The goal of this quasiexperimental study is to evaluate the effects of structured training on inelastic compression bandaging proficiency in fourth-year physiotherapy students. The main questions it aims to answer are: Can supervised training significantly improve primary outcomes such as technical bandaging skills (measured by a standardized rubric)? Does structured education enhance secondary outcomes, including interface pressure accuracy, application time, and student self-confidence? Researchers will compare a Supervised Education Group receiving real-time biofeedback to a Control Group receiving an instructional brochure to see if expert-led training is more effective than passive learning in bridging the gap between perceived and actual clinical competence. Participants will: Perform a baseline bandaging application (T0) assessed via a two-station Objective Structured Practical Examination (OSPE). Be assigned to either the supervised training session (with Kikuhime pressure sensors for feedback) or the brochure-based self-study group. Complete a post-intervention assessment (T1) to measure improvements in technical skill, pressure precision, and self-confidence levels.
Objective: This study aimed to evaluate the effects of structured training on inelastic compression bandaging skills, interface pressure accuracy, and self-confidence among physiotherapy students. Methods: This study was conducted with 41 physiotherapy students (Education Group: n=21; Control Group: n=20). The Education Group received supervised training with objective pressure feedback while the Control Group received an instructional brochure. Clinical bandaging skills were evaluated using a two-station Objective Structured Practical Examination (OSPE), consisting of standardized rubric and time, and interface pressure monitoring. Students were assessed at baseline (T0) and post-intervention (T1) for bandaging skills (via rubric), interface pressure (Kikuhime), application time (seconds), and self-confidence (VAS). Results: At baseline, only 9.5% of the Education Group and 0% of the Control Group achieved the target pressure. Post-intervention, these rates increased to 33.3% and 35.0%, respectively. The Education Group demonstrated a significantly greater improvement in Rubric scores (p=0.030, rrb =0.390) and self-confidence levels (p=0.005, rrb =0.512) compared to the Control Group. Intra-group analysis revealed that application times increased significantly in both the Education (p\<0.001, rrb =0.983) and Control groups (p\<0.001, rrb =1.000). While absolute real pressure error improved significantly within the Education Group (p=0.024, rrb=0.581), no significant inter-group difference was found for pressure-related variables (p\>0.05). Notably, in the Education Group, self-confidence showed a strong positive correlation with Rubric scores (rho= 0.619, p=0.003) and a significant negative moderate correlation with absolute real pressure error (rho: -0.408, p=0.037). In contrast, no significant correlation was found between confidence and technical performance in the Control Group, suggesting a tendency toward overconfidence. Conclusion: Supervised training with objective feedback is superior to passive learning for mastering the complex psychomotor skill of multilayer inelastic bandaging. While theoretical instruction may artificially inflate self-confidence, it fails to bridge the experience paradox which perceived competence masks technical insufficiency. Integrating real-time biofeedback into physiotherapy curricula is essential to ensure sensory calibration, technical proficiency, and patient safety, transitioning students from conceptual understanding to objective clinical mastery.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
41
The supervised intervention consisted of a 3-hour session led by a lymphedema therapist with 14 years of experience. Training was conducted in groups of 5-9 students using peer-to-peer practice. The program included: Theory: Instruction on inelastic bandage properties, Laplace's Law, and pressure distribution principles. Demonstration: A step-by-step showcase of multi-layer below-knee bandaging, including stirrup and figure-of-eight techniques. Practice: Students practiced on peers in a supine position. Biofeedback: To master therapeutic pressure, students utilized the Kikuhime device for real-time monitoring. The instructor provided individual corrections for each application. This structured approach aimed to calibrate students' tactile perception and ensure technical mastery through expert supervision and objective feedback.
The control group was provided with a brochure detailing how to perform the bandaging. All technical details provided in the supervised training were included in this brochure. Visuals were used to demonstrate the final appearance of the stirrup technique, starting and ending positions, and the positioning of both the patient and the ankle. Great care was taken to ensure that the visuals and descriptions were simple, clear, and explanatory. After the brochure was distributed, any points of confusion were clarified for the students
Bolu Abant Izzet Baysal University
Bolu, Central, Turkey (Türkiye)
Bandaging Skills
A Bandaging Skills Rubric was developed to objectively evaluate bandaging proficiency. To prevent bias, the rubric assessments were performed by a researcher who did not provide the training and who was specifically trained on each rubric criterion. The rubric consisted of 5 criteria, each rated on a 3-point scale: Inadequate (1 point), Satisfactory (2 points), and Proficient (3 points). The minimum and maximum possible scores for the rubric are 5 and 15, respectively. Higher rubric scores indicate superior bandaging technique and quality.
Time frame: Baseline, and immediately after the intervention
Bandage Interface Pressure
The students were instructed to apply the bandages within a pressure range of 35-45 mmHg. Following the completion of the bandaging procedure, the interface pressure values at rest were recorded from B1 point (transition point of gastrocnemius tendon to muscle, from medial aspect of leg) in mmHg.
Time frame: Baseline, and immediately after the intervention
Absolute real pressure error
To determine how much the participants deviated from the desired pressure-that is, to find the actual error-calculations were performed before and after the application according to the following formula: Absolute error = \|Pre-training interface pressure/Post-training interface pressure - Desired mean bandage pressure (40 mmHg)\| These values were recorded as mmHg.
Time frame: Baseline, and immediately after the intervention
Perceived Interface Pressure
Physiotherapy students were asked to estimate the pressure they applied before and after the training, and their estimations were recorded in mmHg.
Time frame: Baseline, and immediately after the intervention
Perceived pressure error
the perceived error was calculated for both pre- and post-training applications. The perceived error was calculated with the formula. Perceived error = \|Pre-training perceived mean interface pressure/ Post-training perceived mean interface pressure - Pre-training interface pressure/ Post-training interface\|. The perceived error was recorded as mmHg.
Time frame: Baseline, and immediately after the intervention
Confidence in Bandage Application
The students' confidence in bandage application was evaluated using a Visual Analog Scale (VAS). The students were asked how confident they felt in achieving the desired compression bandage pressure, and they were requested to mark their level of confidence on the VAS . A score of '0' represented 'not confident at all,' while '10' represented 'highly confident.' The marked point was measured with a ruler and recorded in centimeters
Time frame: Baseline, and immediately after the intervention
Bandage application time
The bandage application time was recorded in seconds before and after the training.
Time frame: Baseline, and immediately after the intervention
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