{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T13:11:59Z","timestamp":1793452319892,"version":"4.5.0"},"reference-count":49,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Educ"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Although the implementation of simulation-based learning has progressed substantially in medicine, physical therapy education shows a lower level of development regarding standardized collaborative models.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to determine the effectiveness of collaborative versus individual simulation-based learning in developing clinical competence in undergraduate physical therapy students in the care of standardized patients with low back pain flare-ups.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A parallel-group randomized controlled trial was conducted. Thirty-one physical therapy undergraduate students were randomized (1:1) to a collaborative or individual simulation-based learning group. Students underwent 3 weeks of clinical simulation training. Standardized patient assessments were performed before and after the simulation-based learning intervention. Clinical competence was evaluated as the primary outcome, while effective communication and therapeutic alliance were evaluated as secondary outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n For clinical competence, a significant main effect of time was observed (\n \u03b7<\/jats:italic>\n p<\/jats:sub>\n 2<\/jats:sup>\n =0.739;\n P<\/jats:italic>\n <.001), with equivalent pre-to-post improvements in both the collaborative (\n \u0394<\/jats:italic>\n =+6.17;\n P<\/jats:italic>\n Bonf<\/jats:sub>\n <.001) and individual simulation-based learning groups (\n \u0394<\/jats:italic>\n =+5.39;\n P<\/jats:italic>\n Bonf<\/jats:sub>\n <.001); the interaction effect was nonsignificant (\n P<\/jats:italic>\n =.61). For communication, no significant time (\n P<\/jats:italic>\n =.91) or group \u00d7 time interaction (\n P<\/jats:italic>\n =.83) effects were observed. Therapeutic alliance scores demonstrated a significant main effect of time (\n \u03b7<\/jats:italic>\n p<\/jats:sub>\n 2<\/jats:sup>\n =0.294;\n P<\/jats:italic>\n =.008), indicating an overall decrease, though group-specific pre-to-post declines did not survive Bonferroni correction (both\n P<\/jats:italic>\n Bonf<\/jats:sub>\n \u2265.11).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Collaborative simulation-based learning effectively develops physical therapy clinical competencies, and its effects are comparable to those of individual simulation-based learning with a standardized patient. However, there were no differences between the groups for effective communication or therapeutic alliance. Further research is warranted to assess the efficacy of these modalities in diverse clinical settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/85442","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:13:21Z","timestamp":1790014401000},"page":"e85442-e85442","source":"Crossref","is-referenced-by-count":1,"title":["Collaborative Simulation-Based Learning to Develop Competencies in Physical Therapy Students: Randomized Controlled Trial"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-0503","authenticated-orcid":false,"given":"Iv\u00e1n","family":"Cuyul-V\u00e1squez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7287-3957","authenticated-orcid":false,"given":"Hilda","family":"Aravena-P\u00e1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-4233","authenticated-orcid":false,"given":"Felipe","family":"Araya-Quintanilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5884-3540","authenticated-orcid":false,"given":"Sergio","family":"Guinez-Molinos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4068-9338","authenticated-orcid":false,"given":"Rodrigo","family":"N\u00fa\u00f1ez-Cort\u00e9s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4650-3426","authenticated-orcid":false,"given":"H\u00e9ctor","family":"Guti\u00e9rrez Espinoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1001\/jama.287.2.226","article-title":"Defining and assessing professional competence","volume":"287","author":"Epstein","journal-title":"JAMA"},{"issue":"4","key":"R2","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1002\/msc.1813","article-title":"Core competencies for first contact physiotherapists in a direct access model of care for adults with musculoskeletal disorders: a scoping review","volume":"21","author":"Vervaeke","journal-title":"Musculoskeletal Care"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-024-05086-x","article-title":"Development of low back pain curriculum content standards for entry-level clinical training","volume":"24","author":"Jenkins","journal-title":"BMC Med Educ"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1136\/annrheumdis-2013-204428","article-title":"The global burden of low back pain: estimates from the Global Burden of Disease 2010 study","volume":"73","author":"Hoy","journal-title":"Ann Rheum Dis"},{"issue":"11","key":"R5","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1016\/j.jpain.2019.03.009","article-title":"A definition of \u201cflare\u201d in low back pain: a multiphase process involving perspectives of individuals with low back pain and expert consensus","volume":"20","author":"Costa","journal-title":"J Pain"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2019.06.003","article-title":"Impact of flare-ups on the lives of individuals with low back pain: a qualitative investigation","volume":"43","author":"Tan","journal-title":"Musculoskelet Sci Pract"},{"issue":"9","key":"R7","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1001\/jama.2011.1234","article-title":"Technology-enhanced simulation for health professions education: a systematic review and meta-analysis","volume":"306","author":"Cook","journal-title":"JAMA"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1136\/bmjstel-2018-000370","article-title":"Using clinical simulation to study how to improve quality and safety in healthcare","volume":"6","author":"Lam\u00e9","journal-title":"BMJ Simul Technol Enhanc Learn"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-024-06184-6","article-title":"Creating a safe space: medical students\u2019 perspectives on using actor simulations for learning communication skills","volume":"24","author":"Antila","journal-title":"BMC Med Educ"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/jep.12883","article-title":"Human-simulation-based learning to prevent medication error: a systematic review","volume":"25","author":"Sarfati","journal-title":"J Eval Clin Pract"},{"issue":"5","key":"R11","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1136\/bmjstel-2020-000601","article-title":"Simulation past, present and future\u2014a decade of progress in simulation-based education in the UK","volume":"7","author":"Higham","journal-title":"BMJ Simul Technol Enhanc Learn"},{"issue":"9","key":"R12","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.2522\/ptj.20150500","article-title":"Simulated patients in physical therapy education: systematic review and meta-analysis","volume":"96","author":"Pritchard","journal-title":"Phys Ther"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1186\/s41077-016-0020-3","article-title":"Issues of cost-benefit and cost-effectiveness for simulation in health professions education","volume":"1","author":"Maloney","journal-title":"Adv Simul (Lond)"},{"issue":"5","key":"R14","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1136\/bmjstel-2020-000645","article-title":"Peer-assisted learning in simulation-based medical education: a mixed-methods exploratory study","volume":"7","author":"Nunnink","journal-title":"BMJ Simul Technol Enhanc Learn"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jphys.2015.02.015","article-title":"Physiotherapy students and clinical educators perceive several ways in which incorporating peer-assisted learning could improve clinical placements: a qualitative study","volume":"61","author":"Sevenhuysen","journal-title":"J Physiother"},{"issue":"4","key":"R16","doi-asserted-by":"publisher","DOI":"10.3205\/zma001472","article-title":"Collaborative clinical simulation in cardiologic emergency scenarios for medical students. An exploratory study on model applicability and assessment instruments","volume":"38","author":"Guinez-Molinos","journal-title":"GMS J Med Educ"},{"issue":"2","key":"R17","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1080\/0142159X.2016.1248913","article-title":"A collaborative clinical simulation model for the development of competencies by medical students","volume":"39","author":"Guinez-Molinos","journal-title":"Med Teach"},{"issue":"1","key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/23370","article-title":"A web platform (MOSAICO) to design, perform, and assess collaborative clinical scenarios for medical students: viewpoint","volume":"7","author":"Guinez-Molinos","journal-title":"JMIR Med Educ"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","first-page":"194","DOI":"10.3138\/ptc.2014-40E","article-title":"Use of simulation learning experiences in physical therapy entry-to-practice curricula: a systematic review","volume":"67","author":"Mori","journal-title":"Physiother Can"},{"issue":"4","key":"R20","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1097\/SIH.0000000000000150","article-title":"Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements","volume":"11","author":"Cheng","journal-title":"Simul Healthc"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04033-6","article-title":"A modified Medical Education Research Study Quality Instrument (MMERSQI) developed by Delphi consensus","volume":"23","author":"Al Asmri","journal-title":"BMC Med Educ"},{"key":"R22","unstructured":"RANDOM.ORG. URL: https:\/\/www.random.org\/ [Accessed 09-09-2026]"},{"key":"R23","unstructured":"Abulebda K Auerbach M Limaiem F . Debriefing techniques utilized in medical simulation. In: StatPearls [Internet]. StatPearls Publishing; 2024. URL: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK546660\/ [Accessed 09-09-2026]"},{"issue":"3","key":"R24","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.pec.2007.05.005","article-title":"Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool","volume":"67","author":"Makoul","journal-title":"Patient Educ Couns"},{"issue":"4","key":"R25","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.edumed.2020.12.007","article-title":"Validaci\u00f3n de la versi\u00f3n en espa\u00f1ol de un instrumento de evaluaci\u00f3n de la comunicaci\u00f3n centrada en el paciente en OSCE","volume":"22","author":"Armijo-Rivera","journal-title":"Educaci\u00f3n M\u00e9dica"},{"key":"R26","volume":"18","author":"Waizmann","journal-title":"Anuario de investigaciones"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-018-1377-x","article-title":"Validity and reproducibility of a tool for assessing clinical competencies in physical therapy students","volume":"18","author":"Torres-Narv\u00e1ez","journal-title":"BMC Med Educ"},{"issue":"4","key":"R28","first-page":"262","volume":"10","author":"Fenton","journal-title":"J Psychother Pract Res"},{"issue":"2","key":"R29","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1037\/h0085419","article-title":"A comparison of six measures of working alliance","volume":"26","author":"Tichenor","journal-title":"Psychother Theory Res Pract Train"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.pec.2017.08.009","article-title":"Training physiotherapy students to educate patients: a randomised controlled trial","volume":"101","author":"Forbes","journal-title":"Patient Educ Couns"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2013.00863","article-title":"Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs","volume":"4","author":"Lakens","journal-title":"Front Psychol"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1037\/a0024338","article-title":"Effect size estimates: current use, calculations, and interpretation","volume":"141","author":"Fritz","journal-title":"J Exp Psychol Gen"},{"issue":"4","key":"R33","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1002\/pst.1514","article-title":"Bonferroni-based correction factor for multiple, correlated endpoints","volume":"11","author":"Shi","journal-title":"Pharm Stat"},{"key":"R34","unstructured":"Effectiveness of collaborative and traditional clinical simulation to develop clinical competencies in physical therapy students. Open Science Framework. URL: https:\/\/osf.io\/yfwht\/overview [Accessed 09-09-2026]"},{"issue":"1","key":"R35","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-022-03500-x","article-title":"Simulation-based holistic education in physiotherapy interns to increase empathy toward older adults and individuals with disabilities","volume":"22","author":"Lin","journal-title":"BMC Geriatr"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1186\/s12909-021-02812-7","article-title":"Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial","volume":"21","author":"Sandoval-Cuellar","journal-title":"BMC Med Educ"},{"issue":"1","key":"R37","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s41077-018-0062-9","article-title":"The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice","volume":"3","author":"Wright","journal-title":"Adv Simul (Lond)"},{"issue":"2","key":"R38","doi-asserted-by":"publisher","first-page":"28","DOI":"10.56976\/rjsi.v7i2.357","article-title":"Effects of peer tutoring on academic achievement: a social constructivist perspective","volume":"7","author":"Alnas","journal-title":"Res J Societal Issues"},{"issue":"8","key":"R39","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.ecns.2015.05.004","article-title":"Using cognitive load theory to inform simulation design and practice","volume":"11","author":"Reedy","journal-title":"Clin Simul Nurs"},{"issue":"3","key":"R40","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/SIH.0000000000000886","article-title":"Exploring the barriers to clinical reasoning in high-fidelity simulation for undergraduate medical students: a phenomenological study","volume":"21","author":"Williams","journal-title":"Simul Healthc"},{"issue":"2","key":"R41","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1080\/10253890.2018.1494152","article-title":"Acute stressor effects on cognitive flexibility: mediating role of stressor appraisals and cortisol","volume":"22","author":"Gabrys","journal-title":"Stress"},{"issue":"1","key":"R42","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-026-08734-6","article-title":"The relationship between cognitive flexibility and decision-making styles of midwifery and nursing students","volume":"26","author":"Kucukkelepce","journal-title":"BMC Med Educ"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2021.104815","article-title":"Cognitive load experienced by nurses in simulation-based learning experiences: an integrative review","volume":"99","author":"Rogers","journal-title":"Nurse Educ Today"},{"issue":"2","key":"R44","doi-asserted-by":"publisher","first-page":"141","DOI":"10.5055\/jem.0756","article-title":"Human information processing under stress","volume":"21","author":"Rogers","journal-title":"J Emerg Manag"},{"issue":"1","key":"R45","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-018-1943-8","article-title":"Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain","volume":"19","author":"Rossettini","journal-title":"BMC Musculoskelet Disord"},{"issue":"3-4","key":"R46","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1080\/10833196.2019.1639011","article-title":"The influence of verbal suggestions in the management of musculoskeletal pain: a narrative review","volume":"24","author":"Cuyul-V\u00e1squez","journal-title":"Phys Ther Rev"},{"issue":"4","key":"R47","doi-asserted-by":"publisher","first-page":"477","DOI":"10.2522\/ptj.20130118","article-title":"Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study","volume":"94","author":"Fuentes","journal-title":"Phys Ther"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1831-7","article-title":"Individuals\u2019 explanations for their persistent or recurrent low back pain: a cross-sectional survey","volume":"18","author":"Setchell","journal-title":"BMC Musculoskelet Disord"},{"issue":"4","key":"R49","doi-asserted-by":"publisher","first-page":"348","DOI":"10.4103\/0974-2700.70743","article-title":"Simulation-based learning: just like the real thing","volume":"3","author":"Lateef","journal-title":"J Emerg Trauma Shock"}],"container-title":["JMIR Medical Education"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:43:15Z","timestamp":1793407395000},"score":1,"resource":{"primary":{"URL":"https:\/\/mededu.jmir.org\/2026\/1\/e85442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":49,"URL":"https:\/\/doi.org\/10.2196\/85442","relation":{},"ISSN":["2369-3762"],"issn-type":[{"value":"2369-3762","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"article-number":"v12i2e85442"}}