Online versus offline Fugl-Meyer lower extremity training for physical therapy students: a randomized study

Standardized training is essential for improving the accuracy and reliability of the Fugl-Meyer Assessment of the lower extremities (FMA-LE), yet evidence comparing online and offline education for this purpose is limited.

To compare online versus offline education for improving FMA-LE scoring accuracy among novice physical therapy students and to examine changes in accuracy across repeated practice sessions.

Forty-four students were assigned to offline (n = 24) or online (n = 20) education groups and received identical FMA-LE content delivered either in person or online. Participants completed four practice scoring sessions and one final test using video-recorded stroke cases. Scoring accuracy, defined as the percentage of exact agreement with expert ratings across 17 items, was analyzed using linear mixed-effects models, and item-level differences were explored using Fisher's exact tests.

Both groups demonstrated significant improvements in overall scoring accuracy from baseline to the final test (F(1, 42) = 9.85, p = .003, partial η² = 0.16), with no significant difference between the online and offline education groups (F(1, 42) = 1.23, p = .273, partial η² = 0.03). Scoring accuracy improved progressively across the five sessions, with significant gains appearing at the third practice session (p = .009) and persisting through the final test (p = .007) relative to baseline. Additionally, certain items, such as synergistic ankle dorsiflexion and plantar flexion, remained more difficult, with no significant between-group differences.

No significant difference was observed between online and offline education in improving FMA-LE scoring accuracy, suggesting that online training may be a viable and effective alternative for standardized assessment training.