Physiotherapy lecturers’ perceptions of online curriculum delivery during the COVID-19 pandemic: a cross-sectional survey

Abstract

Purpose

To establish UK Physiotherapy lecturers’ perceptions of online learning during the COVID-19 pandemic.

Materials and methods

A cross-sectional mixed methods electronic survey of UK higher education lecturers, actively teaching pre-registration undergraduate or postgraduate physiotherapy degrees, was conducted between October 2020 and February 2021. Data was converted into proportions with a 95% confidence interval. Likert scale questions were treated as numeric variables with the mean and standard deviation calculated for combined responses. The thematic analysis reported patterns of data extracted from open-ended questions.

Results

96 respondents completed the survey, reporting some positive attributes attached to online learning. 81% (n = 78, 95% CI 72–88) agreed that students developed their digital skills and were able to learn conveniently at their own pace (n = 75, 78%, 95% CI 69–85). However, 62.5% (n = 60, 95% CI 23–72) of respondents felt that students were overall disadvantaged with online learning, with 72% (n = 69, 95% CI 62–80) reporting that online learning was not comparable to face-to-face to teaching. The reasons for perceived student disadvantage were categorised into three themes; 1) a lack of ability in sessions to practice handling techniques, 2) the inability to gauge student understanding and check practical skill competence and 3) the lack of student self-directed practice time. UK physiotherapy lecturers did indicate they would continue to incorporate online learning in the future (n = 84, 87.5%, 95% CI 79–93). Such responses were based on two key themes; an improved work-life balance and the perception that online learning was no more challenging than traditional on-campus delivery.

Conclusions

UK physiotherapy lecturers reported that students were disadvantaged with online learning delivery compared to face-to-face teaching. Lecturers indicated a willingness to continue with aspects of online learning across the curriculum, despite suggesting it had a negative impact on students subject understanding.

Keywords:

• COVID-19
• digital education
• distance education
• entry-level physiotherapy
• health education
• lecturers
• online learning
• physiotherapy
• remote education

Introduction

Physiotherapy is an allied health discipline aimed to prevent or restore patients' pre-injury, illness or disability levels. An essential aspect of pre-registration physiotherapy education is the necessity to equip graduates with clinical and non-clinical skills, knowledge and behaviours required to enter the profession [1]. Physiotherapy curriculums within the United Kingdom (UK) often implement a blended teaching strategy for students, including a traditional on-campus delivery supplemented by placement education located within clinical practice.

Due to the emergence of a novel coronavirus (COVID-19), which was declared an official pandemic by the World Health Organisation (WHO) in March 2020 [2], Higher Education institutions within the UK closed campuses. Course teaching was forced to rapidly evolve from face-to-face delivery to an online learning environment with the introduction of many interactive online platforms [3]. This transition to ‘emergency remote teaching’ [4], offered limited time to provide the extensive faculty training needed to support such a shift in teaching approaches and pedagogy. A lack of preparation also prevented the adaptation of course content and structure to facilitate the move to online delivery. This presented significant challenges to academic staff to guarantee that core physiotherapy skills were taught to pre-registration students effectively, in a comparable method to the pre-designed face-to-face strategy, ensuring competence [5].

Online learning can be effective in digitally advanced countries with blended or distance learning equal to or more effective than traditional teaching [6]. UK physiotherapy pre-registration curriculums have conventionally delivered course content in person via campus delivery. Chesterton et al. [1] reported UK physiotherapy students to value taught practical seminars which prepare them for graduation and clinical practice. Online learning was considered the least preferable method of taught delivery [7]. Despite this, students at one Italian University, were equally satisfied with online and face-to-face physiotherapy teaching delivery methods [5]. Higher performance was also reported following online delivery compared to traditional on-campus delivery. Physiotherapy undergraduates across four institutions in Malaysia reported moderate to high levels of readiness following online learning [7]. Advantages of online delivery in healthcare have been suggested to include increased student flexibility, material accessibility, self-pacing and comfort [8]. Online healthcare delivery also has the potential to target different audiences with various needs and backgrounds, through multi-didactical strategies and methods tailored to the needs of attendees [9].

Physiotherapy faculty members from Brazil, Cyprus and The United States of America have described teaching during the COVID-19 pandemic as one of their most challenging professional experiences [10]. The phenomenological study, from semi-structured interviews, identified four key themes from the online physiotherapy teaching experience including adapting pedagogy in real-time, maintaining expected excellence, online teaching limitations and informing future teaching practice [10]. Despite the challenges of student engagement and assessment of taught content, faculty developed innovative and meaningful learning experiences by creating a social, cognitive and teaching presence. Whilst acknowledging the weaknesses of digital physiotherapy education during the pandemic, Rossettini et al. [11] encourage embracing online learning as a resource to both replace or integrate with traditional face-to-face teaching [10]. The progression of technology has the potential to facilitate the digital transformation of pre-registration education contributing to digitally ready and literate future physiotherapists [11,12].

Whilst evidence exists to understand the views of students in relation to physiotherapy online delivery including overall satisfaction, little research has investigated the perceptions of physiotherapy lecturers towards digital education. No study to the authors' knowledge has investigated UK physiotherapy lecturers’ perceptions of online learning during the COVID-19 pandemic, and thus our study aims to address this.

Materials and methods

Design

A cross-sectional mixed methods questionnaire of UK higher education lecturers who taught on a pre-registration undergraduate or postgraduate physiotherapy degree was conducted between October 2020 and February 2021. The School of Health and Life Sciences at Teesside University approved the study in accordance with the Helsinki Declaration (ID2014). This report is conducted with recommendations from CHERRIES (The Checklist for Reporting Results of Internet E-Surveys), GRAMMS (Good Reporting of A Mixed Methods Study) and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) [13–15].

Survey development

The questionnaire aimed to investigate lecturers’ perceptions of the online aspect of their model of physiotherapy teaching during the COVID-19 pandemic. A mixed method approach allowed respondents to share their experiences and facilitate the exploration of questions requiring further in-depth thought [16]. The questions were designed to develop an understanding of how lecturers perceived the delivery of physiotherapy education through an online format, during the COVID-19 pandemic, both from their perspective and its impact on their student body. Questions were generated from an informal focus group comprising healthcare faculty teaching staff from multiple UK Higher Education Institutions. Quantitative questions were designed for an online format and included dichotomous, multiple choice, or Likert scales, of which all scales were unipolar [1]. The Likert scale questions were scored as follows: 1, Strongly Disagree; 2, Disagree; 3, Impartial; 4, Agree; 5, Strongly Agree. Participants were able to expand on answers through open-ended text boxes where appropriate. These opportunities to discuss thoughts and experiences in detail were included to provide depth to the dataset and determine additional understanding and meaning. Thematic analysis, based on an inductive approach within the work of Braun and Clarke [17], was employed to provide unforeseen insights adding further richness to the dataset [18].

Pre-testing

The survey was initially piloted and assessed for content validity by five physiotherapy lecturers based across different UK Higher Education Institutions [19]. The survey was independently assessed with comments on the format, content, wording, technical functionality and overall ease of completion requested. Following two rounds of pilot testing three questions were removed, two added and answer options changed in seven questions. The final online survey was hosted at Onlinesurveys.ac.uk and consisted of 18 main questions across 5 pages (Supplementary Material 1). All questions were required to be completed prior to submission of the survey. Respondents were able to review and change their answers by selecting the ‘back’ option on the survey's hosting platform. The first section of the survey captured participant and course characteristics including age, gender, level of students taught, the teaching of clinical or non-clinical modules, previous experience of online teaching and the current format of physiotherapy education at their institution. The second section of the survey asked a range of questions related to online curricula delivery. To maintain participant anonymity no identifiable personal data including the University they were employed by was collected.

Participants

All UK higher education physiotherapy lecturers actively teaching at the time of the survey on pre-registration undergraduate or postgraduate physiotherapy degrees were eligible to take part. It was not possible for the authorship team to obtain the current number of physiotherapy lecturers across all UK institutions due to data protection restrictions. The lead author as a member of the Chartered Society of Physiotherapy (CSP) the UK’s professional, educational and trade union body, posted an open survey invitation on the organisation’s website (iCSP https://www.csp.org.uk/icsp) as a means of capturing lecturers from across the UK. This was the only method of recruitment instigated by the authors.

A snowball sampling technique was also employed to facilitate the distribution of the survey within higher education settings [20]. Respondents were asked to complete the questionnaire only once and not submit multiple entries, however, this was not monitored or controlled by the online platform (i.e. via cookies, IP checks, registration). Respondents were instructed regarding the aims of the study, the length of time required for completion and the storage of anonymised data. Survey completion was voluntary with respondents able to withdraw at any point prior to submitting the final answers. Respondents were instructed that by completing and submitting the survey they were consenting to take part. No incentives were provided for survey completion.

Data analysis

Following survey closure the data were extracted from online surveys.ac.uk into Microsoft Excel (Microsoft Corp, Redmond, WA) using the analyse function. Surveys not completed were disregarded from the analysis. As the survey was not designed to test for differences between respondents no such analysis was performed. Data from dichotomous and multiple-choice questions were converted into proportions with lower and upper limits of the 95% confidence interval calculated using the Wilson procedure [21]. The confidence intervals represent the sampling uncertainty and the likely range of the true (population) proportion. Power presented in this way is appropriately and more effectively illustrated by the calculation of confidence intervals for the effect of interest [22]. Likert scale questions were treated as numeric variables with mean and SD calculated for combined responses across each potential answer [23].

For qualitative responses, two investigators (PC and MR) analysed the data separately, as part of an investigator triangulation process to reduce the risk of observer and other experimenter biases [24]. Both investigators coded the data manually and generated a set of sub and main themes from their analysis. The hermeneutic revisiting of the data reduced researcher prejudices which could have de-valued theme generation. Following individual analysis, a de-briefing session was held between PC and MR to discuss their findings and redefine themes as necessary. Comments not aligning with any theme were reviewed by a 3^rd researcher (CT) and were discarded if they failed to provide further insights into the phenomenon. The triangulation process highlighted the similarity of both researchers’ conclusions from the data set, increasing our confidence in the credibility, validity, and trustworthiness of our findings [25].

Results

Participant and course demographics

96 respondents completed the questionnaire and were included in the analysis. One survey was partially completed and therefore discarded from statistical analysis, providing a completion rate of 99%. The number of visitors to the survey site or those who failed to submit was not captured. Respondent age ranged from 26 to 65, with the largest proportion aged between 36-45 (n = 60, 62.5%, 95% CI 53–72) followed by 46-55 (n = 21, 21.9%, 95% CI 15–31). In total 75 (n = 78%, 95% CI 69–85) respondents identified as a female with 21 (n = 22%, 95% CI 15–31) males. Table 1 displays respondents and course characteristics.

Table 1. Respondents and course characteristics.

Characteristic	Respondents n = 96 n, %, (95% CI)
Which level of teaching do you currently deliver?
Undergraduate	78, 81 (72–88)
Postgraduate	63, 65.5 (56–74)
Do you teach clinical or non-clinical skills online?
Clinical	9, 9.4 (5–17)
Non-Clinical	12, 12.5 (7–21)
Both	75, 78.1 (69–85)
Do you have any previous experience of teaching online?
Yes, extensive	0
Yes, limited	11, 11.5 (7–19)
No	85, 88.5 (81–93)
Under the current COVID restrictions how are you delivering your teaching on your programme?
Remains fully face to face	0
Fully online	15, 15.6 (10–24)
Hybrid (face to face and online) – approx. 25% face-to-face	51, 53.1 (43–63)
Hybrid (face to face and online) – approx. 50% face-to-face	30, 31.3 (23–41)
Hybrid (face to face and online) – approx. 75% face-to-face	0

Perceived advantages and disadvantages of online learning

Respondents were asked what they perceived as both the advantages (Table 2) and disadvantages (Table 3) of online pre-registration physiotherapy education. In addition, to the options available, respondents identified the ability for students to revisit recorded material in an accessible and flexible way following taught sessions as a major advantage of digital learning. Lecturers also acknowledged that they could meet with students on a more regular basis due to the reduction in student travel.

Table 2. Perceived advantages of online learning.

Available answer	Respondents N (%, CI)
Student's development of technology and digital skills for future use	78, 81.3 (72–88)
Student's may be more confident to interact/answer questions (secondary to anonymity)	36, 37.5 (28–47)
Student’s find video’s/demonstrations useful to supplement learning	57, 59.4 (49–69)
Student's able to learn better at their own pace (secondary to recorded sessions)	75, 78.1 (69–85)
The convenience of learning in home environment for the student	72, 75 (65–83)
Fast and easy sharing of resources	45, 46.9 (37–57)
Fostering collaborative and exploratory learning environments beyond scheduled teaching	24, 25 (17–35)
Monitoring of student engagement/additional analytics easier	21, 21.9 (15–31)
Fosters independence, time management skills and allows students to manage their learning	45, 46.9 (37–57)
I don't believe there are any advantages to Online learning	0
Other	12, 12.5 (7–21)

Table 3. Perceived disadvantages of online learning.

Available answer	Respondents N (%, CI)
Lack of cohort identity	81, 84.4 (76–90)
Students unable to develop close relationships with peers	90, 93.8 (87–97)
Lack of peer feedback during sessions for students	48, 50 (40–60)
Lack of one-to-one feedback from tutors	39, 40.6 (31–51)
Unable to practice ‘hands on’ skills	87, 90.6 (83–95)
Decrease chances of employability – if student's lack exposure to clinical skills	12, 12.5 (7–21)
Students can lack confidence in using the technology	45, 46.9 (37–57)
Connectivity issues during sessions	90, 93.8 (87–97)
Pace of delivery can be affected	42, 43.8 (34–54)
Doesn’t meet preferred learning style of the students	48, 50 (40–60)
Difficult to track individual student progress	60, 62.5 (53–72)
Requires competence in using online platforms beyond delivering subject level knowledge only	54, 56.3 (46–66)
More time-intensive for academics due to increased preparation	72, 75 (65–83)
I don't believe there are any disadvantages to Online learning	0
Other	3, 3.1 (1–9)

The three respondents who selected ‘other’ all commented that decreased student engagement was a disadvantage of the online delivery format. Overall, 62.5% (n = 60, 95% CI 23–72) of respondents felt students were disadvantaged with online learning compared to face-to-face teaching across all modules, whether the content was clinically focussed or not. Thirty-one percent (n = 30, 95% CI 23–41) indicated that students were only disadvantaged if the module content was clinical, with six respondents reporting they felt the learning was comparable to traditional on-campus delivery. In addition to those selected, the reasons for believing students were disadvantaged are categorised into three themes; 1) lack of ability in sessions to practice handling techniques, 2) the inability to gauge student understanding and check practical skill competence and 3) the lack of student self-directed practice time.

‘Online learning doesn’t allow for the development of hands-on skills, the ability for us to check that students understand the principles and can perform them well’

‘Campus delivery allows me to factor in practice time and be flexible with my lesson plan to ensure students are competent with practical skills’

Outside of these themes lecturers identified that despite the positives of online learning the production of high-quality learning material and delivery requires careful planning which was not afforded due to the nature of the pandemic.

Lecturers' perception of the students' online experience

In total 72% of respondents (n = 69, 95% CI 62–80) felt pre-registration online physiotherapy learning is not comparable with face-to-face teaching. Overwhelmingly the responses generated themes of the inability to deliver high-quality clinical skills training, reduced cohort identity and decreased student engagement.

‘Student experience is definitely reduced, less interaction with materials and each other’

‘the students are unable to consolidate theory and practice and have less time for peer reviewed learning/independent practice.’

‘interaction is reduced and it can be very difficult to read a cohort – to get a sense of cohesion, understanding and development ‘

For some elements of the curriculum e.g. leadership, research methods, online learning was perceived to be equivalent to in person teaching. Over half of respondents felt that online learning had a negative impact on students understanding of the subject (n = 57, 59%, 95% CI 49–69). Respondents (n = 54, 56.3%, CI 95% 46–66) indicated that online teaching would affect graduates’ abilities to perform the proficiencies of physiotherapy upon student graduation. Respondents partially disagreed (Mean 2.68 ± SD 0.95) when asked if they perceived the student body was satisfied with the online learning approach to their entry-level physiotherapy programme.

Lecturer experience of online learning

Table 4 displays lecturers experiences of the transition from modules typically taught in person to online delivery. Respondents partially agreed (Mean 3.59 ± SD 1.17) that they were equally motivated to teach online compared to in an in-person face-to-face environment. Despite the acknowledgement of the professional responsibility to provide a high-quality educational experience, face-to-face teaching allowed lecturers to gauge the pace of teaching and student understanding. Further themes identified 1) increase in workload; 2) the fatiguing nature of online teaching and 3) reduced overall teaching enjoyment.

Table 4. Lecturer’s experience of the transition to online learning.

Available answer	Respondents N (%, CI)
Difficult to manage time effectively	75, 78.1 (69–85)
Use of new digital tools has been challenging	69, 71.9 (62–80)
Requires a lot of extra work to plan sessions, make recordings etc.	57, 59.4 (49–69)
It has provided beneficial opportunities to use technology to enhance teaching	39, 40.6 (31–51)
There has been plenty of support available to help with the transition	33, 34.4 (26–44)
Other	3, 3.1 (1–9)

‘Online teaching is exhausting for lecturers and increases workload significantly. Trying to teach in environments where at times there is no response is soul destroying.’

‘(Online) Teaching is not fun, interaction is hard and identifying engagement with topics is hard’

‘It takes so much more preparation time for online teaching. A session I could walk in and deliver with little preparation (face-to-face) takes days to create. This is not taken into consideration with workload’.

Respondents suggested additional training (n = 66, 68.8%, 95% CI 59–77) and in-house continuous professional development was needed to develop lecturer skills to deliver excellence through a virtual platform. Furthermore, student professional development of how to ‘learn’ online is necessary. Lecturers reported that opportunities for students to engage online existed and were similar to face-to-face sessions, but students often chose not to (n = 45, 46.9%, 95% CI 37–57). However, only a quarter of respondents (n = 24, 25%, 95% CI 17–35) felt opportunities to engage were the same as face-to-face classes. A total of 84% (n = 81, 95% CI 76–90) of lecturers had experienced difficulties with online delivery ranging from connectivity and engagement issues to a lack of energy to deliver in this format. A lack of experience in this teaching space was also a theme generated. Table 5 displays the positives and negatives associated with physiotherapy online teaching.

Table 5. The positives and negatives associated with physiotherapy online teaching.

Available answer	Respondents N (%, CI)
Positives:
Recorded sessions allow students to review content	54 (56.3, 46–66)
Technology/Apps aid the learning process	24 (25, 17–35)
Increases attendance	21 (21.9, 15–31)
Interactive teaching techniques (e.g. polls, quizzes) allows all students to participate	36 (37.5, 28–47)
Online environment ‘safe’ for students to participate compared to face-to-face classes in front of peers	27 (28.1, 20–38)
Negatives:
Connectivity issues	66 (68.8, 59–77)
Opportunity for students to ‘hide’ in sessions	63 (65.6, 56–74)
Decrease practice time for clinical skills	63 (65.6, 56–74)
Inability to practice clinical skills on range of individuals	60 (62.5, 53–72)
Difficult for students to contribute as much compared to a face-to-face session	48 (50, 40–60)

Respondents broadly suggested they would continue the use of online teaching delivery methods (n = 84, 88%, 95% CI 79–93), assuming teaching can resume to pre-virus norms, following the resolution of COVID-19 (Table 6). Two key themes were 1) improved work life balance, and 2) the perception that online learning was no more challenging that traditional on-campus delivery.

Table 6. Respondents views on continuing online learning following COVID-19 resolution.

Available answer	Respondents N (%, CI)
Yes – but only non-clinical modules	45, 46.9 (37–57)
Yes – but only clinical modules	0
Yes – any approved modules	39, 40.6 (31–51)
No – we will revert to a face-to-face delivery for all modules	12, 12.5 (7–21)

‘The move to online has had several benefits for me. More working at home time in a permitted, supported and structured manner’

‘I enjoy having a better work/life balance where I save time on my commute. I feel I have time to be more engaged and think of new methods to engage students online versus face to face.’

‘Teaching face-to-face is also difficult. We are adapting to online now and well positioned to improve the experience for both students and faculty’.

Discussion

The novel findings of this survey suggest that UK physiotherapy lecturers felt pre-registration students were disadvantaged with online learning delivery compared to face-to-face teaching. The majority of lecturers felt the educational experience, especially for clinical modules was not comparable to traditional on-campus delivery. Despite respondent's overall feeling that online teaching had a negative impact on students subject understanding, there was the willingness for lecturers to continue online learning within course delivery.

Perceived advantages and disadvantages of online learning

Whilst both academic faculties and students have previously reported that online education during the pandemic has been useful, its efficacy has been reported to be less effective than face-to-face teaching [26]. Previously UK physiotherapy students ranked online delivery as the least preferred method of learning [1]. Despite this, respondents perceived the development of learners’ digital skills, and the ability for students to self-pace their own learning within the convenience of their home environment as key advantages in our study. Similar advantages have been identified within online healthcare education, with medical students perceiving the flexibility of online delivery and the ability to digest information in their own time as benefits of the delivery method [27]. Physiotherapy lecturers reported that connectivity issues and the inability for students to develop close relationships with peers as disadvantages of the online platform, with a lack of cohort identity, developed. A lack of socialisation has been suggested as a missing component of online teaching [8] with the interaction of sharing ideas, knowledge and information partially absent [28]. The practicalities of online learning including family distractions and connectivity issues have also been identified by medical students [27].

Lecturers' perception of the students' online experience

Online instruction has been considered a less satisfying learning experience for students [29] and results from our study suggest that lecturers felt the online experience was not comparable to traditional in-person teaching. Furthermore, lecturers perceived students’ to be disadvantaged across all modules, regardless of indicative content. A theme from respondents suggested that the lack of assigned structured learning time to practice core clinical skills was a key reason behind such disadvantage. Providing an authentic learning experience is key to successful pre-registration physiotherapy education. Transforming curricula to ensure authentic learning through a constantly changing clinical practice environment will optimally prepare graduates for the profession [30,31]. The ability to design, adopt and evaluate significant course structures and teaching strategies may facilitate the online student experience. Such development of authentic online delivery strategies is key for content delivery and effective assessment and student feedback. Over half of lecturers (56%) in our study suggested online learning would affect students’ proficiencies upon graduation. This is an area for future research to explore with only limited evidence currently existing which demonstrates online learning can sufficiently prepare both students [32] and qualified professionals for specific clinical tasks [33].

Lecturer experience of online learning

Lecturers found it difficult to manage their time effectively (78%) when transitioning to emergency online learning, with 84% having no previous experience in digital teaching. Further, the adoption of new digital tools was challenging to many (71.9%) which increased demands to plan sessions and generate recordings (59.4%) whilst ensuring an excellent student experience. Careful planning and preparation are prerequisites to facilitate a high-quality student learning experience. Planning for both synchronous and asynchronous online teaching is often more laborious than face-to-face preparation and delivery [34,35].

Despite over half of respondents feeling that online learning negatively impacted students understanding of the physiotherapy discipline a number of positives and negatives were identified. The ability to record online sessions to provide students with materials to review key content was perceived as a considerable benefit of digital learning. Beyond the connectivity issues associated with online learning, lecturers described how this platform enabled students to ‘hide’ in sessions, linked to decreased engagement despite opportunities presented. As engagement is directly correlated to learning outcomes, critical thinking skills, academic achievement and overall learning satisfaction it is vital that lecturers strive to enhance this aspect of teaching [36–38]. To support successful learning, lecturers need to develop strategies for enabling online ‘antennae’, humanising the digital environment, whilst implementing innovative ways to direct students in discussion, engaging them in the construction of learning [39]. Such an approach requires adequate time to design and prepare teaching strategies, a barrier highlighted within this narrative. The limited opportunity to organise emergency online teaching at the beginning of the COVID-19 pandemic may in part explain the findings of this study.

The inability to deliver high-quality clinical skills training to students was highlighted by respondents, who felt that practical hands-on delivery of course content, was difficult through an online platform. A model of remote assessment to evaluate students’ clinical competence does not exist, with the requirement of physical demonstration remaining a barrier to remote online delivery [40]. Such physiotherapy psychomotor skills (e.g. manual therapy) continue to rely on the feedback of hands-on training which cannot be entirely replaced by online delivery [10,41]. Despite this, little evidence of the effectiveness of the ‘See one, do one’ approach to manual skills physiotherapy training exists [42]. A multifaceted hybrid approach to clinical physiotherapy skill teaching can be at least as effective as traditional learning in relation to student outcomes and satisfaction [43]. Despite this, future research needs to explore the role of hybrid learning as a distinct curricular model [43], to understand its impact on physiotherapy pre-registration education.

Lecturers partially agreed that they were equally motivated to teach online but felt they required further training on how to deliver effectively. Knowledge, perceptions and skills have been identified as factors that can affect lecturers’ motivation in adopting and utilising online tools [44]. A lack of motivation is one barrier to successful online teaching, alongside expertise and the absence of dedicated support to develop e-content, which also impede online education adoption [45]. An integrative review of the known barriers to medical educators developing and implementing online learning programs pre-COVID-19 concluded that time constraints, poor technical skills, inadequate infrastructure, absence of institutional strategies and support and negative attitudes of all involved prevented adoption of online learning [46]. Within our study, the increased workload and fatiguing nature of online teaching were themes that resulted in reduced overall enjoyment of online teaching. Healthcare lecturers from Brunei have also reported higher stress levels due to meeting deadlines, unexpected online disruptions and higher workloads from the transition to digital delivery in response to the COVID-19 pandemic [47]. Interestingly, lecturers within our study reported an improved work-life balance, which has been highlighted as a challenge for many academic professionals in higher education due to increasing demands imposed upon faculty [48]. Respondents also acknowledged their professional responsibility to provide a comparable experience for students to the traditional face-to-face delivery strategy. A hybrid delivery of physiotherapy education may present personal benefits to faculty staff in achieving equilibrium within their academic and personal lives.

The COVID-19 pandemic accelerated the digitalisation movement in education providing new ways of learning and working [49]. Whilst the move to online delivery at the beginning of the COVID-19 pandemic resulted in an emergency remote teaching strategy rather than a planned online learning approach, UK physiotherapy lecturers indicated they would continue to incorporate online learning in the future. Online delivery potentially provides both personal (lecturer/student work-life balance) and professional advantages (preparation of a digitally competent workforce). Re-engineering the negative educational events of the emergency online delivery can bring about the potential to embrace new technologies in healthcare education [11]. A culture of digital teaching and learning should be encouraged [50], to meet the changing delivery of modern physiotherapy with e-health becoming ubiquitous and increasingly important [51]. As this transition continues from emergency remote learning to the post-pandemic world, online developments need to be grounded within the pedagogical theory, reported and shared across the academic community to drive innovation [52].

Limitations

This study was conducted within the UK and therefore the nuances of results reported may not generalise to other international institutions that operate in a different educational context. This study aimed to understand how the transition to online learning had impacted higher education institutional physiotherapy lecturers during the COVID-19 pandemic. Longitudinal studies investigating the impact of physiotherapy online learning, which has been suitably planned, designed and implemented through course design, are warranted to fully understand the potential impact of this delivery method. Responder/non-response bias may have occurred with lecturers responding to the questionnaire not representative of the entire target population, and therefore confidence interval’s presenting the uncertainty in quantitative data [52] are presented [22,53,54].

The questionnaire utilised was assessed for content validity, although the questions set may have limited the potential breadth of responses respondents were able to give, and further reliability and validity testing would be beneficial. The use of thematic analysis has its own limitations as the researchers were ‘active’ in the research process and therefore themes did not just ‘emerge’ but were decided by the two investigators conducting the data analysis. Consequently, the thematic analysis could have had a negative impact on the validity of the results, however, this was negated in part by using investigator triangulation, with two separate investigators analysing the data independently yet still reaching the same conclusions. This process improved both the trustworthiness of our findings and the credibility and validity of the data presented.

Conclusion

The key findings of this study revealed that UK physiotherapy lecturers who participated in this study felt that students were disadvantaged by online learning delivery during the COVID-19 pandemic, compared to traditional face-to-face teaching methods. Respondents felt that the traditional face-to-face campus experience is a superior learning environment when compared to online learning. The lack of design and preparation time afforded by the COVID-19 pandemic influenced lecturers' views. Key themes such as an inability to practice handling skills, assess students’ competence and a lack of practice time, were identified as contributing factors behind these opinions. However, despite lecturers suggesting their perception was that online learning negatively impacted students' understanding of the subject, respondents indicated a willingness to continue with aspects of online delivery across the curriculum beyond the pandemic. Future longitudinal research to evaluate the impact on the course and student outcomes is warranted to understand the influence of online learning in physiotherapy education.

Acknowledgements

The authors would like to thank all physiotherapy lecturers within the United Kingdom who completed the survey.

Disclosure statement

The authors report there are no competing interests to declare. The authors alone are responsible for the content and writing of the article.