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Generation Z is starting to reach college age. They have adopted technology from an early age and have a deep dependence on it; therefore, they have become more drawn to the virtual world. M-learning has experienced huge growth in recent years, both in the medical context and in medical and health sciences education. Ultrasound imaging is an important diagnosis technique in physiotherapy, especially in sports pathology. M-learning systems could be useful tools for improving the comprehension of ultrasound concepts and the acquisition of professional competencies.
The purpose of this study was to evaluate the efficacy and use of an interactive platform accessible through mobile devices—Ecofisio—using ultrasound imaging for the development of professional competencies in the evaluation and diagnosis of sports pathologies.
Participants included 110 undergraduate students who were placed into one of two groups of a randomized controlled multicenter study: control group (ie, traditional learning) and experimental group (ie, Ecofisio mobile app). Participants’ theoretical knowledge was assessed using a multiple-choice questionnaire (MCQ); students were also assessed by means of the Objective Structured Clinical Examination (OSCE). Moreover, a satisfaction survey was completed by the students.
The statistical analyses revealed that Ecofisio was effective in most of the processes evaluated when compared with the traditional learning method: all OSCE stations,
The Ecofisio mobile app may be an effective way for physiotherapy students to obtain adequate professional competencies regarding evaluation and diagnosis of sports pathologies.
ClinicalTrials.gov NCT04138511; https://clinicaltrials.gov/ct2/show/NCT04138511
Generational evolution is nothing new; constant social change poses a challenge for education. During the last several years, concepts referring to subsequent generational learning styles, such as those of Generation X, Generation Y (ie, millennials), or even Generation Z, have been emerging as new ways of understanding new generations [
Some studies have shown how these generations absorb and process information in very different ways compared to previous generations [
In this new teaching-and-learning era, the adaptation of methodologies to new technologies is completely necessary to improve social learning. Educational activity has moved from distance learning to e-learning and, finally, to mobile learning (m-learning), as knowledge has increased exponentially and the demand has escalated [
M-learning is surpassing its predecessor (ie, e-learning), since it takes advantage of all its characteristics and overcomes all its disadvantages, making the content much more accessible in time and space [
There has been an incredible expansion of mobile phone apps in both the medical context [
There is an increasing number of studies on the use of m-learning in health sciences, such as in surgical skills [
Our research team has previously conducted some e-learning [
A total of 110 undergraduate physical therapy students took part in this study; students were enrolled at the Health Science Faculty at the University of Granada, Spain, or at the Campus of Tudela, University of Navarra, Spain. These students were in their first or second year of Physical Therapy Fundamentals and Physical Therapy Assessments courses or in their second year of the Physiology of Effort, Physical Exercise, and Health course during the 2014-2015 academic year. Participants’ theoretical knowledge was assessed and they were also assessed by means of the Objective Structured Clinical Examination (OSCE). The participants were recruited via a public announcement at both universities. All students signed an informed consent form to participate in this study.
To be eligible for this trial, students needed to meet the following criteria: not having received any previous training in ultrasound imaging and management, having anatomy and biomechanics knowledge, being enrolled in any required subjects, having the basic ability to use a mobile app, and having a mobile phone with Internet access running on the Android operating system.
We conducted a multicenter study, which consisted of a double-blinded, randomized controlled study involving volunteer students earning degrees in physical therapy from two public Spanish universities. The study was registered at ClinicalTrials.gov (NCT04138511). We used a computer program to randomly assign a number to each student in both universities. These numbers were provided in numbered, opaque envelopes by an external study member to ensure that the study member responsible for outcome assessments was blinded to intervention and control group assignment. The envelopes were opened after a baseline assessment. The assessment evaluator was blinded to both the assessment and the outcomes. There were 55 participants in the experimental group and 55 in the control group. The students were also blinded to the group to which they were assigned.
After students received theoretical and practical lessons about ultrasound skills in sports pathology areas, the role that the Ecofisio mobile app played was assessed in a traditional way and by means of the OSCE. The OSCE allows us to measure ultrasound competence as expressed in specific observable behaviors. This study was approved by the
The theoretical and practical lessons were conducted by three professors and three teaching fellows; the teacher-to-student ratio was 1:6-8. The same lessons were taught in both universities by the same professors.
There were a total of six contact sessions on site; this was followed by self-study time focused on the theoretical and practical learning of ultrasound imaging procedures, on different areas of the body, regarding sports pathologies. Each study group—Ecofisio intervention group and control group—attended 2 hours of theoretical lessons and 4 hours of practical lessons. The ultrasound imaging sessions were developed following a previously reported methodology [
Both groups had 2 weeks to study after the on-site lessons. To prevent the control group from accessing information related to the mobile app, they were assessed before the Ecofisio group. The Ecofisio mobile app is focused on sports pathologies and contains relevant written and digital information about ultrasound imaging and management, as well as diagnosis of sport injuries. For each anatomical structure, there exists a theoretical description, a drawing with the anatomical description, an image with the specific placement of the ultrasound probe, an ultrasound slice, a diagram of the ultrasound image, and a video of the manual palpation procedure.
All variables were measured among both study groups after their self-study periods.
An OSCE [
An evaluation of students’ theoretical knowledge was conducted using a multiple-choice questionnaire of 20 questions, where a maximum score of 10 points could be obtained.
Satisfaction scores related to the interventions were assessed among both groups through a specific 5-point Likert questionnaire, ranging from 1 (
It would require a power of 90% to detect a significant mean difference of 3.5 (SD 3) points in the palpation assessment via the OSCE, assuming a type 1 error (alpha) of 5% and a type 2 error (beta) of 10%. Considering a dropout rate of 20%, we decided to enroll 55 subjects per group. Before the on-campus sessions, an independent researcher randomly assigned each participant to a group using Epidat 3.1 software (Xeral de Saúde Pública).
Descriptive analyses were obtained for all randomized participants. The Kolmogorov-Smirnov test was applied to test the hypothesis of normality for all variables. We calculated Student
The final sample was comprised of 50 students in the Ecofisio group and 55 students in the control group, with mean ages of 19.8 years (SD 2.1) and 19.7 years (SD 6.0), respectively. At the beginning of the study, there were no group differences in study variables such as gender or previous experience (see
Characteristics of groups.
Characteristic | Ecofisio group (N=50) | Control group (N=55) | |
Age (years), mean (SD) | 19.8 (2.1) | 19.7 (6.0) | |
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Female | 30 (60) | 32 (58) |
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Male | 20 (40) | 23 (42) |
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Yes | 0 (0) | 0 (0) |
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No | 50 (100) | 55 (100) |
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Yes | 0 (0) | 0 (0) |
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No | 50 (100) | 55 (100) |
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Yes | 1 (2) | 4 (7) |
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No | 49 (98) | 51 (93) |
Consolidated Standards Of Reporting Trials (CONSORT) flow diagram of the study.
We found a significant difference in the theoretical exam score (
Regarding the satisfaction results, we only found significant differences between groups for two items. The Ecofisio group showed a higher satisfaction level than the control group for the following items:
Differences between groups in data obtained from the Objective Structured Clinical Examination (OSCE) stations 1 and 2.
Station, specific components | Ecofisio group (N=50) | Control group (N=55) | ||
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Total theoretical knowledge (maximum 10 points) | 7.3 (1.5) | 6.3 (1.5) | <.001a |
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Positioning of patient (maximum 4 points) | 3.9 (0.3) | 2.3 (1.4) | <.001a |
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Positioning of ultrasound probe (maximum 4 points) | 3.9 (0.3) | 1.6 (1.5) | <.001a |
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Orientation (ie, angle) of ultrasound probe (maximum 4 points) | 3.8 (0.6) | 1.8 (1.7) | <.001a |
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Handling of ultrasound probe (maximum 4 points) | 3.3 (0.8) | 0.7 (0.9) | <.001a |
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Image adjustment (maximum 4 points) | 3.0 (1.4) | 1.6 (1.5) | <.001a |
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Time to identify the lesion (seconds) | 60.2 (25.9) | 45.3 (18.3) | <.001b |
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Suitable | 43 (86) | 15 (27) | <.001c |
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Not suitable | 12 (14) | 35 (73) | <.001c |
aMann-Whitney U test.
bOne-way analysis of variance (ANOVA).
cChi-square test.
Differences between groups regarding training satisfaction.
Item | Ecofisio group (N=50), mean (SD) | Control group (N=55), mean (SD) | |
The teacher was competent (maximum 5 points) | 4.8 (0.4) | 4.5 (0.5) | .009a |
The subject was interesting (maximum 5 points) | 4.3 (0.5) | 4.4 (0.6) | .08a |
I am satisfied with the training (maximum 5 points) | 3.6 (0.7) | 3.5 (0.7) | .98 |
I believe that the training is applicable (maximum 5 points) | 3.3 (0.8) | 3.0 (0.9) | .04a |
aMann-Whitney U test.
Descriptive data related to the Ecofisio group’s satisfaction.
Item | Ecofisio group (N=50), n (%) | ||
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Very clear | 40 (80) | |
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Not very clear | 10 (20) | |
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Not clear | N/Aa | |
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Yes | 46 (92) | |
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Not quite | 4 (8) | |
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No | N/A | |
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Yes | 37 (74) | |
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In some cases | 13 (26) | |
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No | N/A | |
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Very good | 7 (14) | |
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Good | 43 (86) | |
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Not very good | N/A | |
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Bad | N/A | |
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10 | 1 (2) | |
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9 | 11 (22) | |
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8 | 28 (56) | |
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7 | 10 (20) | |
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6 | N/A | |
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5 | N/A | |
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4 | N/A | |
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3 | N/A | |
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2 | N/A | |
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1 | N/A | |
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0 | N/A |
aNot applicable.
This work presents the results obtained on the use and efficacy of an interactive platform accessible through mobile devices using ultrasound imaging for the development of professional competencies in the evaluation and diagnosis of sports injuries. The mobile app has demonstrated its effectiveness in the majority of the processes evaluated when compared with the traditional learning method. Moreover, the results revealed that the app is attractive and useful from the point of view of the students.
The findings presented are in line with previous work developed by our research group, where different technological tools were used to acquire professional competencies among physiotherapy students [
A surprising result was that there were significant differences between groups in the time required to identify the lesion. The identification time was almost 20 seconds lower for the control group when compared with the Ecofisio group. This finding was also described in our previous work [
According to the results of the postprogram survey on training satisfaction, nearly all the scores were better in the Ecofisio group than in the control group. We think that the students in the group with access to the app felt a greater motivation for the project in general, so they felt more satisfied with the experience; this fact was also stated in all our previously published works [
At the end of the project, the students in the Ecofisio group were asked about their level of satisfaction with the app; the results were quite good for all of the items evaluated. A total of 80% of the students gave scores of 8 or more on a 0-10-point rating scale about their overall satisfaction level with the app, similar to our previous studies [
Finally, we have to recognize some limitations of this research. Our study results with this mobile app should be supported in different countries and with different languages in order to extrapolate the results to other populations. On the other hand, we are aware of the fact that conducting the project during the course sessions may have prompted extra motivation among the students and that ultrasound imaging was an attractive tool for them to use; therefore, the results were quite good for both study groups. In this sense, it would be interesting to develop an independent study with the mobile app in other settings. Finally, there was no follow-up period with which to evaluate the sustainability of the benefits of this interactive platform. Nevertheless, this study also presents a number of strengths. This project was carried out in two different universities in Spain with an important sample of students; therefore, the results could be generalized to physiotherapy students. To our knowledge, this is one of the few studies that has been developed in the area of physiotherapy, showing the use of new technologies to complement traditional learning. In fact, we believe this is the first m-learning system designed to improve the acquisition of professional competencies in the assessment of sports pathologies. In addition, this m-learning system could be implemented in different areas of knowledge, such as sports medicine or sports sciences.
Ecofisio is an interactive platform accessible through mobile devices, which uses ultrasound imaging. It is an effective way to develop professional competencies in the evaluation and diagnosis of sports pathologies in physiotherapy students, in a way that students find satisfying. Similar experiences could be implemented in different areas of knowledge with good results.
CONSORT-eHEALTH checklist (V 1.6.1).
mobile learning
Objective Structured Clinical Examination
We are grateful to Ms Carmen Sainz-Quinn for her assistance with the English language. The authors are also grateful for the collaboration of the students who participated in the study. This study was funded by a grant from the Educational Innovation Unit of the University of Granada, Spain (PID 14-56). This study was conducted thanks to the additional funding from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES).
None declared.