ACQUISITION OF COMPLEX THERAPEUTIC PROCEDURES IN PRE-REGISTRATION PHYSIOTHERAPY EDUCATION USING MOTOR LEARNING PRINCIPLES

Abstract

This thesis focuses on the acquisition of complex procedures in physiotherapy education using two motor learning principles and reports on five separate key studies: Chapter II: A study about the definition of procedural skills in physiotherapy education using a systematic review design and a text mining approach. Chapter III: A systematic review about the effectiveness of different attentional foci on the acquisition of complex motor skills. Chapter IV: A critical analysis of mental practice interventions in health professions education: A condensed review. Chapter V: The development and validation of a mental practice script for a transfer procedure for people with hemiparesis after stroke. Chapter VI: A randomised controlled trial evaluating the effectiveness and feasibility of two motor learning principles on the acquisition of complex procedures in physiotherapy education Chapter II: Randomised controlled trials and systematic review reporting about procedural skills were systematically searched. A qualitative analysis identified several relevant sub-concepts of procedural skills such as “execution of a motor task” or “decision-making”. A quantitative analysis was performed to identify term occurrences and to create a network of associations between the used terms. Based on both analyses a novel definition of “procedural skills in physiotherapy education” was proposed and operationalised. Chapter III: Studies comparing the effectiveness of an external focus of attention versus an internal focus of attention on the acquisition of complex motor skills were systematically searched in Medline, Embase, ERIC and SPORTDiscus. Findings of a meta-analysis were in favour of external focus of attention (SMD: -0.54; 95% CI between -0.86 and -0.22). Meta-regression identified “task complexity” as potential relevant predictor variable. Chapter IV: This study analysed how mental practice interventions designed for health professions were defined, structured and adhered to proposed best practice variables of mental practice. Chapter V: A mental practice script for a transfer procedure for people with hemiparesis was developed and validated in this study. Experienced physiotherapists were interviewed how they perform the procedure. Analysis of the interviews resulted in the development of a preliminary script, which was piloted to validate the manuscript. Chapter VI: The effectiveness and feasibility of two motor learning principles (mental practice and focus of attention) was evaluated on two different task procedures in pre-registration physiotherapy education. The difference between mental practice and no mental practice was not statistically significant. Findings of the comparison of the attentional focus differed between task procedures. An internal focus of attention was more effective for the acquisition of a transfer task procedure. For the second task procedure in vestibular rehabilitation the performance between the internal and external focus of attention groups was similar. Conclusions: This was the first study, to the authors knowledge, that investigated the acquisition of complex motor task skills in pre-registration physiotherapy students. The results presented in this thesis will help inform educators and researchers regarding the use of mental practice and different attentional foci to support the teaching approach for acquisition of complex skills in physiotherapy education.