Effects of metaverse-based education on motivation and academic achievement in undergraduate physiotherapy students: a randomized three-arm study

BACKGROUND: Conventional synchronous online education may be less engaging than face-to-face instruction in physiotherapy education, particularly for practice-oriented content. Metaverse-based environments may offer a more interactive alternative, but comparative evidence in undergraduate physiotherapy students remains limited. This study compared metaverse-based, synchronous online, and face-to-face education for the theoretical component of palpation-related content. METHODS: This randomized three-arm controlled trial used a pre-test/post-test design. Ninety undergraduate physiotherapy students were randomized to metaverse-based, synchronous online, or face-to-face education; 83 completed the study (metaverse n = 28, online n = 26, face-to-face n = 29). All groups received the same theoretical palpation content, differing only in delivery mode. Motivation was assessed using the Instructional Materials Motivation Survey (IMMS), including its Attention-Relevance and Confidence-Satisfaction subscales, and academic achievement was assessed using a 15-item multiple-choice quiz after the intervention. RESULTS: Motivation increased in all groups after instruction. Significant group-by-time interactions were found for IMMS total (p = 0.001) and Attention-Relevance (p < 0.001), with greater improvement in the metaverse group than in the online group for IMMS total, and greater improvement than both the online and face-to-face groups for Attention-Relevance. Quiz scores also differed across groups (p = 0.048), with significantly higher post-test quiz scores in the metaverse group than in the online group. No significant group-by-time interaction was observed for Confidence-Satisfaction (p > 0.05). CONCLUSIONS: Metaverse-based education may provide motivational advantages and higher post-test quiz performance over conventional synchronous online education in undergraduate physiotherapy students. Its clearest benefit was observed in the Attention-Relevance dimension of motivation toward the instructional materials. These findings suggest that more interactive virtual learning environments may enrich online physiotherapy education when theoretical content is delivered remotely.