Overview of styles, content, learning effects and attitudes of students towards digitally enhanced physiotherapy education – a scoping review

doi:10.21203/rs.3.rs-5016637/v1

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Research Article

Overview of styles, content, learning effects and attitudes of students towards digitally enhanced physiotherapy education – a scoping review

https://doi.org/10.21203/rs.3.rs-5016637/v1

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Background

Digital competences are essential for lifelong learning, as highlighted by the European Commission and emphasized in the Digital Education Action Plan 2021–2027. The COVID-19 pandemic necessitated an unprecedented shift to online education, profoundly impacting fields like physiotherapy that heavily rely on practical skills. This scoping review aims to provide an overview of currently applied digitally enhanced learning methods, content, effectiveness and student perceptions in physiotherapy education.

Methods

Following PRISMA guidelines for scoping reviews, a comprehensive search was conducted across multiple databases, including Medline, Web of Science, and ERIC, incorporating hand searches and expert consultations. Studies were included if they reported on any digital educational methods in physiotherapy education, involving clinical trials, observational studies, or case reports published in English or German from 2010 to February 2024. Data extraction focused on the digital tools that were used, the educational contents, individually measured outcomes, and the impact of digital education.

Results

Out of 2988 screened studies, 68 met the inclusion criteria, encompassing 7160 participants. These studies primarily used quantitative methods (n = 51), with a minority using qualitative (n = 7) or mixed methods (n = 6). Nearly half employed hybrid educational approaches. Outcomes measure included knowledge, performance, perception, satisfaction, and attitudes. Most studies reported positive impacts of digital education, particularly in knowledge transfer and skill performance. Synchronous and asynchronous methods were used, with varying success across theoretical and practical courses. Gamification and virtual reality emerged as promising tools for enhancing engagement and learning outcomes. However, challenges included the limited direct interaction and perceived self-efficacy among students.

Conclusion

Digital learning formats in physiotherapy education can enhance learning experiences and is generally welcomed by students, especially when blended with traditional methods. The integration of innovative digital strategies holds promise for the future of physiotherapy training, contingent on comprehensive support and training for educators and students alike.

Digital

education

physiotherapy

hybrid

learning

Digital competences are stated as one of the key requirements for lifelong learning by the European Commission (1,2). The enhancement of these are prioritized in the Digital Education Action Plan 2021–2027, involving the ability to use digital technologies confidently, critically and responsibly and engage with them for learning, work and for participation in society (1,3). There appears to be increasing attention to the pedagogical use of digital technologies in higher education, but the possibilities are far from being fully exhausted (4). Educational institutions worldwide were facing major challenges due to the pandemic caused by the Sars-COVID-19 virus. Where comprehensive containment strategies for digital / distance learning were not enforced by governments, students were unable to attend their usual classes (5,6). The switch to a purely online format at the beginning of 2020 was unprecedented (6–8). This resulted in teachers being forced to switch from traditional face-to-face teaching to online teaching and making use of different e-learning methods to impart knowledge (9,10). In response to the lockdowns due to the pandemic, teachers had to quickly adapt their curriculum to the new online teaching format. The biggest challenge was teaching and assessing practical skills remotely (11,12).

In degrees that offer theoretical and practical courses such as physiotherapy, the limitations of distance learning for active skill acquisition (observation, palpation, examination, manipulative treatment, exercise techniques) may affect the ability to gain knowledge and skill performance, further affecting students' attitudes towards distance learning (13).

In 2011, Veneri reported on the role of computer-assisted learning in physiotherapy education in a systematic review, followed by Mącznik et al. (2015) who concluded that the use of technologies may enhance practical skills performance, knowledge acquisition and the development of critical and reflective thinking in physiotherapy students (14,15). More recently, Ødegaard et al. (2021) published a systematic review about the effectiveness of different digital learning designs in physiotherapy education, concluding that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching (16).

A recent qualitative study about the characteristics of physiotherapy students’ digital learning practices shows that physiotherapy students adapt to, use and have experience with digital technologies in different learning contexts (17). Furthermore, the development of informal digital learning practices was perceived as collaborative by the students. However, these informal digital learning practices do not correspond to the existing practical competence areas within the courses. The discrepancy becomes obvious when trying to integrate the dimensions found by Ødegaard et al. (2023) into the European Digital Skills Framework (17). Students seem to find it difficult to make connections between their digital learning practices and the demands of the clinical workspace (17).

Recent studies analyzed the effect of rapidly changed curricula from face-to-face to digital education facing the pandemic restrictions. Rossettini et al. (2021) concluded that online instruction in entry-level physiotherapy appears to be a viable option to address the changes due to the COVID-19 pandemic as it satisfies students and results in performance similar to in-person courses (18).

The asynchronous remote training and feedback model has been found to be an effective strategy for developing skill performance (namely neurodynamic testing skills) in students and represents a feasible alternative to face-to-face training (19).

The aim of this scoping review was to summarize the effects of digital educational methods in physiotherapy education on knowledge gain, skill performance and students’ satisfaction as reported in existing literature (including publications after 2020), as well as to provide an overview over the examined teaching and learning methods. The review also seeks to provide insights into the most suitable digital learning methods for particular courses and strategies to maintain student engagement.

The PRISMA recommendations were used for the design, conduction and report of this scoping review (20). The protocol was pre-registered in the open science framework platform (OSF; https://doi.org/10.17605/OSF.IO/D6ECM).

The search was conducted in the databases Medline (PubMed), Web of Science, EBSCO Teacher Reference Center, ERIC Institute of Education Sciences, Fachportal Pädagogik with predefined combinations of MeSH terms and free-text terms (Table 1). Hand searches were added by following the reference lists of the included studies.

Table 1

combination of search terms for the data base search
Terms	Identifier
physiotherapy	1
education	2
digital OR hybrid OR virtual OR augmented OR flipped OR blended OR e-learning OR web-based OR streaming OR “distance education” OR “massive open online course” OR technology OR multimedia OR “user training” OR applications OR interactive OR gaming	3
Database	Simplified strategy
PubMed	1 AND 2 AND 3

The database results were entered into the online software Rayyan. First, titles and abstracts were screened by two independent reviewers against the eligibility criteria. All studies rated as eligible by at least one reviewer were screened in a full-text evaluation against the same eligibility criteria. The decisions for inclusion or exclusion of studies were made by two independent researchers (LP, OS). Conflicting results were rated by a third independent researcher (KL).

Studies were included if they were clinical trials, observational studies or case reports and reported any kind of digital educational method (hybrid, completely digital) in physiotherapy education. As this review focused on assessing both the direct effects and secondary outcomes (e.g., student satisfaction, perception) of digitally enhanced education, either or both should be reported in the included studies. The study population had to be physiotherapy students with no limit of degree or year of studying. Only studies published in German or English language until February 2024 were included. Studies published before 2010 were excluded because there were limited uses of digital learning designs in physiotherapy education before the pandemic (16). Studies were excluded if reporting on mixed health profession students and results for the physiotherapy students alone could not be distinguished.

Data from included studies were mapped in a pre-designed data extraction table. These included the number of participants, study inclusion and exclusion criteria, the form of education (e.g. augmented reality simulation, blended learning, open online course), the detailed intervention with information about how and how long the digital educational methods were applied, outcome measurements used to measure the effect of the digital education including soft outcomes (e.g. satisfaction, perception) and if there was a positive impact of digital education (Table I, supplementary material). Additionally, it was recorded whether the digital education was conducted due to the Sars-COVID-19 pandemic. The data extraction was performed by two researchers and counterchecked for correctness (LP, OS). Qualitative outcomes were analyzed by applying a narrative synthesis and summarized in a sankey diagram. If data was not reported in the full-texts, authors were contacted via email and reminded after one week.

A total of 2988 studies were screened at title and abstract level. In the next step, the full texts of 106 studies were examined and subsequently, 67 studies were included into this review (Fig. 1).

Study characteristics

Included studies were published between 2012–2023 (Fig. 2), reporting on a total of 7160 participants (6514 physiotherapy students). Four studies also included physiotherapy professors (21), medical students (22), exercise physiology and exercise science students (23) and home care, elderly care, first and emergency aid students (24). Only results for the physiotherapy students were included in this review. Most studies used a quantitative research approach for the purpose of analyzing the effect of digital or hybrid education (n = 54), while 7 studies had a qualitative study design and 6 used a mixed methods approach. Nearly 50% of the studies reported hybrid educational methods (19,22,23,25–53) defined as digitally enhanced education, while the remaining 35 reported digital educational methods without any face-to-face sessions. The outcomes measured were either knowledge or performance (12,18,19,21–23,25–27,29–36,39,42–44,46–71), perception (12,19,26,27,29,30,34,36,38,41,42,45,46,48,49,53,55,59,63,64,66,69,70,72–77), satisfaction (18,26–31,33,37,42,49,50,56,57,59,61,63,66,69,70,73,77,78) or attitude (25,28,43,68,72) of the students towards the digital learning methods used in the respective studies. Other outcomes measured were the student’s opinion about the used digital education method (17,21,24,25,27,31,32,40,41,44,45,52,66,67,73,74,74–76,79–81) and perceived self-efficacy while learning in a digitally (enhanced) environment (37,62,68). Furthermore, 46 of the included studies reported an overall positive impact of the respective digital educational approach (17–19,21–23,25–27,29,31–35,37–39,41–48,51,52,54,55,57–61,65,67,68,70,71,77–82), while 9 studies reported a positive impact in some of their outcome measured (30,50,53,56,62,63,74,75,83). The Sars-COVID-19 pandemic was reported as a major reason for the conduction of the analyzed digital educational approach in 25 of the included studies (12,17–19,24,28–30,41,43,44,47,48,50,51,57,58,62,68,71–73,76,78,83). The results of the individual sources of evidence are shown in Table I (supplementary material).

Content delivery methods

The included studies used a variety of different delivery methods for the digital teaching of physiotherapy students. In some cases, lectures that were originally developed for face-to face teaching were reorganized and held as synchronous online lecture (18,22,31,36,48,50–52,56,66,75,76) or pre-recorded and provided as asynchronous online lectures (18,19,22,41,45,46,68,76) or screencasts (26). 19 of the included studies analyzed virtual learning environments that were either self-conducted on the learning management system (42–44,48) of the university or made available by external providers as Ecofisio (27,61), Rheumatoid Arthritis for Physiotherapists e-Learning Platform (74,82), King's eLearning and Teaching Service (26), Physiotherapy eSkills Training Platform (67), C1D1 (19) or Nearpod (50). One study reported using a massive open online course (59), one used “cursos on-line”, a multimedia online tool (65) and the remaining did not provide explicit information about the frame of the virtual learning environment used in their studies. The content was mainly delivered as videos (e.g. for the presentation of skills (12,19,23,27,32,34,36,41,42,44–50,53,58,59,61,63–65,67,70,71,78,80)), via written case scenarios or other written theoretical information (31,34,44,48,49,55,61,64,65,67,78,80,82), images presented two-dimensional or three-dimensional, sometimes interactive (21,27,30,31,49,50,60,61,65,78). Podcasts were utilized to provide information either in audio format (19,43–46,49) or as video-podcast (38). In 4 studies, the content was merely delivered by power-point slides (26,50,68,80) and in 3 studies, the syllabus was uploaded (25,42,43). Blog posts were used for the distribution of information in 2 studies (54,80). Vision-based augmented reality was only used in one study to facilitate the learning of anatomical structures (39). Additional information was provided via links to external websites (e.g. links to websites of international and national scientific societies) for further references (42,43,46,48,50).

Gamification as a method for content delivery and knowledge testing

Besides the beforementioned digitally enhanced educational methods, there were 24 studies using a gamification-based approach to facilitate learning motivation in students (23,26,29,32,34,36,37,42–44,48,50,52,55,57,59,69,77,80,83). For content delivery, three studies used virtual reality simulations and two had access to high fidelity mannequins. In one of the virtual reality scenarios, the students were asked to manage a patient as a physical therapist and received access to the information needed to diagnose this patient (55). Ulrich et al. (2023) showed a 360° video of correct supine positioning via a virtual reality head mount display as a non-immersive way to use the device (69). In the third study, the students tested virtual reality games to be used with patients in neurological rehabilitation as part of the “physiotherapy in neurological diseases” course (77). The high fidelity mannequins were either used in a simulation-based educational scenarios or in an escape room scenario (32,37). Students had to build a physiotherapy diagnosis based on the symptomatology of the advanced simulation mannequin (32) or targeted other clinical domains (37).

Escape rooms that incorporated puzzle solving and using clues to complete activities and thus escape from the room within a certain amount of time, were analyzed by two different studies (32,83). Students had to decipher hidden messages, open locks and correctly carry out a prior learned treatment protocol in order to escape.

The most used gamification approach for knowledge testing was quizzes, that were provided in different formats (e.g. drag and drop, Kahoot!, multiple choice; (23,26,29,32,34,36,42–44,48,50,52,57,59,80,83)). One additional study examined “Physiotherapy Party” as a content delivery and knowledge testing method, that included mimicry, questions, forbidden words and drawings (83).

Briefing and debriefing

Discussion boards and online forums were used for student interaction, briefing and debriefing of learning sessions often by using the learning management system platform of the university or twitter (n = 9; (23,34–36,40,42,43,48,79)). Furthermore, social media groups (facebook (59,75), online platforms (47,50,80) and e-mail (18) were used for communicational purpose.

Knowledge gain and improvement in skill performance

47 studies analyzed the effect of digital (enhanced) education on knowledge gain and skill performance. Of these, 7 reported a significant positive effect either on theoretical or practical knowledge performance over time (19,25,43,49,54,57,62)). Additionally, 28 studies compared the effect on performance or knowledge of digitally (enhanced) education with traditional or less invasive digital teaching methods and found significant differences. Of these, 18 reported significant increases of theoretical knowledge or clinical skill performance in favor of the experimental groups in at least one of their outcome measurements (18,22,26,27,29–31,34,36,39,42,44,58,60,61,63,65,70)), while 9 of the remaining studies found no significant differences between the experimental and control group (12,32,47,50,53,56,64,69) and one found a difference in favor of the control group that received a clinical case presented in text form instead of via immersive virtual reality (p = 0.023; (55)). The remaining studies did neither report the significance nor effect sizes of their findings.

Students’ satisfaction, perception and experiences

The overall student satisfaction was measured in 18 studies with a positive outcome (> 50% of the individual score) in 16 studies (18,21,27,29,31,33,36,45,49,50,59,61,64,70,77,78). One study reported a significantly better student satisfaction in the traditional learning group compared to two different styles of digital learning (video and 360° video) (69). Etoom et al. (2023) analyzed distance learning in a cross-sectional online survey with a comparable low satisfaction score of 17.14/40 (73).

The improvement of the learning experience has been measured in 8 of the included studies with ambiguous results. In half of the studies, students rated that their learning improved with the use of digital methods (21,57,70,79). As before, the students in the study by Ulrich et al. (2021) favored the traditional teaching method with a significant difference (69). In Nicklen et al. (2016), only 21% of the students experienced an improvement of the learning experience with the use of a remote-online case based scenario (66). There was a difference in cohorts analyzed in Luedtke et al. (2022), with the second year cohort rating their learning experience as improved (6.14/10) and the first and third year cohort did not experience a strong improvement (3.04/10 and 4.41/10, respectively) (12).

Furthermore, 15 studies rated the delivery method of the learning content as appropriate (> 50% of the individual score) (21,25,27,37,42,43,48–50,53,61,78,79,81,83). Web-based distance education or remote-online case-based learning was rated as not appropriate for content delivery in only two studies (24,66).

The knowledge gain (either theoretical or skill related) was measured by 17 studies (12,19,21,25–27,30,31,39,42,43,48,52,53,63,64,67,77–79,82). Only two studies reported a rating of theoretical knowledge gain of less than 50% of the achievable score (52,66).

Some advantages and disadvantages of the change from traditional face-to-face teaching to digitally enhanced teaching were reported, with an improvement of dedication and motivation analyzed by 16 studies (25,26,29,31,36,42–44,49,52,53,69,70,77,78,83). Only Ulrich et al. (2021) reported a significant difference to the traditional teaching method in favor of the face-to-face teaching (69). The detailed information about the quantitative results for students’ satisfaction, perception and experience can be obtained in Table II (supplementary material).

Adding on the beforementioned quantitative findings, 13 studies followed a qualitative research design to gain an insight into reasons for students’ satisfaction, attitude and perception with digital education. The key themes of the qualitative studies were synthesized and categorized into overarching categories. Common subcategories were identified and extracted. The result of the narrative synthesis is displayed in Fig. 3.

Subjects/courses

The digital learning and teaching method was implemented in either theoretical courses, practical courses or skill trainings, with musculoskeletal courses being the most. The course distribution is shown in Table 2.

Table 2

courses in that digital teaching was implemented
Theoretical courses	• professional ethics (25) • professional and multidisciplinary team issues (79) • evidence based practice (40,48,54) • viva preparation (70) • abdomen and pelvis anatomy (57) • musculoskeletal anatomy (23,30,35,39,59) • neuroscience (34)
Practical courses	• respiratory pathologies (37,55,65) • cardiac rehabilitation (32,37,42,43) • rheumatoid arthritis (82,84) • lymphatic issues (41) • ICU/first aid (80,83) • pediatrics (75) • neurological rehabilitation (37,59,77) • obgyn (66) • musculoskeletal therapy (18,19,37,44,46,50,52,61,63,64,71,83) • chronic condition therapy (22,71)
Skill training	• manual therapy (12,21,60) • fit-ball (75) • ultrasound skills (27,31,58) • clinical practice skills (not further defined) (38,45,47,51,67,69,76,78)

The substantial number of studies addressing digitally enhanced education in physiotherapy as well as the significant increase of related publications underscores the increasing importance of digital technologies in this field.

Looking at the results for knowledge and skill gain, most of the studies included in this review showed either a positive effect of the digital enhanced education or no significant difference to a control condition. Most of the studies reporting the overall satisfaction of the students had a positive outcome as well, but only with a small number indicating that the change of educational methods led to a positive impact on the learning experience. However, this review presents highly heterogeneous results with a high variety of digital educational methods and no clear consensus for or against individual methods can be given. Notably, digital teaching seems most accepted and effective in the theoretical and basic knowledge transfer, particularly as preparation for skill acquisition training. The results of this review complement the results of existing publications on this topic by adding studies conducted during the Sars-COVID-19 pandemic and focusing on the students’ satisfaction next to the knowledge gain (14–16).

Impact of COVID-19, challenges and limitations of digital learning

The Sars-COVID-19 pandemic was pointed out as the major facilitator for implementing digital education approaches with varied perceptions of distance learning in many of the here included studies (5,5,9,13,85). Due to the pandemic restrictions, face-to-face learning or even blended learning strategies were not possible. Solely digital content was created to substitute for the traditional teaching methods. While both synchronous and asynchronous online teaching methods offer certain advantages, intensive consideration is needed regarding the effective delivery of learning content in digital formats and appropriate pedagogical strategies to increase learning engagement (86). Digital learning formats may as well limit the direct exchange of knowledge, skills and experiences between students and teachers, which could affect confidence in the knowledge and skills acquired (28).

Another considerable factor is, that universities must provide adequate support for teaching staff in economical, organizational and technological aspects to ensure high educational standards when adding digital teaching formats to the curriculum (18). This includes the provision of technical support, training in distance learning and the development of effective workload management skills for the teaching staff (18,87).

Despite the rapid adoption to the teaching possibilities during the pandemic, a significant proportion of respondents in the here included studies expressed a dissatisfaction with digital learning compared to the traditional face-to-face teaching experienced before. This dissatisfaction led to recommendations for curriculum design changes, emphasizing a blended learning approach that integrates online resources with face-to-face practical skill development (7).

Blended learning: the preferred method

Adding to recent research, the results of this review support the use of blended learning approaches in physiotherapy education for reasons of knowledge gain, improvement of skill performance and students satisfaction (16). The combination of traditional and technology-based teaching approaches also seems to be successful in the improvement of the clinical performance and increase of students' confidence in their clinical practice. Interestingly, Evans et al. concluded in their systematic review (2019, (88)) that there is no clear evidence for better academic outcomes in health profession students after changing to flipped classroom as teaching. A preference for blended learning over purely online learning was observable in the results of this review and might be explained by the provision of a higher degree of adaptability and more efficient promotion of active learning as described in Ødegaard et al. (2021; (16)).

Student-centered or active remote learning does allow students to learn at their own pace increasing learning engagement (89). But special interest has to be on feedback opportunities that are reported as often missing in the digital learning offers (19,76). Additionally, digital methods often offer individually adaptable learning paths supporting the development of specialized knowledge (6,90–96). For example, students especially appreciated the versatility and audio-visual nature of student-self-videos in preparation for practical examinations.

Enhancing student satisfaction

It is important to consider students' expectations, preferences and personal relevance in educational planning (97). The increase of knowledge is positively correlated with the satisfaction of the students, hence, improvements of average exam results are estimated by consideration of the students satisfaction while learning (98).

To increase students’ satisfaction, the support provided by the lecturer plays a decisive role, especially in online or distance learning (85). Interestingly, students, that are experienced in distance education, are often more satisfied in follow up courses. This could be due to appropriate teaching methods or to predictable expectations (85).

Gamified e-learning concepts can optimize training of physiotherapy skills (23,26,29,32,34,36,42–44,48,50,52,55,57,59,69). In particular, virtual reality technologies represent an effective resource for knowledge transfer and can play a fundamental supporting role, underlining the benefit of innovative teaching technologies in the development of clinical skills in training sessions and in clinical placements (92,99–104). On another note, students who use quizzes (e.g. Kahoot!) and reward cards as learning tools demonstrate better academic results on knowledge gain with the reinforcing component of being tested compared to those without reinforcement (23,26,29,32,34,36,42–44,48,50,52,57,59,80,83). Hence, this methodology can be an effective tool to promote student engagement and support content acquisition as well (105).

On the contrary, results from studies using 360° videos indicate that traditional teaching is either equivalent or even more effective in most aspects. In addition, 360° videos represent a viable alternative to virtual reality and conventional videos. They are characterized by their cost-effectiveness and have a positive influence on the user's emotional reaction to the learning environment (103). Students who were offered an escape room learning scenario, have gained extensive knowledge on the provided subject. Additionally, the qualitative comments of escape rooms as teaching method were fairly positive (106). The methodology of case studies and role plays were rated as the most effective techniques in knowledge transfer by students (107).

The application of gamification proves to be extremely effective in other health professions as well (108). Innovative learning methods that combine curiosity and intrinsic motivation with the transfer of knowledge seems to arouse particular interest among learners. Furthermore, there seems to be potential in focusing on cognitive stimuli through playful elements and thus sustainably increase learning engagement and students satisfaction (90,93,95,96,106,109–111).

Future directions

The findings of this review support recommendations to adopt a blended learning approach in future programs. Additionally, implementing online formats could enhance access to education for future physiotherapists, given the opportunity to partially learn remotely, hence, more flexible. A transition to e-learning could also be considered specifically for additional parts of physiotherapy undergraduate programs to thoroughly facilitate access to tertiary education (6).

There is a clear need for further research to determine the best possible design of distance learning courses in physiotherapy education. In addition, it is essential to develop strategies to improve the effectiveness of distance learning. Further research is particularly necessary in clinical placements to improve technology-enhanced learning and to address the decline in perceived self-efficacy among students (6,97,112–117).

Limitations

The comparability of the evaluated studies is limited due to heterogeneity in design, digital teaching and learning methods used, and in the recording of results.

Due to the extensive number of studies included, the character of the present review is mainly descriptive.

Some of the studies integrated online or hybrid teaching methods used in the context of the COVID-19 pandemic, which implies a rapid adaptation from face-to-face teaching to online teaching alone. This may differ significantly from online methods that have been developed, tested and optimized over longer periods of time.

The temporary switch to a fully digital learning approach in physiotherapy education appears to intensify the extent of negative emotions. In addition to the rapid adaptation of learning modalities and existing uncertainties within a study program, many students reported changes in other areas of life, such as job loss or loss of social support systems. Such changes presumably had an impact on students' psychosocial well-being and on their perceptions while learning.

The present review provides an overview about different teaching strategies used for distance education or digital enhanced education in physiotherapy degrees in the past.

Both quantitative and qualitative studies included in this review show that the learning experience of physiotherapy students and their satisfaction could be increased by digitally enhanced educational opportunities. Gamified learning strategies facilitated the engagement of students the best.

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APP	Assessment of Physiotherapy Practice
ASES	academic self‐efficacy scale
AQPEPT	Attitudes Questionnaire towards Professional Ethics in Physiotherapy
BHT	bronchial hygiene techniques
BL	blended learning
BLG	blended learning group
C1D1	see one, do one
CBL	case-based learning
CG	control group
CI	clinical instructor
CP	cardiopulmonary
DE	distance education
DELES	Distance Education Learning Environments Survey
DL	distance learning
DREEM	Dundee Ready Educational Environment Measure
EBP	evidence based practice
EBPQ2	Evidence-Based Practice Questionnaire
EE	educational environment
EER	Educational Escape Rooms
EG	experimental group
ES	Exercise Science
EP	Exercise Physiology
FCM	flipped classroom model
FG	face-to-face learning group
LMS	learning management system
LORI	Learning Object Review Instrument
MCQ	Multiple Choice Questionnaire
MEAH	model of emotions, adaptation and hope
MLE	Maximum likelihood estimation
MOOC	Massive open online course
NMS	neuromusculoskeletal
OL	online learning
OLSES	online learning self‐efficacy scale
OSCE	objective structured clinical examinatron
PTIP	Physiotherapy
PTIP	physiotherapy teaching innovation project
PVT	pre-recorded video tutoring
RA	rheumatoid arthritis
RAP-eL	Rheumatoid Arthritis for Physiotherapists e-Learning
RO-CBL	remote‑online case based learning
S4BE	Students for best Evidence
SBE	simulation based education
SFS	Student Feedback on Subjects
SMS	self-management system
SNS	social networking sites
SSV	student produced self-video
TEL	technology enhanced learning
VR	virtual reality

- Ethics approval and consent to participate

Not applicable

- Consent for publication

Not applicable

- Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

- Competing interests

The authors declare that they have no competing interests

- Funding

This review is funded by the HySkiLabs project supported by the "Stiftung Innovation in der Hochschullehre".

- Authors' contributions

Conception or design of the work: LP, KL

Collection of data: LP, OS

Analysis of the data: LP

Interpretation of the data: LP

Drafting the manuscript: LP, OSi

Critical revision of the manuscript for important intellectual content: LP, KL

All authors give final approval of the version to be published. All authors declare that they are responsible for all aspects of the work and ensure that issues relating to the accuracy or integrity of any part of the work are adequately investigated and resolved.

- Acknowledgements

Not applicable

No competing interests reported.

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Overview of styles, content, learning effects and attitudes of students towards digitally enhanced physiotherapy education – a scoping review

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Abstract

Background

Methods

Results

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Introduction

Methods

Results

Study characteristics

Content delivery methods

Gamification as a method for content delivery and knowledge testing

Briefing and debriefing

Knowledge gain and improvement in skill performance

Students’ satisfaction, perception and experiences

Subjects/courses

Discussion

Impact of COVID-19, challenges and limitations of digital learning

Blended learning: the preferred method

Enhancing student satisfaction

Future directions

Limitations

Conclusion

References

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