorphic markers. Increasing the number of STR markers from 13 to 20 (expanded CODIS panel) improves the accuracy of allele count-based estimation methods for low-order mixtures, but accuracy for high-order mixtures (> 3 contributors) remains poor due to allele masking. An alternative technique, massively parallel sequencing, holds great potential to improve the accuracy of the estimate of number of contributors due to its ability to detect sequence polymorphisms within alleles. This process results in an expansion of the number of alleles when compared to that obtained using capillary electrophoresis. Here, we show that the detection of these additional sequence-defined alleles in 22-marker panels improves number of contributor estimates in conceptual mixtures of 4 and 5 contributors.

Lateral Foot Pain in a Recreational Runner.

A 35-year-old male recreational runner with a 9-month history of left lateral foot pain self-referred to physical therapy while awaiting orthopaedic consultation. Before presenting to physical therapy, his primary care physician ordered radiographs and referred him to orthopaedics with a provisional diagnosis of multipartite os peroneum. Following examination, the initial treatment hypothesis was cuboid syndrome, as he met the majority of items in a proposed diagnostic cluster. J Orthop Sports Phys Ther 2017;47(1):41. doi:10.2519/jospt.2017.6941.

Sequence variation of 22 autosomal STR loci detected by next generation sequencing.

Sequencing short tandem repeat (STR) loci allows for determination of repeat motif variations within the STR (or entire PCR amplicon) which cannot be ascertained by size-based PCR fragment analysis. Sanger sequencing has been used in research laboratories to further characterize STR loci, but is impractical for routine forensic use due to the laborious nature of the procedure in general and additional steps required to separate heterozygous alleles. Recent advances in library preparation methods enable high-throughput next generation sequencing (NGS) and technological improvements in sequencing chemistries now offer sufficient read lengths to encompass STR alleles. Herein, we present sequencing results from 183 DNA samples, including African American, Caucasian, and Hispanic individuals, at 22 autosomal forensic STR loci using an assay designed for NGS. The resulting dataset has been used to perform population genetic analyses of allelic diversity by length compared to sequence, and exemplifies which loci are likely to achieve the greatest gains in discrimination via sequencing. Within this data set, six loci demonstrate greater than double the number of alleles obtained by sequence compared to the number of alleles obtained by length: D12S391, D2S1338, D21S11, D8S1179, vWA, and D3S1358. As expected, repeat region sequences which had not previously been reported in forensic literature were identified.

Microbial community profiling of human saliva using shotgun metagenomic sequencing.

Human saliva is clinically informative of both oral and general health. Since next generation shotgun sequencing (NGS) is now widely used to identify and quantify bacteria, we investigated the bacterial flora of saliva microbiomes of two healthy volunteers and five datasets from the Human Microbiome Project, along with a control dataset containing short NGS reads from bacterial species representative of the bacterial flora of human saliva. GENIUS, a system designed to identify and quantify bacterial species using unassembled short NGS reads was used to identify the bacterial species comprising the microbiomes of the saliva samples and datasets. Results, achieved within minutes and at greater than 90% accuracy, showed more than 175 bacterial species comprised the bacterial flora of human saliva, including bacteria known to be commensal human flora but also Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae, and Gamma proteobacteria. Basic Local Alignment Search Tool (BLASTn) analysis in parallel, reported ca. five times more species than those actually comprising the in silico sample. Both GENIUS and BLAST analyses of saliva samples identified major genera comprising the bacterial flora of saliva, but GENIUS provided a more precise description of species composition, identifying to strain in most cases and delivered results at least 10,000 times faster. Therefore, GENIUS offers a facile and accurate system for identification and quantification of bacterial species and/or strains in metagenomic samples.

Short-read, high-throughput sequencing technology for STR genotyping.

DNA-based methods for human identification principally rely upon genotyping of short tandem repeat (STR) loci. Electrophoretic-based techniques for variable-length classification of STRs are universally utilized, but are limited in that they have relatively low throughput and do not yield nucleotide sequence information. High-throughput sequencing technology may provide a more powerful instrument for human identification, but is not currently validated for forensic casework. Here, we present a systematic method to perform high-throughput genotyping analysis of the Combined DNA Index System (CODIS) STR loci using short-read (150 bp) massively parallel sequencing technology. Open source reference alignment tools were optimized to evaluate PCR-amplified STR loci using a custom designed STR genome reference. Evaluation of this approach demonstrated that the 13 CODIS STR loci and amelogenin (AMEL) locus could be accurately called from individual and mixture samples. Sensitivity analysis showed that as few as 18,500 reads, aligned to an in silico referenced genome, were required to genotype an individual (>99% confidence) for the CODIS loci. The power of this technology was further demonstrated by identification of variant alleles containing single nucleotide polymorphisms (SNPs) and the development of quantitative measurements (reads) for resolving mixed samples.

The addition of cervical thrust manipulations to a manual physical therapy approach in patients treated for mechanical neck pain: a secondary analysis.

STUDY DESIGN: Secondary analysis of a randomized clinical trial (RCT). OBJECTIVES: To perform a secondary analysis on the treatment arm of a larger RCT to determine differences in treatment outcomes, adverse reactions, and effect sizes between patients who received cervical thrust manipulation and those who received only nonthrust manipulation as part of an impairment-based, multimodal treatment program of manual physical therapy (MPT) and exercise for patients with mechanical neck pain. BACKGROUND: A treatment regimen of MPT and exercise has been effective in patients with mechanical neck pain. Limited research has compared the effectiveness of cervical thrust manipulations and nonthrust mobilizations for this patient population, and no studies have investigated the added benefit of cervical thrust manipulations as part of an overall MPT treatment plan. METHODS: Treatment outcomes from 47 patients in the treatment arm of a larger RCT, with a primary complaint of mechanical neck pain, were analyzed. Twenty-three patients (49%) received cervical thrust manipulations as part of their MPT treatment, and 24 patients (51%) received only cervical nonthrust mobilizations. All patients received up to 6 clinic sessions, twice weekly for 3 weeks, and a home exercise program. Primary outcome measures were the Neck Disability Index (NDI), 2 visual analog scales for cervical and upper extremity pain, and a 15-point global rating of change scale. Blinded outcome measurements were collected at baseline and at 3-, 6- and 52-week follow-ups. RESULTS: Consistent with the larger RCT, both subgroups in this secondary analysis demonstrated improvement in short- and long-term pain and disability scores. Low statistical power (beta< or =.28) and the resultant small effect size indices (-0.21 to 0.17) preclude the identification of any between-group differences. No serious adverse reactions were reported by patients in either subgroup. CONCLUSIONS: Clinically meaningful and statistically significant improvements in both subgroups of patients over time suggest that cervical thrust manipulation, as part of the MPT treatment plan, did not influence the results of the treatment arm of the larger RCT from which this study was drawn. Although no between-group differences can be identified, the small observed effect sizes in this study may benefit future studies with sample size estimation for larger RCTs and indicate the need to incorporate clinical prediction rule criteria as a means to improve statistical power. LEVEL OF EVIDENCE: Therapy, level 4.

Isolation and partial purification of the Saccharomyces cerevisiae cytokinetic apparatus.

Cytokinesis is the process by which a cell physically divides in two at the conclusion of a cell cycle. In animal and fungal cells, this process is mediated by a conserved set of proteins including actin, type II myosin, IQGAP proteins, F-BAR proteins, and the septins. To facilitate biochemical and ultrastructural analysis of cytokinesis, we have isolated and partially purified the Saccharomyces cerevisiae cytokinetic apparatus. The isolated apparatus contains all components of the actomyosin ring for which we tested-actin, myosin heavy and light chain, and IQGAP-as well as septins and the cytokinetic F-BAR protein, Hof1p. We also present evidence indicating that the actomyosin rings associated with isolated cytokinetic apparati may be contractile in vitro, and show preliminary electron microscopic imaging of the cytokinetic apparatus. This first successful isolation of the cytokinetic apparatus from a genetically tractable organism promises to make possible a deeper understanding of cytokinesis.

Responsiveness of the Neck Disability Index in patients with mechanical neck disorders.

PURPOSE: Report the test-retest reliability, construct validity, minimum clinically important difference (MCID), and minimal detectable change (MDC) for the Neck Disability Index (NDI). STUDY DESIGN/SETTING: Cohort study of patients presenting to outpatient physical therapy clinics. PATIENT SAMPLE: Ninety-one subjects with a primary complaint of neck pain, with or without concomitant upper extremity (UE) symptoms, who were participants in a randomized clinical trial. OUTCOME MEASURES: NDI and the 15-point Global Rating of Change (GRC) self-report measures. METHODS: All subjects completed the NDI at baseline and at a 3-week follow-up. Additionally, subjects completed the GRC scale, which was used to dichotomize patients into improved or stable groups. Changes in the NDI were used to assess test-retest reliability, construct validity, MCID, and MDC. RESULTS: Test-retest reliability was moderate for the NDI (intraclass correlation coefficient, 0.64; 95% confidence interval, 0.19-0.84). For the NDI, the MCID was 7.5 points and the MDC was 10.2 points. CONCLUSIONS: The NDI appears to demonstrate adequate responsiveness based on statistical reference criteria when used in a sample that approximates the high percentage of patients with neck pain and concomitant UE referred symptoms. Because the MCID is within the bounds of measurement error, a 10-point change (the MDC) should be used as the MCID.

Neck pain and headaches in a patient after a fall.

The patient was a 64-year-old woman who reported a sudden onset of neck pain and headaches following a fall 2.5 months prior to her initial physical therapy visit. Cervical spine radiographs, which were ordered by the referring physician, revealed extensive degenerative disc disease of the lower cervical spine. At her initial physical therapy evaluation, cervical spine range of motion was within functional limits except for bilateral rotation, which was limited to 45 degrees due to pain and stiffness. The patient's headache symptoms were abolished with the Sharp-Purser test. Although assessment of symptoms was not the intent of the Sharp-Purser test, a reduction of symptoms during the test would warrant further evaluation. Therefore, the physical therapist ordered cervical spine flexion-extension radiographic views to assess for atlantoaxial instability. The radiologist's report noted a stable atlantodens interval that did not change with cervical flexion and extension and a course of physical therapy was initiated. At the time of discharge from physical therapy, the patient reported no neck pain and only very mild occasional headaches, which she believed she could manage on her own.

The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain.

Shoulder pain is a common orthopedic condition seen by physical therapists, with many potential contributing factors and proposed treatments. Although manual physical therapy interventions for the cervicothoracic spine and ribs have been investigated for this patient population, the specific effects of these treatments have not been reported. The purpose of this investigational study is to report the immediate effects of thoracic spine and rib manipulation in patients with primary complaints of shoulder pain. Using a test-retest design, 21 subjects with shoulder pain were treated during a single treatment session with high-velocity thrust manipulation to the thoracic spine or upper ribs. Post-treatment effects demonstrated a 51% (32mm) reduction in shoulder pain, a corresponding increase in shoulder range of motion (30 degrees -38 degrees ), and a mean patient-perceived global rating of change of 4.2 (median 5). These immediate post-treatment results suggest that thoracic and rib manipulative therapy is associated with improved shoulder pain and motion in patients with shoulder pain, and further these interventions support the concept of a regional interdependence between the thoracic spine, upper ribs, and shoulder.

The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial.

STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To assess the effectiveness of manual physical therapy and exercise (MTE) for mechanical neck pain with or without unilateral upper extremity (UE) symptoms, as compared to a minimal intervention (MIN) approach. SUMMARY OF BACKGROUND DATA: Mounting evidence supports the use of manual therapy and exercise for mechanical neck pain, but no studies have directly assessed its effectiveness for UE symptoms. METHODS: A total of 94 patients referred to 3 physical therapy clinics with a primary complaint of mechanical neck pain, with or without unilateral UE symptoms, were randomized to receive MTE or a MIN approach of advice, motion exercise, and subtherapeutic ultrasound. Primary outcomes were the neck disability index, cervical and UE pain visual analog scales (VAS), and patient-perceived global rating of change assessed at 3-, 6-, and 52-weeks. Secondary measures included treatment success rates and post-treatment healthcare utilization. RESULTS: The MTE group demonstrated significantly larger reductions in short- and long-term neck disability index scores (mean 1-year difference -5.1, 95% confidence intervals (CI) -8.1 to -2.1; P = 0.001) and short-term cervical VAS scores (mean 6-week difference -14.2, 95% CI -22.7 to -5.6; P = 0.001) as compared to the MIN group. The MTE group also demonstrated significant within group reductions in short- and long-term UE VAS scores at all time periods (mean 1-year difference -16.3, 95% CI -23.1 to -9.5; P = 0.000). At 1-year, patient perceived treatment success was reported by 62% (29 of 47) of the MTE group and 32% (15 of 47) of the MIN group (P = 0.004). CONCLUSION: An impairment-based MTE program resulted in clinically and statistically significant short- and long-term improvements in pain, disability, and patient-perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mobility exercise, and subtherapeutic ultrasound.