Teaching a single manual therapy technique at a time reduces cognitive load in physiotherapy students: a randomized controlled educational study

Background Manual therapy is a fundamental component of physiotherapy education, requiring students to develop complex procedural skills through structured instructional methods. Sweller’s cognitive load theory can provide a framework in manual therapy education on how teaching design affects learning efficiency, especially in the acquisition of procedural skills. This study examines the impact of different teaching approaches on students’ cognitive load in manual therapy education. Methods A randomized controlled educational study was conducted with 48 physiotherapy students from two cohorts in spring 2022 and 2023. Participants were randomly assigned to an individual practice group (learning one technique at a time) or a series practice group (learning 3–4 techniques simultaneously). A questionnaire assessed global cognitive load as the primary outcome and intrinsic, extraneous, and germane cognitive load as secondary outcomes. Results 477 questionnaires were analysed. Global cognitive load was significantly lower in the individual group than in the series practice group (MD = -0.55, 95% CI -0.87 to -0.22). Compared to the series practice group, the individual practice group had lower intrinsic cognitive load (MD = -0.29, 95% CI -0.40 to -0.18), slightly lower extraneous cognitive load (MD = -0.07, 95% CI -0.13 to -0.01), and reduced germane cognitive load (MD = -0.29, 95% CI -0.43 to -0.17). Conclusion Teaching manual therapy one technique at a time may reduce cognitive load, potentially enhancing student learning and performance. This approach underscores the value of applying cognitive load theory in instructional design for physiotherapy education, offering practical benefits for teaching strategies.