Learning spaces for health sciences – what is the role of e-learning in physiotherapy and occupational therapy education? A literature review

Figures & data

Table 1 The e-learning activities categorized into; communication space

Article	Learning theories	Aim	Study description	E-learning strategies	Student group	Conclusion
Maloney et al. [7]	Socially constructivist pedagogy	Identify use and behaviors with social networking sites and views on potential apps	Cross sectional	Psychological constructivist pedagogy, ‘cultural constructivism’	Physiotherapy	97% uses, learning networks in line with socially constructivist pedagogy. Students reluctant to formalize beyond peer groups, maintain privacy. Obtain information or ‘follow’ clinician. Avoid educator involvement
Usher et al. [8]		Determine the habits of use of social media and preferred media sourcing	Cross sectional		Students of health profession courses, physiotherapy 1.9%	The majority skilled. Universities could benefit regardless of platform. Guidance, support and professional conversation could enhance collegiality of the professional nationally and globally

Figure 1 PRISMA 2009 flow diagram

Notes: From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097. For more information, visit www.prisma-statement.org.

Table 2 The e-learning activities categorized into; Enabling learning activities

Article	Learning theories	Aim	Study description	e-learning strategies	Student group	Conclusion
Gallagher et al. [9]	Video-based instruction enables students to direct the pace of their learning or repeat portions of the desired skill. Repetition can aid in the retention of psychomotor skills	Determine the efficacy of a DVD-based teaching approach compared with the traditional face-to-face (F2F) approach to teach students to transfer a patient using a hoist	Single-blind randomized controlled pilot trial	Four steps when teaching clinical skills:	Occupational therapy	Inconclusive whether DVD-assisted training was as effective as F2F training
				*demonstration
				*deconstruction
						No significant difference as to improvement. F2F class had higher level of perceived confidence in completing the task, more satisfied with the training
				*formulation
				*performance, can lead to a passive learning environment. Clinical expertise and small groups of students can be a challenge
Da Costa Vieira et al. [10]	Distance education could be positive, negative or equal	To assess the level of retention	Prospective randomized controlled trial, blinded	Advantages and disadvantages with e-learning, contradictory results, impressions, biases	Physiotherapy	E-learning led to the same retention, thus promoting this methodology
McAlistar [11]	Asynchronous technology facilitates repetition and feedback at the students preferred pace but also promotes student control and self-directed learning M-learning	Explore how students enrolled in a kinesiology course perceived the value of implementing instructor-produced YouTube videos of in-class assessment demonstrations	Cross sectional, pilot	Occupational therapy		Students perceived that the videos improved the quality of the course, increased their level of engagement and learning, and boosted confidence in their manual skills. Survey results also found that students correlated the instructor’s willingness to develop online videos with a commitment to student learning
Snodgrass. et al. [12]	The importance of feedback. OSCE	Describe the administration of this examination and the evaluation from the academic´s view	Implementation, cross sectional	Physiotherapy, occupational therapy		Immediate individualized feedback. Not all examiners and course coordinators were comfortable with the technology
Snodgrass et al. [13]	Personal digital assistants (PDA) might facilitate transfer of knowledge and skills from the educators to the students. Feedback to achieve reflection on performance and skills in a timely and individualized manner	Explore the perceptions of examiners and students of this feedback system	Implementation, cross sectional, pilot	Occupational therapy, physiotherapy, speech pathology	May facilitate. Students: adjunct to verbal feedback, more and more useful. Clinical supervisors thought loss of time but more regular and accurate documentation. Technology- related issues problems
Westwater-Wood & Moore [14]	Feedback best close to assessment, constructive feed-forward feedback	Compare three modes of providing feedback	Cross sectional, prospective	Physiotherapy	Time saving. Feed forward. Preferred individual. F2F for discussion. Unclear about importance of mode
Fernández-Lao et al. [15]	mLearning any time, on the move	To see if a mobile app as a supplement to traditional learning, would be useful in acquisition palpation and ultrasound skills	Single-blinded, randomized controlled.	Physiotherapy	Some significant impact of mLearning on physical skills
					Group using app better on most of the practical tests, but no significant differences as to theoretical knowledge

Table 3 The e-learning activities categorized into; creating a learning environment

Article	Learning theories	Aim	Study description	E-learning strategies	Student group	Conclusion
Bernard Ashton et al. [16]	PBL	Investigate the effect of habituation (student experiences in using e-learning automatically) on student performance in one PBL module	Retrospective cohort	Assist students’ ability to study and revise material anytime and anywhere. Blended learning, constructivism theory of learning design. Connectivism. Social constructivist e- learning environment	Occupational therapy	No significant difference between 2 cohorts. When well e-learning activities crafted into PBL and students habitual users of the VLE, they perform better in the summative assessments than students who are novice users
Bodell & Hook [17]	Social media seen as a tool for continuing professional development (CPD). Social constructivism emphasizing conceptual development through integration of ideas, opportunities for reflection, having ownership of a given task	Evaluate an extracurricular blended learning opportunity aiming to equip students with the knowledge and skills required to use online social media to create professional networks and facilitate CPD	Qualitative, pilot	Portfolios blog	Occupational therapy	An increased confidence about online professionalism
				Networking. Face to face (F2F). Blended learning		The package was effective in preparing students to use the online environment for CPD
Gaida. [18]	Teaching skills: explanation, demonstration, practice and feedback. Traditional learning; passive, superficial. Implementation of technology, flipped classroom, rewards the prepared learner	To evaluate a flipped classroom teaching method to stimulate learner engagement	Cross sectional, qualitative	E-learning similar to traditional learning, but better than no intervention	Physiotherapy	Thematical analysis: power shift towards the student, enhanced skill development + improved efficiency. Pay-back-time 3 yrs for video production
Green et al. [19]	Time flexibility, interactive, student centered. Pros and cons as to online discussion. If posting on forums – improved learning outcomes	To investigate if the use of asynchronous online discussion forums is an independent factor leading to an improved course mark	Cross sectional		Physiotherapy	Asynchronous online discussion could be a prerequisite for higher final marks. Engagement
Green & Whitburn [20]	Advantages of blended learning and how it can look. More blended ‘pedagogies’, convenience, flexibility, financial benefits, more engaging and meaningful for learners	Describe the implementation of a blended course and evaluate the effectiveness of the design	Retrospective cohort		Physiotherapy	Improved student learning outcomes. Blended learning was well-suited to gross anatomy teaching if well planned and rigorously developed including peer-reviewed content. Keep blended not only online. Interaction components online, high level of engagement
Harvey et al. [21]	Massive Open Online Course (MOOC)	To describe the outcomes of a MOOC in terms of user participation, satisfaction and changes in knowledge	Descriptive audit of a 5 week MOOC	Online virtual classroom often fostering a sense of collectiveness that helps maintain motivation to learn. Free and provide students from all countries access to the same level of education	Physiotherapy and junior PTs with little experience of the specific field	Did not indicate the effectiveness of MOOCs for learning. Only students’ and physiotherapists’ willingness to participate in this style of learning and their satisfaction with the learning experience. Participants were interested and willing to participate in MOOCs although negative aspects were also brought forward
McKenna et al. [22]	Interprofessional education (IPE)	Examine health professional students’ perspective on the value of using online delivery to facilitate interprofessional understandings and learning	Qualitative	Online learning, e-learning, web-based learning. Online learning increase collaboration between learners as well as facilitators. Benefits – overcoming geographical challenges and scheduling	Emergency health (paramedic), nursing, occupational therapy, physiotherapy, nutrition, dietetics	The online delivery of IPE has the potential to enhance learning and overcome some of the barriers to F2F delivery, while still resulting in effective interprofessional understanding by means of for instance, watching how other health professionals worked via videos
Murray et al. [23]	Blended learning stronger learning	Outcomes of traditional learning (TL) as to flipped classroom (FL) in a specific course. Short-term knowledge retention when basic content was online instead of F2F	Cohort case control	Cognitive efficiency in the classroom, mode considered	Physiotherapy	No significant difference but higher score for FL. FL gave more flexibility + accountability. Challenge higher level thinking in class
Myers & O´Brien [24]	Importance of close communication on line. Critical thinking and clinical reasoning, prompts for online discussion. Aspects of online courses	Describe the development and implementation of an IPE course between two institutions, using best teaching practices for online education and assessment (SoTL)	Retrospective, qualitative and quantitative		Occupational therapy, physiotherapy, speech pathology	Increased understanding and more critical thinking. Effective use of online technology requires engagement of all involved as well as purpose, guidance + feedback
Rowe [25]	Student oriented. Interaction rather than information and negotiation of knowledge. Course – space for student engagement not container of information. Collaboration, non-discipline specific skills, different perspectives in the courses. Authentic learning, situated cognition. Benefits of open online course (OCC)	Determine if generic graduate attributes could be developed using principles of authentic learning in an OCC	Cross sectional, qualitative		Physiotherapy	The OOC gave opportunities to reason beyond discipline- specific knowledge and development of an internally motivated learning drive, acknowledge differing perspectives, opportunities to challenge the idea of knowledge and authority, and growth as empathic communicators. So the students had developed some components
						If well designed OCC – possible to develop generic graduate attributes
Sjödahl Hammarlund et al. [26]	Theory of connectivism. Active learner, self-directed	Identification of factors influencing learning processes and self-directed learning online	Cross sectional, qualitative	Constructive perspective. Motivation aspects	Physiotherapy	Pedagogical design, clarity of purpose, goals and guidelines as well as continuous opportunities for communication and collaboration was perceived as important in an online course. As well as internal factors for instance, low self-efficacy

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