Enhancing practical skills in spinal cord injury physiotherapy education using a case-based mobile virtual patient: A randomized mixed-methods study

CONTEXT: Developing practical skills and clinical reasoning in complex conditions such as spinal cord injury (SCI) is a central goal of physiotherapy education; however, opportunities for repeated practice with real patients are often limited, highlighting the potential value-based mobile virtual patient applications. OBJECTIVE: To evaluate whether a case-based mobile virtual patient application, used to supplement traditional teaching, was associated with higher practical examination performance in SCI education, and to explore students' perceptions of usability and educational value. DESIGN: Explanatory sequential mixed-methods study with a randomized post-test-only controlled quantitative phase followed by qualitative analysis of open-ended responses. SETTING: Neurological Rehabilitation course in an undergraduate physiotherapy and rehabilitation program. PARTICIPANTS: Eighty-three eligible undergraduate physiotherapy students were randomly assigned to experimental (n = 42) or control (n = 41) groups. INTERVENTIONS: Both groups received the same face-to-face instruction; only the experimental group had access to the case-based mobile application with interactive decision prompts and structured feedback. OUTCOME MEASURES: Practical skills were assessed in a post-test-only practical examination using a standardized checklist; Functional Neuroanatomy final exam score served as a contextual indicator of prior academic performance, and open-ended responses from the experimental group were categorized and summarized by frequency. RESULTS: Baseline academic performance did not differ between groups (t(81) = 1.445, P > 0.05). The experimental group achieved significantly higher practical examination scores than the control group (M = 26.57 vs. 22.63; t(81) = 3.741, P < 0.001; Cohen's d = 0.819), indicating a large effect. Qualitative findings indicated perceived benefits for theory-practice integration, learning flexibility, case-based clinical decision-making, and confidence, alongside challenges related to small-screen use and content density. CONCLUSION: When integrated alongside traditional instruction, a case-based mobile virtual patient application was associated with higher practical examination performance in SCI education and may support skill acquisition and student engagement within physiotherapy curricula.