The objective of this study was to evaluate the effectiveness of a gamified web platform to acquire knowledge about the neurophysiology of pain and to determine the levels of satisfaction and motivation of physiotherapy students vis-à-vis the platform. .
This is a quasi-experimental study with a single experimental group in which the pre- and post-intervention knowledge of the students, as well as the motivation of the post-intervention students, were analyzed.
This study hypothesizes that the use of a gamified web-based platform increases knowledge acquisition and improves student motivation in physical therapy and sports science-physiotherapy and physical therapy-nursing dual degree programs at the University. ‘UdL.
The study involved a sample of 60 subjects made up of students of the “Physiotherapy in Clinical Specialties” course. These students were enrolled in physiotherapy and dual degree programs in sports science-physiotherapy and physiotherapy-nursing. The sample consisted of 30 men and 30 women.
The intervention took place online. The subjects of the study had access to a gamified web platform accessible from any electronic device to watch explanatory videos, download PDF material or answer online questionnaires (quizzes). To solve the problems, the students had the possibility of accessing the professor in three ways: via the forum of the virtual campus of the UdL, by direct e-mail to the professor or by videoconference.
Gamified web platform
To develop both the web platform and the educational material, professionals from different fields, such as physiotherapy, nursing, sociology, medicine and computer engineering, participated. The website was developed using Drupal as the content management system. Some modules of the management system, including those related to questionnaires and video tutorials, have been modified and adapted to the needs of the project. This has increased the versatility of the platform, resulting in better use of most systems (e.g. registration modules by adding data security available through an advanced encryption standard, synchronization modules and mass mailings).
The students had individual access to a gamified web platform with all the material available to acquire knowledge in the neurophysiology of pain. The main screen of the gamified web platform (Fig. 1) contained a study information sheet. The gaming web platform contained five sections (Table 1).
To increase the motivation and participation of our students, we used gamification techniques (defined as elements that are part of the design of video games but used in a different context) [29, 30]. Two sections of the web platform have been gamified, the “chronic low back pain” section and the quiz section.
1) The “Notes” section was divided into eight blocks: basic neurophysiology, advanced neurophysiology, chronic pain in clinical practice, fibromyalgia, arthropathies, scientific articles (English) and assessment systems for serious pathologies related to low back pain and aspects psychosocial (flag system). Each of the blocks contained its specific material.
2) In the “Videos” section, there were three categories. The “basic neurophysiology” category included an introductory video and three educational videos. The “advanced neurophysiology” category included a video on advances in the neurophysiology of pain. Finally, the “pain and sleep” category included two educational videos on the relationship between pain and sleep.
3) The section on “chronic low back pain” contained five educational videos: pain modulation; origin and causes of CLBP; the relationship between pain and stress; the relationship between pain and physical activity; and the beneficial effects of physical activity. Specific cuts were made to the videos so that short videos were generated to respond more specifically to the statements selected by the students after viewing them. After the student viewed the “Introduction” video, a series of messages appeared on the screen. The student was asked to select the statement related to back pain with which he agreed. Each post was associated with a different aspect of low back pain and was a hyperlink to a specific video related to that statement. For example, if the student had clicked on the statement “Pain is always in the brain and it is the brain that decides whether or not to feel pain”, a new screen would have appeared with video 2 “Modulation of pain”.
In this way, we used gamification through personalized tasks that allowed the student to use the metaphor of the journey (the story as a game dynamic) to feel that he was managing his path. Therefore, each student watched the videos in a particular order that depended on the utterance selected at each time. Thus, each student followed a different and personalized course thanks to the gamification of the site.
4) In the “Clinical Cases” section, there were clinical cases with answers on jaw pain, rotator cuff pain, groin pain, knee pain, sprains of the ankle, fibromyalgia, femoral neck fractures, chest pain, and finally, two clinical cases on CLBP.
5) The “quiz” section contained four links allowing students to access four questionnaires on the neurophysiology of pain, ranked from least difficult to most difficult. The authors developed these four questionnaires specifically for this study. A virtual platform called Quizziz (Quizizz – the world’s most engaging learning platform) was used to contribute to the fun of the game .
Each quiz consisted of ten multiple-choice questions, which could contain either single or multiple responses; in both cases, the students had 30 s to answer. In this quiz section, we used different gamification mechanisms described by Werbach and Hunter such as challenges, cooperation and competition, feedback, rewards and victory states. .
Knowledge of pain was measured using the “Neurophysiology of Pain Questionnaire” developed by Professor Moseley  in its version adapted to Spanish . The questionnaire consists of 19 questions requiring true, false or undecided answers, with 19 points as the maximum score. The questionnaire was found to be easy to use, short, valid and reliable .
Another measurement instrument used to assess misconceptions about pain and movement was the “Tampa Scale for Kinesiophobia” (TSK) developed by R. Miller and S. Kopri in the early 1990s, as revised and shortened from of the TSK-11 questionnaire by Woby et al. . . This questionnaire has been validated in Spanish by Gómez et al. . It has 11 questions to be answered on a scale of 1 (totally disagree) to 4 (totally agree), with scores ranging from 11 to 44 points. The questionnaire was found to be reliable, valid and easy to use .
Student motivation and satisfaction with the methodology used were measured using an adaptation of Escobar-Pérez and Lobo-Gallardo . This questionnaire consists of 16 questions to be answered using the Likert scale. It consisted of two questions with five response levels that assessed the degree of usefulness of the methodology and the content of the subject; 14 questions with six response levels that assess the degree of student compliance with the statements made; and a single question answered with 11 response levels that assessed the likelihood of recommending the web platform to future students.
The variables of sex, age, class studied and whether they had ever suffered from pain were analyzed. The results of the socio-demographic variables are presented in Table 2.
The main variable (knowledge of chronic pain) and the secondary variable (misknowledge of pain and movement) are expressed with the mean (standard deviation) and the effect size (d). The size of the effect was determined using the “barometer of influences” . Thus, an effect size less than 0 is associated with an opposite effect; 0 to 0.15 with a developmental effect; 0.16 to 0.40 with typical teacher effect; and 0.40 to 1.20 is associated with desired area of effect.
To analyze the results of knowledge in the neurophysiology of pain and kinesiophobia, the authors used the Student’s t-test for related samples. Percentages were used to analyze student satisfaction and motivation with the fun web platform.
Statistical power was calculated with the GRANMO sample calculator. Statistical analysis was performed with SPSS software, assuming an alpha error of 0.05.
Ethical approval and consent to participate
All participants provided their written consent after being informed of the objectives of the study and guaranteed the confidentiality of personal data in accordance with Regulation (EU) 2016/679 of the European Parliament and of the Council of April 27, 2016.
This study followed the principles of the Declaration of Helsinki and the Guide to Good Clinical Practice (CPMP/ICH/135/95) and was approved by the Studies and Research Committee of the Faculty of Nursing and Physiotherapy from the University of Lleida.