Comparison of online versus in-person education of lumbopelvic manipulation: a mixed methods study

The expansion of online and blended learning has raised questions about how to teach manual skills. While online resources support learning and provide flexible access, uncertainty remains about their effectiveness for developing practical competence and confidence compared with in‑person instruction.

To explore physiotherapy students' perspectives of learning a novel manipulation using online resources compared to an in-person workshop.

A parallel, convergent mixed methods design combined surveys and qualitative focus groups. After an online module, 25 physiotherapy students were randomized to attend an online class followed by in‑person, or vice versa. Self‑confidence was rated after each class using a modified Likert questionnaire. Focus groups (n = 21) were conducted and analyzed using inductive thematic content analysis.

The qualitative analysis generated three themes: (1) students pinpoint what drives learning, (2) self‑confidence is central to applying skills, and (3) students hold a preference for in‑person learning. Quantitative data showed self‑confidence increased after both classes, with the greatest increase when the in-person followed the online class. Students expressed a preference for in‑person learning, citing feedback, questioning, practice, and rapport building. Online resources were valued as helpful adjuncts, especially replaying video demonstrations, but were not sufficient on their own.

For teaching complex manual skills, a blended learning approach using online methods, followed by an in‑person practical class, was preferred. Students identified that in‑person instruction allowed for personalized feedback and supported safe skill acquisition, thus building self-confidence. To translate this learning into practice, students felt they would need support from supervising physiotherapists.