Blended Learning is Effective for Physiotherapy Education | Digital Learning | Article of The Week #25

Digital learning designs have the potential to support teaching and learning within physiotherapy education however the impact on learning and outcomes is not fully understood. A new systematic review has helped to further our understanding.

Digital and online learning transforms both the way we learn and the way we are taught. Digital learning can improve the quality, enhance sustainability and enable inclusive education for all and there are a number of different types and approaches used.  Over the past decade physiotherapy education has been gradually integrating a digital approach to learning at all levels of professional development but which approach is best specifically for physiotherapy?

Learn More About Digital Learning and Physiotherapy

Physiotherapy curriculums are characterised by a combination of theory, skills training and learning in practice and until now digital learning has not been fully embraced by our profession and has been criticised for not being grounded from a theoretical learning perspective. This is interesting as for a long time there has been evidence to demonstrate the effectiveness of using digital learning for healthcare education. Prior to the covid-19 pandemic digital learning had been under researched in the physiotherapy profession but there has been a boom in interest since for obvious reasons. A new systematic review has aimed to readress this balance by identifying and investigating the effectiveness of digital learning designs in physiotherapy education.


A Breakdown: Commonly Used Digital Learning Designs

Digital learning designs use lots of different technologies and there are a number of different methods. The language used is difficult and confusing to understand, so below is a breakdown of the most commonly used digital learning strategies.

Blended Learning

Blended learning is the thoughtful integration of classroom face-to-face learning experiences with online learning experiences. A lot of students and teachers do this already. It is basically the use of integrating face-to-face / same-time (synchronous) and flexible-time learning (asynchronous) activities together. Simply put the combination of learning the same things at the same time as others and learning the same things as others in your own time.

Examples of Blended Learning Models

Flipped Classroom Model: In a flipped classroom the traditional face-to-face lecture is done prior to the classroom and the learning in-class is active, collaborative task and problem-solving focussed. After class they follow up and consolidate their knowledge

Blended Learning On & Off Campus: An example of blended learning design is where the students, for example, gain access to digital learning resources prior to in-class teaching and/or after classroom teaching, but the teaching is traditionally offered. Another example is that the learning activities in the classroom teaching are given and answered through digital learning technology and software.

Hybrid Learning: One student group follows the course on campus and at the same time another group follows the course remotely through digital technology. Hybrid learning can combine synchronous learning with asynchronous learning elements.

Distance Learning

Distance learning is planned learning that occurs in a different place from teaching and requires special course design and methods of communication by electronic and other technology, as well as formalised organisational and administrative arrangements.

Examples of Distance Learning Models

E-learning Courses: a structured course delivered electronically with different elements: live or pre-recorded lecture content, video, quizzes, simulations, games, activities, and other interactive elements. E-learning can also be facilitated as virtual classrooms – a type of online learning in which live interaction between instructors and participants take place at the same time.

Mobile Learning: Variant of e-learning where teaching takes place via mobile equipment.

Remote/at-home Learning: A course designed to be delivered online, not intended to meet in-person, students intended not to work on assignments in the same space, and do not attend lectures or classes virtually with video or audio communication to participate.

Massive Open Online Courses (MOOC): A massive open online course is an online course aimed at unlimited participation and open access via the web. MOOC integrates the connectivity of social networking, the facilitation of an acknowledged expert in a field of study, and a collection of freely accessible online resources. The learners are typically adults and self-organize their participation according to learning goals, prior knowledge and skills, and common interests

Benefits of digital learning


This systematic review was carried out according to the PRISMA guidelines and was pre-registered with PROSPERO. The studies included within the review were RCTs and Cohort studies which met the follow criteria; a study population of physiotherapy students in a physiotherapy education programme, assessed the learning outcomes of a digital learning design, compared the outcomes to traditional classroom teaching; and reported on students’ final grades and self-reported learning outcomes.

Eight databases were used to search for research to include within the review. The complete search strategy is available to review. The search period was from 2010 since that was around the time when digital learning in physiotherapy started to become more central to education.

The risk of bias was assessed using Cochranes Risk of Bias Tool. The outcome measures used were student satisfaction, student perception of lerning, learning outcomes and if data was unable to be analysed statistically narrative description was used. A total of 22 studies were used within the review analysis which included 2186 students across a number of degree programmes across undergraduate and post graduate levels.

A breakdown of all of the included studies is available in full.

Clearly these results are not able to be generalised beyond physiotherapy education and different modules and availability of internet and access to technology also limits this. Additionally due to the type of research and lack of consistently used definition of digital learning methods comparison of study designs is challenging. Furthermore several non-validated outcome measures are used to report student satisfaction and outcome.

Clinical Importance and Take Home Messages

The main take away from this systematic review is that blended learning showed at least equal if not statistically better learning outcomes compared to traditional methods. Of the different blended learning approaches flipped classroom was the most commonly used and also had the biggest positive effect on learning outcomes.

Quick Summary of Results of This Systematic Review

  • Blended learning is likely more effective than traditional classroom teaching in physiotherapy education for both knowledge and practical skill acquisition
  • Students preferred flipped classroom, interactive website / apps and self-produced videos rather than traditional classroom experiences which also translated into better learning effects
  • More consistent experimental design studies are required incorporating statistical methods for reporting results
  • Teacher experience is often not considered within this research
  • MCQ’s offer a useful and effective learning tool

The results from this systematic review are similar to findings from other healthcare professional education however conflicting of others. Flipped classroom is the most commonly used approach to blended learning but lacks a consistent definition which makes it challenging to pool the results together in a systematic review.

Interactive website and app based blended learning showed improved learning outcomes compared to traditional methods when students were obtaining new skills and knowledge. This is inpart due to the interactive design of mobile / web learning activities which make it simple to align to learning outcomes and type of assessment method. They also facilitate authentic learning, situated learning and facilitate context aware learning due to its affordances, accessibility and portability. However to maximise the benefits different learning materials and technology must be integrated to complement each other.

The creation of students own content leads to improved student satisfaction as well as higher perceptions of learning. This is likely because this facilitates and supports students’ self-directed learning, independence, intrinsic motivation and responsibility. Also the output, as in creation of content, clearly demonstrates and communicates a learning outcome. An example of this are the Content Development Projects used by Physiopedia.

In summary this systematic review shows significant effects on student learning in favour of the interventions using flipped classrooms, interactive websites/apps and students self-produced videos. However the caveat is that larger controlled studies are required to fully understand the nuances that result in improved learning outcomes.

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