This study examined the potential for m-learning in clinical skills acquisition using a specific exercise prescription app and evaluate student’s perception. Results show a high degree of satisfaction with the specific app and aspects that students consider should be improved.
This educational m-learning app intervention is the first interactive method to educate physiotherapy students in designing therapeutic exercise program skills. The usefulness of e-learning to develop clinical competencies and specific physiotherapy skills was previously reported [5, 6, 34–38], however to our knowledge this study is the first to explore users’ perceptions and satisfaction focused in designing therapeutic home exercise program skills.
Current literature reveals that healthcare trainees in a variety of practice environments share similar trends and perceptions of health care apps. Our findings were similar to those obtained by other e-learning experiences assessing students experiences and perceptions [37, 39, 40].
In the present study the app was used as a supplement to on campus education to enhance the knowledge and training of students. Students used the tool in the resolution of clinical cases, individual and group tasks in various contents such as musculoskeletal and neurological pathologies, injury prevention and risk of falls. This flexibility to be used in different fields of physiotherapy can be considered an important advantage over applications focused on a single field of action.
Positive responses about the m-learning experience and positive responses about innovative methodology confirm that students are interested in using customary technologies. In this context, the change of attitude of the students is becoming more and more evident. They participate, become involved and show great affinity especially when they use known technologies that they encounter on a daily basis [41] what could be considered an important advantage compared to face-to-face master classes. Nevertheless, students continue to point out that these learning tools should be a complement to classroom training, which they consider irreplaceable. This is a clear disadvantage of mobile learning. Some experts have pointed out, software and hardware issues, distraction and misuse as frequent disadvantages of mobile learning while variety of content and access from anywhere in the world and anytime are recognized as the main advantages [42, 43].
Positive results of the first construct of the questionnaire, especially questions about impact and usability, allows us to hypothesize on the adoption of educational strategies to facilitate self-learning in designing therapeutic exercise programmes may expand the implementation of this assessment approach in routine clinical practice.
E-learning has an evident potential to increase re-training for students and professionals promoting self-learning strategies [44]. Students who responded to the open-ended questions insisted on the need to expand their use to mobile technologies (laptops, cell phones, tablets, etc.), a question that had been suggested in previous research in higher education as it can help revive constructivist learning [45]. In student´s opinion, m-learning cannot replace on-campus learning of physiotherapy student’s skills but it appears to be valuable as an additional or complementary activity as expressed by students during the survey.
Within app stores, star ratings and reviews are the main indicators of app quality or value; however, these can be subjective and only relevant if the reviewer has needs and expectations similar to the potential app user. In this context there is evolving literature aiming to identify apps for health conditions, to support self-management, education, or behavior change and to evaluate app quality [46]. For instance, a rubric for evaluating educational apps emphasizes the teaching and learning component of an app; a balance between general and specific criteria is needed to ensure that the rubric is both reliable and objective [47].
Satisfaction with m-learning in university students has been evaluated with multiple instruments [48]; online questionnaires and surveys was a widely used tool [49]. The specifications of the m-learning tools, the student profiles and the outcomes to be measured, make the validity, reliability and objectivity of these evaluations difficult. In our research the use of an ad hoc questionnaire intends to approach the specifications of the m-learning tool and the particularities of the Spanish physiotherapy students.
The most commonly investigated technologies in physiotherapy e-learning tools were websites and discussion boards as has been shown in previous systematic reviews [14]. Websites show improvement in theoretical and practical skills and confirm that student need less time to perform a task [14, 36, 37].
Of special interest is the development of qualitative research with focus groups that include both students and faculty and that allow the achievement of solid constructs, issues that are on the immediate agenda of the authors of this study. In this research we present each of the answers offered by the students in their own words. Although we have grouped the answers into categories, pointing out their own words allows a better qualitative interpretation.
Most of students consider the use of this m-learning tool advantageous from traditional education and conclude with unanimous agreement to recommend the use in universities along the physiotherapy academic period. The students expressed openness and sincerity in their positive and negative responses and continue working with this educational tool in the current academic year.
An additional factor that is relevant for health-related mobile apps is the credibility of the app content. In the education setting, when learning clinical skills, it is critical to learn skills that are relevant and accurate in the local health care environment. Apps that focus on clinical skills provide opportunities for just-in-time learning in clinical settings where textbooks are not available [50, 51].
While promising, there are a number of limitations of the current study that need to be addressed in future research including the limited sample size and lack of a true control group. Another limitation is the frame of reference, that is, that the measurement properties of the questionnaire are only evaluated when applied to one unique app and in one context.