Effects of self-controlled feedback on learning range of motion measurement techniques and self-efficacy among physical therapy students.

doi:10.21203/rs.3.rs-4765343/v1

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Research Article

Effects of self-controlled feedback on learning range of motion measurement techniques and self-efficacy among physical therapy students.

https://doi.org/10.21203/rs.3.rs-4765343/v1

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Background

Accurate range of motion (ROM) measurements using a universal goniometer or visual estimation are difficult for physical therapy students. Self-controlled (SC) feedback, in which learners choose whether or not to receive feedback, promotes learning more than feedback without a choice, but is underutilized in physical therapy education. Therefore, we examined the effects of SC feedback on skill acquisition of these two ROM measurements and physical therapy students' self-efficacy (SE) for ROM measurements.

Method

The participants were 30 physical therapy students randomly assigned to two groups: an SC group, in which they could choose whether to receive feedback during practice, and a Yoked (Yk) group, in which they received feedback according to a schedule created by their SC counterpart. Participants completed tests and practice of two tasks; a goniometric measurement task, in which participants measure the ROM of left knee flexion using a universal goniometer, and a visual estimation task, in which they estimate it visually. Measurement accuracy and measurement time were used as test performance for both tasks. SE for ROM measurement was measured before the start of each test. Feedback related to measurement errors was provided only during a practice in line with each group's conditions.

Results

The feedback frequency of the SC group remained high at 80.0 ± 30.3 % at the end of the practice. The accuracy and measurement time of the goniometer measurements and visual estimation improved in both groups; however, no differences were observed between the groups. In addition, the measurement accuracy was higher with goniometer measurements than with visual estimation. Furthermore, SE before the pretest did not show any relationship with the measurement accuracy of the pretest, but SE before the short-term retention test correlated with measurement accuracy at that time.

Conclusion

Although the effectiveness of SC feedback was not demonstrated, we showed that external feedback improved the accuracy of ROM measurements using a goniometer and visual estimation in physical therapy students and shortened the measurement time. It was also revealed that SE after the end of the practice was temporarily related to measurement accuracy at that time.

range of motion measurement

physical therapy students

self-controlled feedback

When the joint range of motion (ROM) is restricted owing to aging, neurological diseases, or orthopedic diseases, all aspects of daily life are affected. Previous studies have demonstrated that when the joint range of motion is restricted in the knee joint, the propulsive force during walking is reduced, whereas the risk of falling increases [1-5]. Furthermore, in ADLs that require a large range of joint motion, such as squatting and putting on underwear, if the joint range of motion is restricted, the performance of the movement will be hindered [6]. In addition, ROM limitation is associated with a decline in technical motor skills and sports performance [7-9] and has been reported to increase the risk of muscle injury [10-12]. Therefore, ROM measurement is an important testing technique for medical professionals to appropriately understand a patient's condition and determine the effectiveness of treatment.

The measurement methods include measurements based on radiographs [13-15], electronic goniometers [16, 17], universal goniometers [18-19], and visual estimation [20-22] and equipment such as three-dimensional motion analysis devices [23]. Although radiograph-based measurements are considered the gold standard, they are difficult to obtain routinely in clinical settings because of the high cost of equipment, limited measurement locations, and radiation exposure [24]. Therefore, in clinical settings, visual estimation is employed in many situations, using universal goniometers, which are inexpensive, easy to use, and can perform measurements without the use of tools [25].

ROM measurements obtained using a universal goniometer have been found reliable when performed by the same examiner on the same day and within the same session [26-31]. Akizuki et al. compared the accuracy of ROM measurements between physical therapy students and physical therapists with clinical experience and reported that ROM measurement accuracy increased with experience [32]. Although the accuracy of visual estimation also improves with experience, it is less reliable than measurements obtained using a universal goniometer [14, 33]. On the other hand, Blonna et al. reported that visual estimation by experienced therapists has higher measurement reliability and validity than universal goniometric measurements [25]. Regardless of the measurement method, if the measurement values are inaccurate, the assessment of the severity and prediction of the prognosis will be inaccurate as well, which may hinder the selection of appropriate treatment. Improving and mastering these customary measurement techniques from student years is important for providing appropriate medical care to patients in clinical settings after obtaining qualifications as a physical therapist.

One factor that facilitates the acquisition of various skills is feedback provided during practice. Feedback refers to information provided externally as instructions regarding exercise results, such as knowledge of results and knowledge of performance [34]. Akizuki et al. (2020) reported that practicing using a feedback device improved the accuracy of ROM measurements using a universal goniometer in physical therapy students [35]. Various feedback methods exist, and in recent years, the effectiveness of self-controlled (SC) feedback has attracted attention. SC feedback allows learners to choose or control their feedback schedules. Previous studies investigating the effects of SC feedback have typically included a yoked group. For example, each participant in the SC group receives feedback on the trials of their choice, whereas participants in the yoked group receive feedback on the same trials requested by the participants in the SC group. The purpose of this procedure is to control the frequency and timing of feedback. The effectiveness of SC feedback in learning various motor skills has been reported [36-41].

Additionally, practicing under SC feedback condition is expected to affect self-efficacy (SE). SE is defined as the perception of one's ability to successfully perform a required behavior in a particular situation [42]. Although the fundamental mechanism of the learning effect of SC feedback is unclear, several hypotheses have been proposed, including the self-regulated learning model proposed by Zimmerman (2000) [43]. Zimmerman categorizes self-regulation into three phases: forethought, performance control, and self-reflection. The forethought phase includes self-regulatory processes that enable behavior prior to the action and beliefs, such as SE, whereas the performance control phase occurs during the actual execution of the behavior. Finally, the self-reflection phase includes numerous self-regulatory processes that occur after the performance. Information from previous motor performance is used for subsequent adjustments, and the three phases function cyclically, changing the SE and performance in the process. Morton et al. (2006) state that final-year medical students often do not self-assess themselves properly and are unaware that their skills are below the standard and that there is a need to improve students' self-awareness [44]. Even for physical therapy students who have learned the ROM measurement method, SE does not reflect the accuracy of ROM measurement [45], indicating that students do not accurately recognize their performance.

By utilizing the three phases of self-regulation in the learning model, practicing under SC feedback condition is predicted to promote physical therapy students' acquisition of ROM measurement and visual estimation skills more than other feedback methods. In addition, during the process, students may correctly recognize their skills and obtain SE that reflects their measurement accuracy. However, to date, there have been no reports on the effects of practicing SC feedback on ROM measurements, a basic technique in physical therapy. Therefore, this study investigated the effects of SC feedback on the accuracy of ROM measurements and visual estimation in physical therapy students using a universal goniometer. In addition, we observed a relationship between SE and measurement accuracy before and after practice. We formulated the following three hypotheses:

Physical therapy students who have the opportunity to choose when to receive feedback will more effectively produce ROM measurement techniques learning compared to students who do not have the opportunity.
Visual estimation by physical therapy students is less accurate than measurements made using a universal goniometer; however, accuracy improves with practice.
The measurement accuracy and SE using the universal goniometer, which were unrelated before practice, become correlated after practice as self-awareness increases through practice using SC feedback.

Participants

The participants were a total of 30 physical therapy students (male: 18, female: 12, age: 19.6 ± 0.83 years), including 22 second-year students and eight third-year students at the four-year university in Kumamoto Prefecture, Japan. Participants were asked for their cooperation after verbally explaining the content of this study and how to handle the results in advance while showing them the research manual. Consent was obtained by signing the consent form themselves. This study was approved by the Ethics Committee of the Kumamoto Health Science University (approval number: 22007). By the time they participated in the study, they had completed lectures and exercises on joint range of motion measurements; however, they had never performed ROM measurements on patients during training at a hospital.

Measuring equipment

The participants used a universal goniometer with a handle length of 30 cm and angle marks at 1° increments. In this study, the reference ROM values for the knee joint were measured using ARMS software (ATR-promotions, Kyoto, Japan) based on the measured values obtained by two electronic accelerometers (TSND151, AMWS020; ATR-promotions, Kyoto, Japan). The values measured by the accelerometer were transferred to a computer connected via Bluetooth, and the joint angles were calculated based on these values and displayed on a screen in real time. Previous studies have confirmed the reliability of knee joint angle measurements using electronic accelerometers for various movements such as walking, climbing stairs, and jumping. In particular, high reliability has been reported for measurements in the sagittal plane [46]. For left knee flexion measurements, an accelerometer was attached to the lower limb 5 cm from the lateral epicondyle of the femur along the line connecting the greater trochanter and lateral epicondyle of the femur, whereas the other accelerometer was attached 5 cm from the fibular head along the line connecting the fibular head and lateral malleolus. These landmarks were identified by palpation. In addition, electronic accelerometers were installed using the method described by Yamamoto et al. [45]. All accelerometers were secured with surgical tape, whereas elastic bandages were used to prevent slippage. The joint angles calculated from the accelerometer measurements and saved at a sampling frequency of 1,000 Hz were displayed on a monitor using ARMS software to notify individuals who underwent ROM measurements of the joint angles.

Tasks

Goniometric measurement task

In this study, with reference to the study by Akizuki et al., the task was to measure the ROM of the left knee joint of the subject in the supine position [35]. The landmarks for the ROM measurement of the knee joint were the greater trochanter, lateral epicondyle of the femur, fibular head, and lateral malleolus. The angle formed by the line connecting the greater trochanter and lateral epicondyle of the femur and the line connecting the fibular head and lateral malleolus was measured in 1°steps by the participant using a universal goniometer (Figure 1). No instructions were provided on how to locate the landmarks by palpation, passively bend the joint, or apply a goniometer to the measurement site. During the trials, the right knee joint flexion was set to angles of 60° ± 10°, 75° ± 10°, and 90° ± 10°. The person to be measured watched the display of the software, and when the set angle was reached, announced that “the knee will not bend any further” and resisted the force being applied to flex the knee by the participant. Once the movement stopped, participants measured the joint angle in 1° increments using a universal goniometer. Furthermore, as soon as they completed the measurements, they declared “done” and reported the measurements to the experimenter. The experimenter recorded the time at which the measurement was completed using the time-recording function of the ARMS software. The person to be measured was the same for all participants.

Visual estimation task

The visual estimation task was performed in the same manner as the goniometric measurement task, with only the method of measuring the joint angles being changed. In this task, the subject passively flexed the subject's left knee joint, and when it stopped, observed it directly and estimated the joint angle in 1° increments without using a device such as a universal goniometer.

Procedure

The participants were randomly divided into two groups: a self-control group (SC group) and a Yoked group (Yk group). The number of students in each group was the same. All participants participated in the two-day experiment according to their assigned groups (Figure 2). First, SE before the pretest was measured before practice. Each item was scored on a ten-point Likert scale, with 1 indicating a lack of confidence and 10 indicating complete confidence. Many studies on SE have used the Likert scale, although the scores are not uniform and range from 5 to 10 points [47, 48]. According to Gist et al., with high baseline SE, room for improving SE is low [49]. Therefore, to increase the possibility of score dispersion, we used a ten-point Likert scale, which was also used in the fall efficacy scale [50]. After measuring SE, three trials [60° ± 5°, 75° ± 5°, and 90° ± 5°; in random order) of both the visual estimation and goniometric measurement tasks were conducted as a pretest. The acquisition phase was conducted after the pretest. In the acquisition phase, 12 trials (3 trials × 4 blocks) were conducted, and the three joint angles were randomly set for three trials in each block. During practice, after the visual estimation task, the participants performed the goniometric measurement task while keeping their left knee joint. There was a 30-second break between each trial and a one-minute break between each block.

During practice, participants in the SC group chose whether to receive feedback at the end of each trial and were given feedback on the goniometric measurement task only during the preferred trials. The feedback information was the joint angle displayed on the screen when the subject declared completion of the measurement and the experimenter verbally communicated it to the subject in 1° increments. In contrast, the participants in the Yk group were not given the opportunity to make a choice and received feedback only on trials in which the corresponding participants in the SC group received feedback. In addition, the participants in the Yk group performed the tasks in the same order as the corresponding participants in the SC group.

After completing the practice, SE was measured again, followed by a short-term retention test in the same manner as in the pretest. Approximately 24 h after the end of the short-term retention test, SE was measured, and subsequently, the long-term retention test was conducted in the same manner as the pretest. Furthermore, the participants were not provided feedback on either test.

Figure 2 represents the schematic diagram of the measurement procedure. SE of the ROM was measured before each test. In all the tests, the goniometric measurement and visual estimation tasks were measured in the same manner, with three trials each. In the acquisition phase, the participants practiced each task for a total of 12 trials (3 trials × 4 blocks). In addition, feedback was provided according to the condition of the assigned group only during practice, and no feedback was given to all participants during all tests.

Data processing and statistical analysis

First, because the feedback frequency for the SC group fluctuated with the participants’ choices, the feedback frequency was calculated for each block. Next, we set measurement accuracy and measurement time as indicators of ROM measurement technique. The measurement accuracy indicates the accuracy of the technique, whereas the measurement time indicates the smoothness of the technique. The main results of this study were the measurement accuracy and measurement time of the goniometric measurement and visual estimation tasks in each test and the SE for ROM measurement before each test. First, the accuracy of the goniometric measurement task was calculated as the absolute error between the joint angle measured by an electronic accelerometer and that measured by the student using a universal goniometer. Similar to the goniometric measurement task, the measurement accuracy of the visual estimation task was defined as the absolute error between the joint angle measured using the electronic accelerometer and the student's visual estimation. Next, for both the goniometric measurement and visual estimation tasks, the measurement time was defined as the time from the experimenter's declaration of the start of measurement to the participant’s declaration of the completion of measurement and was measured in milliseconds. These results were averaged for each task in the pretest, short-term retention test, and long-term retention test. SE was defined as the real number on a ten-point Likert scale as the SE of the ROM measurement before each test measurement.

Statistical analysis was performed using IBM SPSS ver.29 (IBM Corp., NY, USA). To verify the changes in feedback frequency, we conducted a one-way analysis of variance with the feedback frequency of each practice block as the dependent variable and the practice block as the independent variable. If a significant main effect was found, a Bonferroni test was performed. Subsequently, an analysis was conducted to determine the degree of learning for each task based on the differences in the accuracy of goniometric measurements and visual estimation and the difference in the way feedback was provided. A three-way analysis of variance was conducted with measurement accuracy as the dependent variable and testing, feedback, and measurement method (3 × 2 × 2) as factors. A sub-test using the Bonferroni method was performed if a significant main effect or interaction was observed. A similar analysis was conducted regarding the measurement time of the goniometric measurement method and visual estimation. Finally, to confirm whether the SE of each group was related to the measurement accuracy of the goniometric measurement task, the measurement accuracy of the goniometric measurement task of each test and the SE before each test were subjected to Spearman correlation analysis. A similar analysis was performed on the measurement accuracy of the visual estimation task. In all analyses, a risk rate of less than 5 % was considered statistically significant.

Feedback frequency

The feedback frequencies from block 1 to block 4 were 86.7 ± 21.1%, 75.6 ± 34.4%, 75.6 ± 36.7%, and 80.0 ± 30.3% (mean ± standard deviation) in order. As a result of the one-way analysis of variance using feedback frequency in each block during practice in the SC group as the dependent variable, no significant main effect was found (F(3, 56)=0.425, p=0.736, η_p²=0.022）.

Measurement accuracy

The results of a three-way ANOVA with the measurement error of each test as the dependent variable and 3 (test) × 2 (feedback) ×2 (measurement method) as independent variables revealed that among the within-subject factors, there was a significant main effect of the test (F(2, 56) = 13.756, p < 0.001, η_p²= 0.329) (Figure 3). As a subtest, the short-term and long-term retention tests were significant compared to the pretest using the one-way ANOVA and the Bonferroni method, with the measurement accuracy of each test as the dependent variable and the test as the independent variable. (p < 0.001, p < 0.001, respectively). Furthermore, among the within-subject factors, there was a significant main effect of the measurement method, and the measurement error in the goniometric measurement task was significantly lower than that in the visual estimation task (F(1, 28) = 8.343, p = 0.007, η_p²= 0.230). Although there was a main effect of feedback (F(1, 28) = 0.644, p = 0.429, η_p²= 0.022), no interaction effects of feedback and test (F(2, 56) = 0.698, p = 0.757, η_p²= 0.010), no interaction effects of feedback and measurement method (F(1, 28) = 1.396, p = 0.247, η_p²= 0.047), no interaction effects of test and measurement method (F(2, 56) = 0.776, p = 0.465, η_p²= 0.027 ), and no interaction between feedback, measurement method, and test (F(2, 56) = 0.136, p = 0.873, η_p²= 0.005) were determined.

Measurement time

The results of a three-way ANOVA with the measurement time of each test as the dependent variable and 3 (test) × 2 (feedback) × 2 (measurement method) as independent variables revealed that among the within-subject factors, there was a significant main effect of test（F(2, 56) = 31.683, p < 0.001, η_p²= 0.531） (Figure 3). As a subtest, the short-term and long-term retention tests were significant compared to the pre-test, using the one-way ANOVA and the Bonferroni method, with the measurement accuracy of each test as the dependent variable and the test as the independent variable (both p < 0.001). Furthermore, among the within-subject factors, there was a significant main effect of the measurement method, and the measurement time in the visual estimation task was significantly shorter than that in the goniometric measurement task visual estimation task (F(1, 28) = 110.547, p < 0.001, η_p²= 0.798). Although there was a main effect of feedback (F(1, 28) = 808.225, p = 0.731, η_p²= 0.004), no interaction effects of feedback and test (F(2, 56) = 0.698, p = 0.502, η_p²= 0.024) , no interaction effects of feedback and measurement method (F(1, 28) = 0.542, p = 0.468, η_p²= 0.019), no interaction effects of test and measurement method (F(2, 56) = 2.597, p = 0.083, η_p²= 0.085), and no interaction between feedback, measurement method, and test (F(2, 56) = 0.528, p = 0.593, η_p²= 0.019) were determined.

Correlation between SE and measurement accuracy

A correlation analysis between SE before each test and the measurement accuracy of the goniometric task of each test in the SE group revealed that SE before the short-term retention test had a moderately significant negative correlation with the measurement accuracy of the short-term retention test (ρ= -0.675, p = 0.006) (Figure 5a). In addition, SE before the long-term retention test had a moderately significant negative correlation with the measurement accuracy of the short-term retention test (ρ= -0.636, p = 0.011) (Figure 5b). Subsequently, we conducted a similar analysis in the Yk group and found that SE before the short-term retention test had a moderately significant negative correlation with short-term retention test measurement accuracy (ρ=-0.635, p = 0.011) (Figure 5a). Additionally, a correlation analysis between the measurement accuracy of the visual estimation task for each test and the SE before each test in both groups showed no significant correlation.

This study investigated the effects of SC feedback on physical therapy students’ skills for ROM measurement and visual estimation employing a universal goniometer used by medical professionals such as doctors and physical therapists. In addition, we observed a relationship between SE and measurement accuracy before and after practice.

To our knowledge, this is the first study to examine the effects of SC feedback on the ROM measurement practice. The results of this study showed that regardless of how feedback was given, practicing with feedback improved the accuracy of ROM measurement using a goniometer in physical therapy students. Moreover, this skill was maintained the day after practice. These results revealed that practice using feedback improved the accuracy of ROM measurements in physical therapy students. Akizuki et al. reported that a feedback device using an electronic goniometer improved students' measurement accuracy when practicing passive ROM measurements of the knee joint using a goniometer [35]. However, the effectiveness of SC feedback was not demonstrated in this study. This may be related to the frequency of feedback and information processing during the feedback-based practice. First, regarding feedback frequency, Janelle et al. reported that participants in the SC group requested feedback only in 7% of the practice trials. In addition, Chiviacowsky and Wulf reported that feedback was requested on 44.7% of practice trials in the first practice block, but this decreased to 28% in the final practice block [40]. On the other hand, in the present study, each block consisted of three trials; therefore, feedback frequency did not decrease throughout practice, although the frequency did not decrease as in these studies. Although the number of practice trials in this study was 12, which was not large, one study that verified the motor learning effect of self-selecting the objects to be used reported that it was effective after 15 trials [51]. Furthermore, it has been reported that task-related choices, such as feedback, are more effective than task-irrelevant choices, such as items used; although it would have been easier to obtain this effect in this study, it was not expected [52]. St Germain et al. stated that feedback characteristics are more important determinants of motor learning than the presence or absence of selection [53]. In this study, as the SC group used feedback frequently, the Yk group received frequent feedback during practice as well. High-frequency feedback was proven effective for motor learning when the task was complex for learners [54], and it was argued that this feedback characteristic was effective for physical therapy students whose skill levels were not high.

Additionally, the results of this study showed that similar to measurements using a universal goniometer, the accuracy of visual estimation improved with practice, and this skill was maintained even the day after practice. The improved visual estimation accuracy in both groups might have influenced the improvement in measurement techniques using the universal goniometer. Kantak and Winstein emphasized the importance of encoding processes such as error estimation during practice in motor learning [55]. Error estimation during practice is reportedly effective for learning if feedback is continuously provided [56]. In this study, because the SC group requested feedback frequently, both groups performed goniometric and visual estimation tasks with frequent feedback. By providing frequent feedback on tasks for which they had never been previously given feedback, the participants performed more precise information processing than in practice without feedback. In addition, it is argued that the learners in both groups developed error detection ability (error estimation) and could modify motor programs more precisely. Consequently, the value of the feedback information provided was maximized by comparing the perceived error to the actual error, and the effect of SC was relatively small.

In addition to improving the accuracy of both the universal goniometer measurement and visual estimation, practice with feedback also shortened the measurement time for both methods. However, measurements using a universal goniometer require more time than visual estimation, likely because visual estimation does not use a universal goniometer; therefore, it does not take much time. Using visual estimation, the participants completed the measurement in a shorter time; however, as mentioned earlier, the measurement accuracy was lower than that using a universal goniometer. Hancock et al. reported that the visual estimation accuracy was lower than measurements using a universal goniometer among orthopedic surgeons, orthopedic trainees, and physical therapists [57]. In other words, even if the visual estimation technique of the measurer improves with experience, it remains difficult to make the same or more accurate measurements compared with measurements using a device such as a goniometer. Watkins et al. suggested that ROM measurements of a patient's knee should be performed repeatedly using a goniometer to minimize errors associated with the measurements [30]. The present study supports the results of these studies and recommends measurements using a universal goniometer rather than visual estimation for students and other inexperienced healthcare workers.

Regarding SE of ROM measurement, as reported in a previous study [45], SE before the pretest measurement did not reflect the accuracy of ROM measurement using a universal goniometer. However, for both groups, SE before the short-term retention test measurement, immediately after practice, was related to measurement accuracy at that time. Normally, students do not know the actual ROM when learning techniques in lectures or through independent practice; therefore, it is difficult for them to understand their own skills correctly. However, as physical therapy students correctly recognized their own measurement accuracy through practice using feedback, a relationship between SE before the short-term retention test and the measurement accuracy of the test was determined. Regarding SE on the day after practice, only the SC group was associated with measurement accuracy immediately after practice; however, it did not reflect measurement accuracy on the day after practice. Self-regulation of the learning model was the reason SE on the day after practice was related to measurement accuracy immediately after practice only in the SC group. During the acquisition phase, the SC group reflected on the trials they had performed and repeatedly considered whether they needed to receive feedback. In other words, the three-stage cycle of forethought, performance control, and self-reflection in self-regulation learning was strengthened, and the SC group was able to process information more deeply. As a result, it is believed that the SC group formed SE that was appropriate to the situation of the short-term retention test trial, even though the test trial was not given feedback. However, because the measurement accuracy changed considerably from immediately after practice to the day after practice, there was no relationship between SE and measurement accuracy on the day after practice. Baaji et al. reported that dental students are guaranteed a certain level of competency at the end of their undergraduate training; however, the level of SE varies from student to student and improves over a year as they gain experience after graduation [58]. In the SC group, by incorporating feedback into practice, students correctly recognized the measurement accuracy at that point; however, the amount of practice in this study possibly was insufficient for SE to fully reflect the measurement accuracy after learning.

Finally, the results of this study revealed that physical therapy students' ROM measurement skills of universal goniometer measurement and visual estimation improved, and they learned through practice with feedback. However, even with improved measurement technique, visual estimation remains less accurate than measurements obtained using a universal goniometer. This study demonstrated the effectiveness of feedback as a method for acquiring ROM measurement techniques for physical therapy students.

Limitations of the study

This study has several limitations. First, we were unable to perform a preliminary sample size calculation because no reference studies were identified. If the study results are based on an inadequate sample size, the results of statistical analyses may be overestimated. This means that it can be difficult to determine whether a study's findings are true or whether they can be extrapolated to a larger population. Therefore, we propose conducting further research with a larger sample size to determine the motor learning effects of practice by using feedback on ROM measurement techniques. Second, only knee flexion ROM measurements were evaluated in this study; therefore, it is unclear whether the results can be generalized to measurements of other joints. Finally, this study examined the short-term practice effects. The long-term effects of feedback on motor learning while practicing ROM measurements have not yet been investigated. Therefore, in the future, the team plans to apply feedback-based training to measure joints other than the knee and verify its effects over a longer period.

This study demonstrated that practice with external feedback improved the accuracy of students' ROM measurements and visual estimation and shortened the measurement time. Furthermore, the results showed that the learning effect persisted after 24 h. However, the effectiveness of SC feedback could not be clarified. It was also revealed that SE after the end of the practice was temporarily related to measurement accuracy at that time. We believe that providing external feedback will lead to effective educational methods promoting the use of physical therapy techniques.

ROM

Range of Motion

Self-controlled

Yoked

Self-Efficacy

GMT

Goniometric Measurement Task

VET

Visual Estimation Task

Acknowledgements

We confirm that no individual other than the listed authors provided professional writing or analysis services. Still, we thank all anonymous participants whose contributions enriched this study.

Funding

This study was supported by JSPS KAKENHI (grant number: JP20K19437). The authors declare no conflicts of interest.

Author Information

Authors and Affiliations

Department of Rehabilitation, Kumamoto Health Science University,

325, Izumi-machi, Kita-ku, Kumamoto-shi, Kumamoto, 861-5598, Japan

Ryohei Yamamoto

Department of Rehabilitation, Kyushu University of Nursing and Social Welfare

888, Tomino, Tamana, Kumamoto, 865-0062, Japan

Yushin Yoshizato2), Takaki Imai2),

Department of Physical Therapy, Mejiro University

320, Ukiya, Iwatsuki-ku, Saitama-shi, Saitama, 339-8501, Japan

Kazunori Akizuki

Contributions

All the authors (RY, YY, TI, and KA) contributed to the study design. RY, YY, and TI collected and analyzed the data and wrote the manuscript. KA contributed to critical revision of the manuscript. All the authors have read and approved the manuscript.

Corresponding author

Ryohei Yamamoto.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Kumamoto Health Science University (approval number: 22007), and all participants signed an informed consent form prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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No competing interests reported.

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Effects of self-controlled feedback on learning range of motion measurement techniques and self-efficacy among physical therapy students.

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