Abstract:

Clinical reasoning and physical examination competence are essential in physiotherapy education, yet crossover designs comparing active versus traditional methodologies with objective retention measures remain scarce. This study employed a two-period crossover quasi-experimental design with convergent mixed-methods evaluation in second-year physiotherapy students (N=29). In Period 1, one group received active case-based instruction and the other received traditional teacher-led instruction for identical cervical musculature content (sternocleidomastoid and suboccipitals). In Period 2 (three days later), groups crossed over with new muscle content (levator scapulae and scalenes). The active methodology involved autonomous material review, clinical case analysis, a 15-minute practice phase observed silently by the instructor, individualized feedback, and rotational practice across partners. The traditional methodology involved structured teacher-led explanation, demonstration, and supervised reproduction with continuous corrective feedback. A six-item clinical case-based recall test was administered at crossover to assess short-term knowledge retention. A 29-item perception questionnaire was administered after each session. Qualitative data from open-ended questions were analyzed using thematic content analysis and interpretative phenomenological analysis. Period 1 revealed five significant items favoring the active methodology, with autonomy for case analysis showing the largest effect (p<.001, r=.649, large). The recall test demonstrated that students who learned with the active methodology retained significantly more clinical content three days later (90.0% vs 75.8%, p=.009, r=.379, medium effect), with 60.9% achieving perfect scores versus 25.0%. Within-group crossover comparisons confirmed that the same students rated the active methodology higher for physical examination competence and autonomy, providing evidence that cannot be attributed to pre-existing group differences. Pooled analysis across both periods confirmed autonomy as the most robust effect (p=.005). Satisfaction was equivalently high across both conditions. Qualitative analysis revealed two distinct learning architectures: a validated autonomy cycle (effort-uncertainty-feedback) in the active group, where students described learning as a personal conquest subsequently validated, versus a guided incorporation cycle (security-imitation-correction) in the traditional group, where learning was experienced as progressive appropriation of expert skill. The convergence of perceptual, objective, and qualitative evidence supports integrating active case-based methodologies in musculoskeletal physiotherapy education for reasoning-intensive content, while recognizing complementary value of traditional approaches for technique-intensive content.

Keywords:

Active learning, physiotherapy education, clinical reasoning, crossover design, knowledge retention, case-based learning, mixed methods.