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

## TL;DR

Teaching one manual therapy technique at a time helps physiotherapy students by reducing mental effort, improving learning efficiency.

## Contribution

This study shows that individual technique teaching lowers cognitive load in physiotherapy education.

## Key findings

- Individual practice reduced global cognitive load compared to learning multiple techniques at once.
- Intrinsic and germane cognitive load were also significantly lower in the individual practice group.
- Applying cognitive load theory can improve instructional design in manual therapy education.

## Abstract

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.

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.

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).

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.

The online version contains supplementary material available at 10.1186/s12909-025-08083-w.