Effective teaching of manual skills to physiotherapy students: a randomised clinical trial
Abstract
Context: To date, despite the relevance of manual skills laboratories in physiotherapy education, evidence on the effectiveness of different teaching methods is limited. Objectives: Peyton's four‐step and the ‘See one, do one’ approaches were compared for their effectiveness in teaching manual skills. Methods: A cluster randomised controlled trial was performed among final‐year, right‐handed physiotherapy students, without prior experience in manual therapy or skills laboratories. The manual technique of C1–C2 passive right rotation was taught by different experienced physiotherapist using Peyton's four‐step approach (intervention group) and the ‘See one, do one’ approach (control group). Participants, teachers and assessors were blinded to the aims of the study. Primary outcomes were quality of performance at the end of the skills laboratories, and after 1 week and 1 month. Secondary outcomes were time required to teach, time required to perform the procedure and student satisfaction. Results: A total of 39 students were included in the study (21 in the intervention group and 18 in the control group). Their main characteristics were homogeneous at baseline. The intervention group showed better quality of performance in the short, medium and long terms ( F 1,111 = 35.91, p < 0.001). Both groups demonstrated decreased quality of performance over time ( F 2,111 = 12.91, p < 0.001). The intervention group reported significantly greater mean ± standard deviation satisfaction (4.31 ± 1.23) than the control group (4.03 ± 1.31) (p < 0.001). Although there was no significant difference between the two methods in the time required for teaching, the time required by the intervention group to perform the procedure was significantly lower immediately after the skills laboratories and over time (p < 0.001). Conclusions: Peyton's four‐step approach is more effective than the ‘See one, do one’ approach in skills laboratories aimed at developing physiotherapy student competence in C1–C2 passive mobilisation.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Few studies have explored the factors that influence the learning process and the effectiveness of different educational strategies in manual therapy.
“However, few studies have explored the factors that influence the learning process and the effectiveness of different educational strategies [1].”
From Teaching a single manual therapy technique at a time reduces cognitive load in physiotherapy students: a randomized controlled educational study (2025) · cites this paper as [1]
Cites
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148 · see citing works
Statistical Methods for Rates and Proportions
Fleiss, J. L., Levin, B., & Paik, M. C. (2003) · Wiley Series in Probability and Statistics · doi:10.1002/0471445428 · Cited by 18,646 · see citing works
Moher, D., Schulz, K. F., & Altman, D. G. (2001) · BMC Medical Research Methodology · doi:10.1186/1471-2288-1-2 · Cited by 2,755 · see citing works
Reflection and reflective practice in health professions education: a systematic review
Mann, K., Gordon, J., & MacLeod, A. (2009) · Advances in Health Sciences Education · doi:10.1007/s10459-007-9090-2 · Cited by 2,175 · see citing works
The general self-efficacy scale: multicultural validation studies
Luszczynska, A., Scholz, U., & Schwarzer, R. (2005) · The Journal of Psychology · doi:10.3200/jrlp.139.5.439-457 · Cited by 1,878 · see citing works
Zinbarg, R. E., Revelle, W., Yovel, I., & Li, W. (2005) · Psychometrika · doi:10.1007/s11336-003-0974-7 · Cited by 1,439 · see citing works
Measures in Health Psychology: A User's Portfolio
Johnston, M., Wright, S., & Weinman, J. A. (1995) · Cited by 1,300 · see citing works
The Utility of Simulation in Medical Education: What Is the Evidence?
Okuda, Y., Bryson, E. O., DeMaria, S., Jacobson, L., Quinones, J., Shen, B., & Levine, A. I. (2009) · Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine · doi:10.1002/msj.20127 · Cited by 1,217 · see citing works
Application of the “See One, Do One, Teach One” Concept in Surgical Training
Kotsis, S. V., & Chung, K. C. (2013) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e318287a0b3 · Cited by 460 · see citing works
Three-Point Likert Scales Are Good Enough
Jacoby, J., & Matell, M. S. (1971) · Journal of Marketing Research · doi:10.2307/3150242 · Cited by 457 · see citing works
Leite, W. L., Svinicki, M. D., & Shi, Y. (2009) · Educational and Psychological Measurement · doi:10.1177/0013164409344507 · Cited by 449 · see citing works
Methods for sample size determination in cluster randomized trials
Rutterford, C., Copas, A., & Eldridge, S. (2015) · International Journal of Epidemiology · doi:10.1093/ije/dyv113 · Cited by 429 · see citing works
Simulation Based Medical Education: an opportunity to learn from errors
Ziv, A., Ben-David, S., & Ziv, M. (2005) · Medical Teacher · doi:10.1080/01421590500126718 · Cited by 373 · see citing works
Evaluating the impact of simulation on translational patient outcomes
McGaghie, W. C., Draycott, T. J., Dunn, W. F., Lopez, C. M., & Stefanidis, D. (2011) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e318222fde9 · Cited by 336 · see citing works
Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache
Zito, G., Jull, G. A., & Story, I. H. (2005) · Manual Therapy · doi:10.1016/j.math.2005.04.007 · Cited by 312 · see citing works
Self-regulation theory: Applications to medical education: AMEE Guide No. 58
Sandars, J. E., & Cleary, T. J. (2011) · Medical Teacher · doi:10.3109/0142159x.2011.595434 · Cited by 311 · see citing works
An innovative model for teaching and learning clinical procedures
Kneebone, R. L., Kidd, J. M., Nestel, D., Asvall, S., Paraskeva, P. A., & Darzi, A. W. (2002) · Medical Education · doi:10.1046/j.1365-2923.2002.01261.x · Cited by 289 · see citing works
Beyond “see one, do one, teach one”: toward a different training paradigm
Rodriguez-Paz, J. M., Kennedy, M., Eduardo Salas, A., Wu, A. W., Sexton, J. B., Hunt, E. A., & Pronovost, P. J. (2009) · Postgraduate Medical Journal · doi:10.1136/qshc.2007.023903 · Cited by 279 · see citing works
Ng, S., Kinsella, E. A., Friesen, F., & Hodges, B. D. (2015) · Medical Education · doi:10.1111/medu.12680 · Cited by 224 · see citing works
Dunning, J. R., Cleland, J. A., Waldrop, M. A., Arnot, C. F., Young, I. A., Turner, M., & Sigurdsson, G. H. (2011) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2012.3894 · Cited by 180 · see citing works
A systematic review of medical skills laboratory training: where to from here?
Lynagh, M., Burton, R. C., & Sanson‐Fisher, R. (2007) · Medical Education · doi:10.1111/j.1365-2923.2007.02821.x · Cited by 172 · see citing works
Experts bodies, experts minds: How physical and mental training shape the brain
Debarnot, U., Sperduti, M., Rienzo, F. D., & Guillot, A. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00280 · Cited by 171 · see citing works
Boudreau, S. A., Farina, D., & Falla, D. (2010) · Manual Therapy · doi:10.1016/j.math.2010.05.008 · Cited by 167 · see citing works
Hall, T. M., Chan, H. T., Christensen, L., Odenthal, B., Wells, C., & Robinson, K. W. (2007) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2007.2379 · Cited by 154 · see citing works
Learning in student‐run clinics: a systematic review
Schutte, T., Tichelaar, J., Dekker, R. S., van Agtmael, M. A., de Vries, T. P. G. M., & Richir, M. C. (2015) · Medical Education · doi:10.1111/medu.12625 · Cited by 146 · see citing works
Krautter, M., Weyrich, P., Schultz, J., Buss, S. J., Maatouk, I., Jünger, J., & Nikendei, C. (2011) · Teaching and Learning in Medicine · doi:10.1080/10401334.2011.586917 · Cited by 145 · see citing works
Herrmann‐Werner, A., Nikendei, C., Keifenheim, K. E., Bosse, H. M., Lund, F., Wagner, R. J., Celebi, N., Zipfel, S., & Weyrich, P. (2013) · PLoS ONE · doi:10.1371/journal.pone.0076354 · Cited by 136 · see citing works
A simple five-step method for teaching clinical skills.
George, J. H., & Doto, F. X. (2001) · PubMed · Cited by 132 · see citing works
Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis
Pritchard, S., Blackstock, F. C., Nestel, D., & Keating, J. L. (2016) · Physical Therapy · doi:10.2522/ptj.20150500 · Cited by 126 · see citing works
Comparative analysis and diagnostic accuracy of the cervical flexion–rotation test
Hall, T. M., Briffa, K., Hopper, D. M., & Robinson, K. W. (2010) · The Journal of Headache and Pain · doi:10.1007/s10194-010-0222-3 · Cited by 115 · see citing works
What is a clinical skill? Searching for order in chaos through a modified Delphi process
Michels, M. E. J., Evans, D. E., & Blok, G. A. (2012) · Medical Teacher · doi:10.3109/0142159x.2012.669218 · Cited by 114 · see citing works
Setting up a clinical skills learning facility
Bradley, P., & Postlethwaite, K. C. (2003) · Medical Education · doi:10.1046/j.1365-2923.37.s1.11.x · Cited by 105 · see citing works
Lund, F., Schultz, J., Maatouk, I., Krautter, M., Möltner, A., Herrmann‐Werner, A., Weyrich, P., Jünger, J., & Nikendei, C. (2012) · PLoS ONE · doi:10.1371/journal.pone.0032831 · Cited by 99 · see citing works
Lenchus, J. D. (2010) · PubMed · Cited by 78 · see citing works
Practical Clinical Training in Skills Labs: Theory and Practice
Bugaj, T. J., & Nikendei, C. (2016) · PubMed Central · doi:10.3205/zma001062 · Cited by 75 · see citing works
Delany, C. M., & Watkin, D. (2008) · Advances in Health Sciences Education · doi:10.1007/s10459-008-9128-0 · Cited by 74 · see citing works
Krautter, M., Dittrich, R., Safi, A., Krautter, J., Maatouk, I., Möltner, A., Herzog, W., & Nikendei, C. (2015) · Advances in Medical Education and Practice · doi:10.2147/amep.s81923 · Cited by 74 · see citing works
Donaghy, M. E., & Morss, K. (2007) · Physiotherapy Theory and Practice · doi:10.1080/09593980701211952 · Cited by 70 · see citing works
Maloney, S. R., Storr, M., Morgan, P. E., & Ilić, D. (2012) · Advances in Health Sciences Education · doi:10.1007/s10459-012-9356-1 · Cited by 59 · see citing works
Joint Manipulation Curricula in Physical Therapist Professional Degree Programs
Boissonnault, W. G., Bryan, J. M., & Fox, K. J. (2004) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2004.34.4.171 · Cited by 58 · see citing works
The views of senior students and young doctors of their training in a skills laboratory
Das, M., Townsend, A., & Hasan (1998) · Medical Education · doi:10.1046/j.1365-2923.1998.00182.x · Cited by 58 · see citing works
Are physiotherapy students adequately prepared to successfully gain employment?
Jones, M., McIntyre, J., & Naylor, S. (2010) · Physiotherapy · doi:10.1016/j.physio.2009.11.008 · Cited by 57 · see citing works
Münster, T., Stosch, C., Hindrichs, N., Franklin, J. G., & Matthes, J. (2016) · PubMed Central · doi:10.3205/zma001059 · Cited by 53 · see citing works
Real-time feedback improves accuracy of manually applied forces during cervical spine mobilisation
Snodgrass, S. J., Rivett, D. A., Robertson, V. J., & Stojanovski, E. (2010) · Manual Therapy · doi:10.1016/j.math.2009.05.011 · Cited by 52 · see citing works
Flynn, T. W., Wainner, R. S., & Fritz, J. M. (2006) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2006.2159 · Cited by 47 · see citing works
Self‐regulated learning processes of medical students during an academic learning task
Gandomkar, R., Mirzazadeh, A., Jalili, M., Yazdani, K., Fata, L., & Sandars, J. E. (2016) · Medical Education · doi:10.1111/medu.12975 · Cited by 46 · see citing works
Gradl-Dietsch, G., Lübke, C., Horst, K., Simon, M., Modabber, A., Sönmez, T. T., Münker, R., Nebelung, S., & Knobe, M. (2016) · BMC Medical Education · doi:10.1186/s12909-016-0804-0 · Cited by 44 · see citing works
Focus group study of student physiotherapists’ perceptions of reflection
Roche, A., & Coote, S. B. (2008) · Medical Education · doi:10.1111/j.1365-2923.2008.03178.x · Cited by 39 · see citing works
Jenko, M., Frangež, M., & Manohin, A. (2012) · Croatian Medical Journal · doi:10.3325/cmj.2012.53.486 · Cited by 38 · see citing works
Johnston, S. (2006) · Clinical Orthopaedics and Related Research · doi:10.1097/01.blo.0000224033.23850.1c · Cited by 33 · see citing works
An appraisal of the literature on teaching physical examination skills
Easton, G., Stratford-Martin, J., & Atherton, H. (2012) · Education for Primary Care · doi:10.1080/14739879.2012.11494117 · Cited by 29 · see citing works
Nyberg, R. E., & Smith, A. R. (2013) · Journal of Manual & Manipulative Therapy · doi:10.1179/2042618613y.0000000029 · Cited by 28 · see citing works
Snodgrass, S. J., & Odelli, R. (2011) · Physiotherapy · doi:10.1016/j.physio.2011.02.002 · Cited by 26 · see citing works
Spinal Mobilization Curricula in Professional Physical Therapy Education Programs
Bryan, J. M., McClune, L. D., Romito, S., et al. (1997) · Journal of Physical Therapy Education · doi:10.1097/00001416-199707000-00004 · Cited by 25 · see citing works
Thomas, L. C., Rivett, D. A., Bateman, G. A., et al. (2013) · Physical Therapy · doi:10.2522/ptj.20120477 · Cited by 21 · see citing works
van Trijffel, E., Plochg, T., van Hartingsveld, F., et al. (2010) · Journal of Manual & Manipulative Therapy · doi:10.1179/106698110x12640740712815 · Cited by 19 · see citing works
Michael Constantine, & Carpenter, D. C. (2012) · Physiotherapy Theory and Practice · doi:10.3109/09593985.2012.666333 · Cited by 16 · see citing works
See One. Do One. Teach One. A Perfect Paradigm for Education and Training in Neuroendoscopy
Stagno, V., & Cappabianca, P. (2012) · World Neurosurgery · doi:10.1016/j.wneu.2012.07.017 · Cited by 5 · see citing works
Self‐regulated learning in medical education: the next steps
Corrigan, G. (2012) · Medical Education · doi:10.1111/j.1365-2923.2012.04337.x · Cited by 5 · see citing works
Future direction for research in self‐regulated learning in medical education
Sandars, J. E. (2012) · Medical Education · doi:10.1111/j.1365-2923.2012.04214.x · Cited by 4 · see citing works
Il dolore cervicale - Guida alla valutazione e al trattamento
Testa, M., & Andrea, Z. (2013) · CINECA IRIS Institutial Research Information System (University of Genoa) · Cited by 2 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
A novel model for developing thrust joint manipulation skills: a teaching and learning perspective
Adams, K. R., Kolb, W. H., Geiser, M. B., & Dolphin, M. (2024) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2023.2299184 · Cited by 2 · see citing works
Gärtner, R., Peters, H., & Holzhausen, Y. (2025) · BMC Medical Education · doi:10.1186/s12909-025-08083-w · Cited by 2 · see citing works
- Authors
- Rossettini, G., Rondoni, A., Palese, A., Cecchetto, S., Vicentini, M., Bettale, F., Furri, L., & Testa, M.
- Affiliations
- University of Genoa (IT)
- University of Udine (IT)
- Provincia Autonoma di Trento (IT)
- Psychiatric Hospital Villa Santa Chiara Verona Italy
- University of Verona (IT)
- Corresponding author
- Testa, Marco
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2017-07-12
- Volume
- 51
- Issue
- 8
- Pages
- 826-838
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W2735786423
- Cited by
- 57
- References
- 61
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 14 · 2023: 11 · 2022: 4 · 2021: 4 · 2020: 9 · 2019: 3 · 2018: 2
- FWCI
- 3.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
- Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
- Keywords
- physiotherapy education, skills laboratory, teaching methods, student competencies, student satisfaction, skill retention
- MeSH terms
- Clinical Competence, Educational Measurement, Humans, Students, Teaching, Models, Educational, Physical Therapy Modalities, Physical Therapists
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
