Randomized controlled trial of an E-learning program for physiotherapy students to improve the management of rotator cuff related shoulder pain: a study protocol





E-learning, Rotator cuff injuries, Physiotherapy education


Background: The majority of shoulder complaints are occurred due to rotator cuff pathologies. Although conservative treatments including physiotherapy are acknowledged as the first-line treatment approach in the management of shoulder pain, the uptake of physiotherapy practice is variable. One possible explanation of this could be the poor evidence-based knowledge mobilization to practice. The aim of the study was to evaluate the efficacy of an E-learning program on physiotherapy students' knowledge of evidence-based Rotator cuff-related shoulder pain (RCRSP) management and their confidence in applying this care compared to a control group.

Methods: A randomized controlled study will be carried with 146 fourth-year physiotherapy students. Students will be assigned to one of two groups: E-learning (N=73) or control (N=73). The outcomes will be: (1) RCRSP knowledge and clinical reasoning skills, and (2) self-reported confidence in RCRSP knowledge and clinical reasoning abilities. Both measurements will be held at baseline and post-intervention. 

Conclusions: This is the first trial to investigate if a specifically designed E-learning program besides a regular learning curriculum, improves students’ knowledge and self-confidence in the RCRSP management. Enhancing students’ after-graduation readiness to manage patients with RCRSP may help to allow patients access to evidence-informed physiotherapists.

Trial registration: This trial was registered on clinicalTrials.gov on 17 June 2021 (NCT04952623)

Author Biographies

Bahar Ayberk, Department of Physiotherapy and Rehabilitation, Marmara University, İstanbul, Turkey

Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation.

Mine Gülden Polat, Department of Physiotherapy and Rehabilitation, Marmara University, İstanbul, Turkey

Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation.


Windt DA, Koes BW, Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54(12):959-64.

Kooijman M, Swinkels I, Dijk C, Bakker D, Veenhof C. Patients with shoulder syndromes in general and physiotherapy practice: an observational study. BMC Musculoskelet Disord. 2013;14:128.

Winters JC, Sobel JS, Groenier KH, Arendzen JH, Jong B. The long-term course of shoulder complaints: a prospective study in general practice. Rheumatology. 1999;38(2):160-3.

Dorrestijn O, Stevens M, Winters JC, Meer K, Diercks RL. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg. 2009;18(4):652-60.

Littlewood C, Malliaras P, Chance-Larsen K. Therapeutic exercise for rotator cuff tendinopathy: a systematic review of contextual factors and prescription parameters. Int J Rehabil Res. 2015;38(2):95-106.

Bury J, Littlewood C. Rotator cuff disorders: a survey of current (2016) UK physiotherapy practice. Shoulder Elbow. 2018;10(1):52-61.

Clark RC, Mayer RE. E-Learning and the Science of Instruction: Proven Guidelines for Consumers and Designers of Multimedia Learning. 3rd ed. San Fransisco, CA: Pfeiffer; 2011.

Wentling TL, Waight C, Gallagher J, Fleur J, Wang C, Kanfer A. E-learning- A review of literature. USA: University of Illinois at Urbana-Champaign; 2000: 13-34.

Gibbons A, Fairweather P. Computer-based instruction. In: Tobias S, Fletcher J, eds. Training & Retraining: A Handbook for Business, Industry, Government, and the Military. New York, NY: Macmillan Reference USA; 2000: 43-114.

Cobb SC. Internet continuing education for health care professionals: an integrative review. J Contin Educ Health Prof. 2004;24(3):171-80.

Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: a meta-analysis. JAMA. 2008;300(10):1181-96.

Fary RE, Slater H, Chua J, Ranelli S, Chan M, Briggs AM. Policy-into-practice for rheumatoid arthritis: randomized controlled trial and cohort study of e-learning targeting improved physiotherapy management. Arthritis Care Res (Hoboken). 2015;67(7):913-22.

Harvey LA, Glinsky JV, Lowe R, Lowe T. A massive open online course for teaching physiotherapy students and physiotherapists about spinal cord injuries. Spinal Cord. 2014;52(12):911-8.

Li SH, Sandler CX, Casson SM, Cassar J, Bogg T, Lloyd AR, et al. Randomised controlled trial of online continuing education for health professionals to improve the management of chronic fatigue syndrome: a study protocol. BMJ Open. 2017;7(5):14133.

Tiedemann A, Sturnieks DL, Hill AM, Lovitt L, Clemson L, Lord SR, et al. Does a fall prevention educational programme improve knowledge and change exercise prescribing behaviour in health and exercise professionals? A study protocol for a randomised controlled trial. BMJ Open. 2014;4(11):007032.

Fary RE, Slater H, Gardner P, Jordan JE, Chua J, Briggs AM. Embedding digital rheumatoid arthritis education into physiotherapy curriculum to increase workforce readiness of new graduates: a mixed methods study. Physiotherapy. 2015;101:376.

Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18.

Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:7586.

Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348.

Lewis J, McCreesh K, Roy JS, Ginn K. Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. J Orthop Sports Phys Ther. 2015;45(11):923-37.

Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2016;23:57-68.

Pieters L, Lewis J, Kuppens K, Jochems J, Bruijstens T, Joossens L, et al. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther. 2020;50(3):131-41.

Salamh P, Lewis J. It Is Time to Put Special Tests for Rotator Cuff-Related Shoulder Pain out to Pasture. J Orthop Sports Phys Ther. 2020;50(5):222-5.

Muruganantham G. Developing of E-content package by using ADDIE model. Int J Appl Res. 2015;1(3):52-4.